Use of Hospital-Based Rehabilitation Services and Hospital Readmission following Ischemic Stroke in the United States

Publication date: Available online 24 January 2019

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Amit Kumar, Linda Resnik, Amol Karmarkar, Janet Freburger, Deepak Adhikari, Vincent Mor, Pedro Gozalo

Objective

To examine the association between hospital-based rehabilitation service use and all-cause 30-day hospital readmission among patients with ischemic stroke.

Design

Secondary analysis of inpatient Medicare claims data using Standard Analytical File.

Setting

Acute Hospitals across the U.S.

Participants

From nationwide data, 88,826 Medicare fee-for-service beneficiaries aged 66 or older hospitalized for ischemic stroke between January-November, 2010.

Interventions

Hospital-based rehabilitation services were quantified using Medicare inpatient claims revenue center codes for evaluation (occupational therapy [OT] and physical therapy [PT]), as well as the number of therapy units delivered. Therapy minutes for both OT and PT services were categorized into none, low, medium, and high.

Main Outcome Measures

All-cause 30-day hospital readmission. A generalized linear mixed model was used to examine the effect of hospital-based rehabilitation services on 30-day hospital readmission, after adjusting for patient and hospital characteristics.

Results

In fully adjusted models, compared to patients who received no PT, we observed a monotonic inverse relationship between the amount of PT and hospital readmission; low PT: 30 minutes (OR= 0.90; 95% CI; 0.83-0.96), medium PT: >30 to ≤75 minutes (OR=0.89; 95% CI; 0.82-0.95) and high PT: >75 minutes (OR=0.86; 95%CI; 0.80-0.93).

Conclusion

Hospital-based physical therapy services was associated with lower risk of 30-day hospital readmission in patients with ischemic stroke.

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