Kadivar Zahra, English Alexis, Marx Brian D
Z. Kadivar, PT, PhD, Department of Rehabilitation Services and Child Life, Harris Health System, 3601 N MacGregor Way, Houston, TX 77004 (USA).
A. English, PT, DPT, Department of Rehabilitation Services, Gaylord Specialty Healthcare, Wallingford, Connecticut.
Phys Ther. 2016 Nov;96(11):1705-1713. doi: 10.2522/ptj.20150243. Epub 2016 May 19.
Providing patients with optimal discharge disposition and follow-up services could prevent unplanned readmissions. Despite their qualifications, physical therapists are rarely represented on the interdisciplinary team.
This study aimed to determine the relationship between the participation of physical therapists in interdisciplinary discharge rounds and readmission rates.
In this retrospective observational study, patients discharged by 2 interdisciplinary teams with or without a physical therapist's participation were followed for 5 months. Adherence to the physical therapist's recommendations for follow-up services and unplanned 30-day readmissions were tracked. Multiple logistic regression and random forest models were used to determine factors contributing to 30-day readmission rates.
The odds of 30-day readmissions were 3.78 times greater when a physical therapist was absent from the interdisciplinary team compared with the odds of 30-day readmissions when a physical therapist participated in the interdisciplinary team. In addition, the odds of 30-day readmission for patients discharged to their home were 2.47 times greater than those who were not discharged to their home. An increased lack of postdischarge services was noted when a physical therapist was not included in the interdisciplinary team.
The nonrandom selection of patients into groups, the small sample size, and the inability to adjust risk for unknown factors (eg, medical diagnoses, comorbidities, funding, and functional measures) limited interpretation of the results.
Significantly higher readmission rates were noted for patients whose interdisciplinary team did not have a physical therapist and for those patients who were discharged to their home. These preliminary findings suggest that discharge from the acute care setting is an elaborate process and should be designed carefully. In order to identify the optimal discharge process, future research should account for patient complexities in addition to the composition of the interdisciplinary discharge team.
为患者提供最佳的出院安排和后续服务可预防计划外再入院。尽管具备相应资质，但物理治疗师在跨学科团队中很少有代表。
本研究旨在确定物理治疗师参与跨学科出院查房与再入院率之间的关系。
在这项回顾性观察研究中，对由两个跨学科团队出院的患者进行了5个月的随访，其中一个团队有物理治疗师参与，另一个团队没有。跟踪对物理治疗师后续服务建议的依从性以及计划外30天再入院情况。使用多元逻辑回归和随机森林模型来确定导致30天再入院率的因素。
与物理治疗师参与跨学科团队时的30天再入院几率相比，跨学科团队中没有物理治疗师时的30天再入院几率高3.78倍。此外，出院回家的患者30天再入院几率比未出院回家的患者高2.47倍。当跨学科团队中没有物理治疗师时，出院后服务不足的情况有所增加。
患者分组的非随机选择、样本量小以及无法调整未知因素（如医学诊断、合并症、资金和功能指标）的风险限制了对结果的解释。
跨学科团队中没有物理治疗师的患者以及出院回家的患者的再入院率显著更高。这些初步研究结果表明，急性护理机构的出院是一个复杂的过程，应仔细设计。为了确定最佳出院流程，未来的研究除了跨学科出院团队的组成外，还应考虑患者的复杂性。
