Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
Arch Phys Med Rehabil. 2021 Sep;102(9):1700-1707.e4. doi: 10.1016/j.apmr.2021.02.026. Epub 2021 Apr 2.
To examine the association between the number of physical and occupational therapist visits received in the acute care hospital and the risk of hospital readmission or death.
Retrospective cohort study of electronic health records and administrative claims data collected for 2.25 years (January 1, 2016-March 30, 2018).
Twelve acute care hospitals in a large health care system in western Pennsylvania.
Adults (N=8279) discharged with a primary stroke diagnosis.
The exposure was number of physical and occupational therapist visits during the acute care stay.
Generalized linear mixed models were estimated to examine the relationship between therapy use and 30- and 7-day hospital readmission or death (outcome), controlling for patient demographic and clinical characteristics.
The 30- and 7-day readmission or death rates were 16.0% and 5.7%, respectively. The number of therapist visits was inversely related to the risk of 30-day readmission or death. Relative to no therapist visits, the odds of readmission or death were 0.70 (95% confidence interval [CI], 0.54-0.90) for individuals who received 1-2 visits, 0.59 (95% CI, 0.43-0.81) for 3-5 visits, and 0.57 (95% CI, 0.39-0.81) for >5 visits. A similar pattern was seen for the 7-day outcome, with slightly larger effect sizes. Effects were also greater in individuals with more mobility limitations on admission and for those discharged to a postacute care facility vs home.
There was an inverse relationship between the number of therapist visits and risk for readmission or death for patients with stroke discharged from an acute care hospital. Effects differed by time to the event (30d vs 7d), discharge location, and mobility limitations on admission.
考察急性护理医院接受物理治疗师和职业治疗师就诊次数与再入院或死亡风险之间的关系。
回顾性队列研究，使用 2.25 年（2016 年 1 月 1 日至 2018 年 3 月 30 日）电子健康记录和行政索赔数据收集。
宾夕法尼亚州西部一个大型医疗保健系统的 12 家急性护理医院。
出院时主要诊断为中风的成年人（N=8279）。
暴露因素为急性住院期间接受物理治疗师和职业治疗师就诊的次数。
使用广义线性混合模型来评估治疗使用率与 30 天和 7 天再入院或死亡（结局）之间的关系，同时控制患者的人口统计学和临床特征。
30 天和 7 天的再入院或死亡率分别为 16.0%和 5.7%。治疗师就诊次数与 30 天再入院或死亡风险呈负相关。与未就诊相比，就诊 1-2 次的患者再入院或死亡的可能性为 0.70（95%置信区间[CI]，0.54-0.90），就诊 3-5 次的可能性为 0.59（95% CI，0.43-0.81），就诊次数大于 5 次的可能性为 0.57（95% CI，0.39-0.81）。对于 7 天的结局，也出现了类似的模式，但效应量略大。对于入院时移动能力受限更多的个体和出院到康复护理机构而不是家庭的个体，效果更大。
急性护理医院出院的中风患者接受治疗师就诊的次数与再入院或死亡风险之间存在反比关系。效果因事件发生时间（30 天与 7 天）、出院地点以及入院时移动能力受限程度而有所不同。
