Summers Bianca E, Laver Kate E, Nicks Rebecca J, Andrew Nadine E, Barr Christopher J, Jolliffe Laura, Lannin Natasha A
Flinders University, Australia.
Eastern Health, Australia.
Hong Kong J Occup Ther. 2021 Dec;34(2):73-82. doi: 10.1177/15691861211018758. Epub 2021 Jun 21.
Health care expenditure has rapidly increased in Australia. Effective management of occupational therapy services is required to meet clinical demand. Improving our understanding of factors which influence occupational therapy service delivery is a vital step to manage workload distribution and optimise service efficiency. This study aims to examine the influence of patient sociodemographic characteristics, diagnosis and functional independence on the utilisation of occupational therapy resources in hospital inpatients over 18 years old.
Prospective, cross-sectional, observational cohort study of 4549 inpatients from three hospital sites in Melbourne, Australia. Data extracted from organisational databases and included in this study were: patient demographics, diagnosis, functional level assessed using the SMAF (Functional Autonomy Measurement System) and occupational therapy time-use. Data were analysed using univariable and multivariable modelling.
Occupational therapy time-use was significantly associated with all variables included in analysis ( < 0.05). For each variable the amount and direction of effect differed between hospital sites. The SMAF was the only variable consistently associated with occupational therapy time-use. Higher occupational therapy time-use was associated with lower functional independence (leading to a 3.5 min increase in median occupational therapy time for every unit decrease in SMAF score).
Management of resources within busy hospitals require knowledge of factors associated with occupational therapist time-use. This study identified that time-use could in part be predicted by functional independence, diagnosis and sociodemographic characteristics. Occupational therapy managers can use this information to support decision making while acknowledging other patient and therapist level factors also influence time-use.
澳大利亚的医疗保健支出迅速增加。需要对职业治疗服务进行有效管理，以满足临床需求。增进我们对影响职业治疗服务提供因素的理解，是管理工作量分配和优化服务效率的关键一步。本研究旨在探讨患者的社会人口学特征、诊断和功能独立性对18岁以上住院患者职业治疗资源利用的影响。
对来自澳大利亚墨尔本三个医院站点的4549名住院患者进行前瞻性、横断面观察队列研究。从组织数据库中提取并纳入本研究的数据包括：患者人口统计学信息、诊断、使用SMAF（功能自主测量系统）评估的功能水平以及职业治疗时间使用情况。使用单变量和多变量模型对数据进行分析。
职业治疗时间使用情况与分析中纳入的所有变量均显著相关（<0.05）。对于每个变量，不同医院站点的影响程度和方向有所不同。SMAF是唯一与职业治疗时间使用情况始终相关的变量。职业治疗时间使用量越高，功能独立性越低（SMAF评分每降低一个单位，职业治疗时间中位数增加3.5分钟）。
繁忙医院内的资源管理需要了解与职业治疗师时间使用相关的因素。本研究表明，时间使用情况部分可由功能独立性、诊断和社会人口学特征预测。职业治疗管理人员可以利用这些信息来支持决策，同时认识到其他患者和治疗师层面的因素也会影响时间使用情况。
