Occupational therapy's role in preventing acute readmissions

The effect of occupational therapy services on hospital readmission for patients with cancer in acute care settings: a retrospective data analysis

PURPOSE

This study examined how the use of occupational therapy services affected the likelihood of hospital readmission within 30 days for patients with cancer diagnoses.

METHODOLOGY

This was a retrospective observational study. Patient medical records were analyzed from a National Cancer Institute Hospital over a 5-year period with a sample size of 6614 patients included for analysis in an unadjusted logistic regression model and 1920 patients analyzed in an adjusted logistic regression model. Various factors, including the use of occupational therapy services as well as individual factors such as pain levels, cancer stage, and living environment, were considered in relation to readmission status. Logistic regression analyses were used to assess the provision of occupational therapy service's association with 30-day hospital readmissions.

RESULTS

Patients who received occupational therapy services had a statistically significant decrease in their risk of a 30-day hospital readmission compared to patients with cancer who did not receive occupational therapy services. In an unadjusted analysis, patients with cancer who had occupational therapy services were 33.5% (OR = 0.665) less likely to be readmitted within 30 days compared to a patient who did not have occupational therapy services (p < 0.001). In an analysis after adjusting for patient health-related factors, patients with cancer who had occupational therapy services were 22.2% (OR = 0.778) less likely to readmit to a hospital compared to a patient who did not have occupational therapy services (p < 0.046).

CONCLUSION

The results of the study are intended to contribute to the body of knowledge on the benefits of occupational therapy services on an individual as well as a health systems-based level for patients with cancer diagnoses while hospitalized.

IMPLICATIONS FOR CANCER SURVIVORS

The knowledge of the utility of occupational therapy services for patients with cancer diagnoses while in the hospital can assist providers, patients, and hospital leadership in understanding some of the potential benefits for patient care and healthcare systems at large while seeking to avoid the deleterious effects from a hospital readmission.

[Description of a Pilot Project for Pediatric Occupational Therapy in Daycare and Community Settings]

Background. Occupational therapy interventions that promote and prevent children's health and well-being aim to reduce health inequalities and foster protective factors. The purpose of this study is to describe a pilot community-based occupational therapy project for preschoolers in partnership with community organizations and childcare services. Method. A participatory action research approach was implemented with support from an advisory committee. An occupational therapist provided community-based occupational therapy services in a tiered organization model over one year. Findings. Services were offered in three tiers: 7 awareness workshops for parents and caregivers (Tier 1), 57 visits and 27 consultations in 8 community agencies (Tier 2), and 23 individual follow-ups (Tier 3). Implications. There is an opportunity to implement with community agencies and daycare settings an occupational therapy service based on community-based rehabilitation for children under 5 years of age.

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study

OBJECTIVE

To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission.

DATA SOURCES

EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021).

STUDY DESIGN

We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted.

DATA EXTRACTION

We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay.

PRINCIPAL FINDINGS

In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (β = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA.

CONCLUSIONS

Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.

Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk

IMPORTANCE

Readmissions are costly for Medicare and are associated with poor patient outcomes.

OBJECTIVE

To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP).

DESIGN

Cross-sectional, retrospective study.

SETTING

Single academic medical center.

PARTICIPANTS

Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses.

RESULTS

No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia.

CONCLUSIONS AND RELEVANCE

The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.

Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review

IMPORTANCE

Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear.

OBJECTIVE

To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice.

DATA SOURCES

We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction.

FINDINGS

Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team.

CONCLUSIONS AND RELEVANCE

Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.

Can AM-PAC "6-Clicks" Inpatient Functional Assessment Scores Strengthen Hospital 30-Day Readmission Prevention Strategies?

Background

Prevention of unplanned hospital readmissions remains a priority in the US healthcare sector. Patient functional status has evolved as an important factor in identifying patients at risk for unplanned readmissions and poor predischarge functional performance has been shown to be predictive of increased readmission risk. Yet, patient functional status appears to be underutilized in readmission prediction models.

Methods

To examine the impact of inpatient functional status (mobility and activity performance) on unplanned 30-day hospital readmissions at two tertiary care hospitals, retrospective cohort analysis was performed on electronic health record data from adult inpatients (N = 26,298) having undergone completed functional assessments during their index hospitalization. Primary outcomes were functional assessment scores and unplanned all-cause patient readmission within 30 days following hospital discharge. Secondary analysis stratified the assessment by discharge destination. Functional assessment scores from the Activity Measure for Post-Acute Care (AM-PAC) “6-Clicks” Basic Mobility Short Form or Daily Activity Short Form were extracted along with patient demographics, admission diagnoses, comorbid conditions, and hospital readmission risk score. 

Results

Adjusting for age, sex, and comorbidity, lower AM-PAC “6-Clicks” Basic Mobility and Daily Activity scores resulted in higher readmission rates when each score was considered separately. When both scores were considered, only Daily Activity scores were significant. 

Conclusion

Patients with lower Basic Mobility and Daily Activity scores are at a higher risk for readmission. The relative importance of AM-PAC “6-Click” scores on short-term readmission depends on discharge destination. Timely identification of patient mobility and activity performance may lead to earlier intervention strategies to reduce readmissions. 

Occupational therapy and allied health use for older people in acute care: A description of services, time, and readmission in an Australian setting

Introduction

Acute care readmissions of older people are an ongoing concern in many countries. Occupational therapists are well positioned to play a significant role in contributing to improved outcomes and fewer readmissions following discharge from acute hospitals, yet there is a lack of empirical evidence to support this claim.

Methods

This study used a retrospective clinical audit of secondary hospital data to investigate and describe the time spent on occupational therapy, and the range of occupational therapy and other allied health services provided to older people admitted to acute care, in one Australian health care service.

Results

Occupational therapists conducted numerous assessments and interventions to support patients and to prepare them for safe discharge home. Occupational therapy was significantly associated with length of stay. Readmission was not related directly or significantly to time spent in occupational therapy or any other factor included in this study. However, of the people who received occupational therapy, there was a higher percentage readmitted when they had more services already in place on admission and when they lived alone.

Conclusions

This study provides preliminary evidence regarding the contact time and range of occupational therapy assessments and interventions provided to older people in the acute hospital setting.

Can we talk about it? A qualitative study exploring occupational therapists’ decision making in judging when to ask an older person about drinking alcohol

Older people now currently drink alcohol more frequently than previous generations, indicating a need to understand how this influences health and wellbeing in older adults. However, knowledge and awareness of the changing role alcohol plays in the lives of older people is not necessarily widely understood by allied health professionals in acute hospital contexts. In turn, conversations about drinking alcohol in later life may not be routinely addressed as part of practice, limiting an older person's choice to make informed decisions about their drinking. This paper qualitatively examines when occupational therapists (N = 17) in an acute hospital setting will initiate a conversation with older people (65+ years) about their drinking, guided by a theoretical lens that encompasses both person-centredness and collective occupation. Adopting a qualitative methodology, this study illustrates a typology of reasoning describing how, and in what circumstances, therapists ask older people about their alcohol use. Three themes were generated that provide further insight into the typology, these being ‘hesitancy in practice’, ‘failure to link life transitions to alcohol use’ and ‘challenges of focusing on healthfulness’. These findings provide a potentially useful tool for therapists, services and organisations to self-assess their approach to asking older people about alcohol use; a necessary element of professional health-care practice as social trends in alcohol use continue to increase.

The role and scope of occupational therapy in Africa

Purpose: Occupational therapy (OT) is a global health profession that promotes participation in meaningful occupations to enhance well-being, particularly for persons with disabilities. Occupational therapy is relatively new in many African countries and there is limited research regarding the role of OT in this region. Thus, this study aims to understand the role and scope of OT in Africa by exploring its unique contribution to healthcare and cultural considerations for practicing OT in various African contexts.Methods: We conducted an exploratory qualitative descriptive study involving semi-structured interviews with 15 occupational therapists from 11 African countries. Interview questions focused on participants' work activities, rewards and challenges of their work, and perceived contribution to healthcare. We audio-recorded and transcribed interviews followed by inductive thematic analysis.Results: All participants described maintaining multiple roles. Four main themes (with sub-themes) emerged: advocacy (clients and the profession), collaboration (multi-disciplinary team, professional support, and internationally), maintaining core OT principles (occupation, function, participation, empowerment, and holistic practice), and contextual considerations (community-based services, practice approaches, sustainability, cultural norms, and spirituality).Conclusions: Occupational therapists working in African contexts have a unique and challenging role involving advocacy and collaboration. They need to maintain core OT values whilst addressing contextual considerations to ensure culturally relevant practice.Implications for RehabilitationOccupational therapists have an important role in promoting health and well-being; however, practice is influenced by the cultural context.Occupational therapists in Africa maintain multiple roles, including advocacy for their clients and the profession, and collaboration within a multidisciplinary team, for professional support and internationally.African occupational therapists need to be rooted in core OT principles whilst considering their unique context to ensure culturally relevant practice.

Care Transition Processes to Achieve a Successful Community Discharge After Postacute Care: A Scoping Review

Readmissions to health care facilities are undesirable outcomes that indicate the quality of the care transitions. Although there is a growing evidence-base for preventing readmissions, the focus has been on acute care. Postacute care (PAC) patients are often excluded from these studies, and thus there is limited evidence guiding practitioners' efforts to facilitate an effective community transition after PAC rehabilitation. To provide direction for PAC research and clinical practice, this scoping review summarizes current community transition interventions and identifies practices that facilitate successful community discharge. Thirteen care processes emerged from 35 studies, of which 5 were included in at least 60% of the studies, including coaching on the care transition process, medical self-management, medication self-management, scheduling follow-up medical services, and telephone follow-up. These findings can inform the development, evaluation, and implementation of PAC community transition interventions.

Policy and Payment Changes Create New Opportunities for Occupational Therapy in Acute Care

IMPORTANCE

Changes in health care policy and payment over the past decade have resulted in a greater emphasis on cost effectiveness, quality outcomes, and the health care consumer's experience. Payers' response to the new policies and their expectations have created expanded opportunities for occupational therapy practitioners in health care overall but particularly in acute care hospitals.

OBJECTIVE

The objective of this article is to empower occupational therapy directors, practitioners, educators, and students to be proactive in a rapidly changing acute care setting.

EVIDENCE REVIEW

Research on policy and payment changes since the passage of the Patient Protection and Affordable Care Act (Pub. L. 111-148) was synthesized with evidence related to occupational therapy practice and education.

FINDINGS

Occupational therapy practitioners in acute care environments are experiencing expanded roles in optimizing patient readiness for safe community discharge, decreasing lengths of stay, and protecting them from hospital-acquired conditions.

CONCLUSIONS AND RELEVANCE

Policy and payment initiatives reward health care organizations for the added value occupational therapy practitioners bring to acute care teams.

WHAT THIS ARTICLE ADDS

This article details how occupational therapy practitioners can advance consumer satisfaction, outcomes, and efficiency in acute care, which can lead to increased recognition of the vital role that occupational therapy can play, thus leading to expanded opportunities.

Perceptions of Occupational Therapists on the Patient Protection and Affordable Care Act: Five Years After Its Enactment

This study explored the perceptions of occupational therapists regarding the impact and implications of the Patient Protection and Affordable Care Act (PPACA or ACA) on occupational therapy practice. Fifteen occupational therapists participated in an interview to answer open-ended questions related to their thoughts and perceptions regarding the impact and implications of the ACA on their practice. The participants were practicing in eight different states and worked in five different settings with clinical experience ranging from 3 to 38 years; their positions ranged from staff therapist to owner of a free-standing outpatient clinic. Qualitative content analysis was used to synthesize the interview transcripts. Results showed that therapists did not have sufficient knowledge on the various mandates and provisions of the ACA, or were uncertain about what implications the ACA would have on practice, with the ACA affecting some settings more than others. Data revealed the perceived impacts of the ACA on occupational therapy practice include greater attention on documenting outcome-focused care, external accountability pressures on productivity, conscientiousness about clients' insurance coverage, uncertainty about collaborative care delivery, and survival of small businesses. Findings suggest training regarding knowledge about and implications of different elements of the ACA is needed as well as practices needing to promote the services that occupational therapists can provide to improve cost-effectiveness and outcomes in collaborative care environments.

Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates

Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed.

Role of Occupational Therapy in Case Management and Care Coordination for Clients With Complex Conditions

Specific aspects of the profession of occupational therapy support a distinct value for its practitioners participating fully in the development of case management and care coordination systems. The expectation in the 21st century is that the U.S. health care system must be transformed from one that promotes volume of service to one that promotes value of care. Case management and care coordination will be critical components of that transformation. Occupational therapy's principles, education, practice, approach, and perspective offer much to benefit this increased attention to case management and care coordination. Occupational therapy practitioners should promote themselves and their profession as these system changes develop.

Telehealth and Occupational Therapy: Integral to the Triple Aim of Health Care Reform

Programs and concepts included in the Patient Protection and Affordable Care Act of 2010 are expected to transform health care in the United States from a volume-based health system to a value-based health system with increased emphasis on prevention and health promotion. The Triple Aim, a framework set forth by the Institute for Healthcare Improvement, focuses on improving the health care experience, the health of populations, and the affordability of care. This article describes telehealth as an integral component in achieving the Triple Aim of health care and discusses implications for occupational therapy practitioners.

Population Health and Occupational Therapy

Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function.

Advancing the value and quality of occupational therapy in health service delivery

The authors set forth a foundation on which to build further dialogue and evidence to highlight occupational therapy’s distinctive contribution, significance, and viability as health care policies shift to focus on quality and value.

Primary Care: A New Context for the Scholarship of Practice Model

Interest in the emerging role for occupational therapy in the primary care practice setting has increased due to implementation of the Patient Protection and Affordable Care Act (ACA), which intends to expand health care coverage to uninsured Americans while improving coordination of care, health outcomes, and cost savings. Expanding occupational therapy to encompass promotion of wellness and prevention in a primary care context provides an opportunity for occupational therapy. The purpose of this article is to describe the role of occupational therapy in primary care and how the Scholarship of Practice model can guide the development of occupation-based and evidence-based best practice in primary care.