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Kinney AR, Penzenik ME, Forster JE, O'Donnell F, Brenner LA. Facility-Level and Racial Disparities in Access to Inpatient Psychiatric Occupational Therapy Services in the Veterans Health Administration. Am J Occup Ther 2024; 78:7804205040. [PMID: 38861552 DOI: 10.5014/ajot.2024.050583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
IMPORTANCE Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. OBJECTIVE To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. SETTING VHA inpatient psychiatric setting. PARTICIPANTS Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). OUTCOMES AND MEASURES Occupational therapy utilization. RESULTS Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. CONCLUSIONS AND RELEVANCE Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.
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Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Research Health Science Specialist, Veterans Affairs (VA) Rocky Mountain Mental Illness Research, Education, and Clinical Center (MIRECC) for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, and Assistant Professor, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora;
| | - Molly E Penzenik
- Molly E. Penzenik, MPH, is Data Analyst, VA Rocky Mountain MIRECC for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, and Data Analyst, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora
| | - Jeri E Forster
- Jeri E. Forster, PhD, is Director, Data and Statistical Core, VA Rocky Mountain MIRECC for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, and Associate Professor, Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora
| | - Frederica O'Donnell
- Frederica O'Donnell, OTD, OTR/L, is National Occupational Therapy Discipline Lead, Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, DC
| | - Lisa A Brenner
- Lisa A. Brenner, PhD, is Director, VA Rocky Mountain MIRECC for Suicide Prevention, Rocky Mountain Regional VA Medical Center, Aurora, CO, and Professor, Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora
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Kinney AR, Penzenik ME, Forster JE, O'Donnell F, Brenner LA. Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans. Psychiatr Serv 2024:appips20230650. [PMID: 38807577 DOI: 10.1176/appi.ps.20230650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
OBJECTIVE The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA). METHODS The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition). RESULTS Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses. CONCLUSIONS Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.
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Affiliation(s)
- Adam R Kinney
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Molly E Penzenik
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Jeri E Forster
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Frederica O'Donnell
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
| | - Lisa A Brenner
- Rocky Mountain Mental Illness Research, Education, and Clinical Center for Suicide Prevention, Rocky Mountain Regional Veterans Affairs (VA) Medical Center, Aurora, Colorado (Kinney, Penzenik, Forster, Brenner); Department of Physical Medicine and Rehabilitation, Anschutz Medical Campus, University of Colorado, Aurora (Kinney, Penzenik, Forster); Department of Rehabilitation and Prosthetic Services, Veterans Health Administration, Washington, D.C. (O'Donnell); Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology, Anschutz Medical Campus, University of Colorado, Aurora (Brenner)
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Hand BN, Li CY, Mroz TM. Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness. Am J Occup Ther 2022; 76:23174. [PMID: 35037945 DOI: 10.5014/ajot.2022.761001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Health services research focuses on access, quality, and cost-effectiveness of care. As a result of increasing emphasis on value-based reimbursement models, conducting health services research to demonstrate the value of occupational therapy is timely. This special issue serves to highlight health services research relevant to occupational therapy practice. Articles included in this special issue describe (1) clients' access to and use of occupational therapy, (2) the effects of occupational therapy on important quality-of-care indicators and client outcomes, and (3) the value of occupational therapy services through the lens of cost-effectiveness. This special issue illustrates the state of health services research in the field of occupational therapy and reveals key insights to advance occupational therapy practice using health services research.
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Affiliation(s)
- Brittany N Hand
- Brittany N. Hand, PhD, OTR/L, is Assistant Professor, The Ohio State University, Columbus;
| | - Chih-Ying Li
- Brittany N. Hand, PhD, OTR/L, is Assistant Professor, The Ohio State University, Columbus;
| | - Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Associate Professor, University of Washington, Seattle
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