Number of Therapist Visits Inversely Associated With Readmissions, Death in Patients With Stroke

Janet Freberger, PT, PhD, professor, and Aileen Chou, PT, DPT, PhD student, Department of Physical Therapy at the University of Pittsburgh, discuss their research about patients undergoing rehabilitation for stroke in acute care hospitals, particularly regarding the association between risk of hospital readmission or death, and number of physical and occupational therapist visits.

Read the full transcript:

Welcome back to PopHealth Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary and exclusive insight into key issues in population health management and more.

Today, we are joined by professor Dr Janet Freburger and Aileen Chou, PhD student, both in the Department of Physical Therapy at the University of Pittsburgh. Together, they discuss their research about patients undergoing rehabilitation for stroke in acute care hospitals, particularly regarding the association between risk of hospital readmission or death and number of physical and occupational therapist visits. Dr Freburger?

Dr Janet Freburger:  My name is Janet Freburger. I'm a professor in the Department of Physical Therapy at the University of Pittsburgh. I also serve as a core director for our Clinical Translational Science Institute here at the University of Pittsburgh.

I have a clinical background in physical therapy, but I've spent a majority of my career in an academic setting and conducting research. My research focus is in health services research and policy.

A lot of my work utilizes real-world data, or data that are collected during usual clinical care, and we analyze that in different ways to try to inform care delivery and policy.

Aileen Chou:  Hi, my name is Aileen Chou, and I've practiced physical therapy in hospital and outpatient settings for a number of years.

Since undergrad, I've been involved with psychology and neuroscience research. Naturally, when I became a physical therapist, I wanted to learn how research could apply to clinical questions.

Fast-forward, now I'm finishing my second year as a PhD student in the School of Health and Rehabilitation Sciences at the University of Pittsburgh, working with Janet as my mentor.

Today, we're here to talk about your recent research. What existing data led you both to conduct this research?

Dr Freburger:  There have been a number of studies looking at the impact of physical and occupational therapy in the acute care setting following stroke and how that relates to hospital readmission. There's been positive findings as far as the work that's been done so far.

One limitation of most of those studies was that there was not a strong measure of patients' functional status at hospital admission, which is a big driver of whether or not individuals get physical and occupational therapy.

We had an opportunity to look at data that had information on patients' function, in addition to the standard information on number of therapy visits and other clinical information that the other studies had included.

That was our motivation to do this work because we were able to add something new to the types of work that had been done up to this point.

Can you briefly describe the study and its findings, and were any of the outcomes particularly surprising?

Dr Freburger:  We used a data set on about 8000 patients that were discharged from several hospitals in Western Pennsylvania with a primary diagnosis of stroke.

We looked at the association with the number of therapist visits—occupational and physical therapy visits—that they received during their acute care stay and the risk of hospital readmission or death within 7 or 30 days after discharge.

We conducted a multivariate analysis and observational study where we tried to control for all the factors that might impact whether you received therapy and also impact whether you're going to be at risk for a hospital readmission.

We found that after we controlled for all these factors statistically, that there was indeed an association between the number of therapist visits that someone received and their risk of readmission. People that received more therapy were at lower risk of being readmitted.

The results confirm some of the work that had already been done. One thing that was surprising is we did look at subgroup analyses. We looked at the subgroup of patients that went directly home after the acute care stay and the subgroup of patients that went to a postacute care facility, either a skilled nursing facility or an impatient rehabilitation facility.

We found that the effect of therapist visits on risk of readmission was greatest in the individuals that were discharged to a postacute care facility. In other words, those were the patients that seemed to benefit the most from getting more therapy visits in the acute care setting.

What are the possible real-world applications of these findings in clinical practice?

Ms Chou:  Since the average acute hospital stay was brief, about 3 to 4 days, these positive outcomes were likely driven by the therapists making appropriate discharge recommendations, in addition to mobilizing the patients throughout the hospital stay.

If therapists have more opportunities to interact with a patient, they're able to make better recommendations about the patient's need and evaluate if their family can also support those needs in their next phase of care.

Clinicians, hospital systems, patients, and their families can use this information to advocate for more consistent therapy services during their acute care hospitalization.

Are there any hopes to expand upon this research?

Ms Chou:  We plan on applying similar models to populations with high risk of readmission, such as congestive heart failure and chronic obstructive pulmonary disease. We hope that with further research, we can help make recommendations for therapy dosing and evaluate which interventions were most effective.

Finally, overall, is there anything else either of you would like to add to this conversation today?

Dr Freburger:  Acute care therapy is often viewed by hospital administrators as a cost center, since you get a certain amount of dollars for a patient when they're admitted to the acute care setting based on their DRG codes.

This work is important because it illustrates the value that therapists can bring during the acute care setting. Just trying to get this information out to policymakers and to the frontline providers that work in acute care settings to try to use this information to facilitate rehab in the acute care setting.

Even though it is very quick turnaround time, the data suggests that therapists are bringing some value to the acute care stay.

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