Objective

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.

Design

Retrospective cohort study of electronic health records and administrative claims data collected for 2.25 years (January 1, 2016-March 30, 2018).

Setting

Twelve acute care hospitals in a large health care system in western Pennsylvania.

Participants

Adults (N=8279) discharged with a primary stroke diagnosis.

Interventions

The exposure was number of physical and occupational therapist visits during the acute care stay.

Main Outcome Measures

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.

Results

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.

Conclusions

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.

中文翻译：

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急诊医院康复治疗与卒中患者再入院或死亡率之间的关系

客观的

检查在急症护理医院接受的物理和职业治疗师就诊次数与再入院或死亡风险之间的关联。

设计

收集了 2.25 年（2016 年 1 月 1 日至 2018 年 3 月 30 日）的电子健康记录和行政索赔数据的回顾性队列研究。

环境

宾夕法尼亚州西部一个大型医疗保健系统中的 12 家急症护理医院。

参与者

成人 (N=8279) 出院时诊断为原发性中风。

干预

暴露是急性护理期间物理和职业治疗师就诊的次数。

主要观察指标

估计广义线性混合模型以检查治疗使用与 30 天和 7 天再入院或死亡（结果）之间的关系，控制患者人口统计学和临床​​特征。

结果

30 天和 7 天的再入院率或死亡率分别为 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。相对于没有治疗师就诊，接受 1-2 次就诊的个体再入院或死亡的几率为 0.70（95% 置信区间 [CI]，0.54-0.90），接受 3-5 次就诊的个体为 0.59（95% CI，0.43-0.81） 0.57 (95% CI, 0.39-0.81) 超过 5 次。7 天的结果也有类似的模式，但效应量略大。入院时行动受限的个体以及出院后进入急性期护理机构的患者与在家中的患者相比，影响也更大。

结论

从急诊医院出院的中风患者的治疗师就诊次数与再入院或死亡风险之间存在负相关关系。效果因事件发生的时间（30 天与 7 天）、出院地点和入院时的活动受限而异。