Home-Based Occupational Therapy and Stroke Readmissions in Medicaid Recipients

Abstract

This study examined whether home-based occupational therapy reduces 30- and 90-day hospital readmissions post-stroke among Medicaid recipients. Using the Tennessee Medicaid data (2016–2023), adults ages 18 years and older with ischemic stroke were followed post-discharge. Logistic regression models examined associations between receiving home-based occupational therapy and readmissions. Of 3,393 patients, 19.6% were readmitted within 30 days; 27.3% within 90 days; 5.0% received home-based therapy within 30 days; and 7.9% within 90 days. Unadjusted analysis showed home-based occupational therapy was associated with lower 30-day readmissions (odds ratio [OR]: 0.57; 95% confidence interval [CI] = [0.36, 0.90]). Patients from suburban/rural areas showed increased readmission likelihood within 30 days compared with urban patients (adjusted odds ratio [AOR] = 1.28; 95% CI = [1.02, 1.60]). Adjusting for physical therapy and other covariates, the effect of occupational therapy was similar but non-significant (OR = 0.60; 95% CI = [0.23, 1.53]). Home-based occupational therapy services post-stroke may reduce hospital readmissions.

Plain Language Summary

Home-Based Occupational Therapy and Stroke Readmissions in Medicaid Recipients

This study looked at whether people who had a stroke and received home-based occupational therapy were less likely to be readmitted to the hospital within 30 or 90 days. Researchers used the Tennesee Medicaid information and focused on adults with an ischemic stroke. Out of 3,393 patients, about 1 in 5 were readmitted within 30 days, and more than 1 in 4 were readmitted within 90 days. Those who lived in suburban and rural areas were more likely to be readmitted within 30 days. Early home-based occupational therapy was linked to fewer readmissions in the first 30 days, but after accounting for other services and factors, this relationship was not statistically significant. Occupational therapy services in the home setting soon after a stroke might help prevent hospital readmissions, especially in the early weeks at home.