Date Presented 03/27/20
This research used electronic health-record data to identify how often OT’s discharge recommendations were followed in the acute-care hospital setting. We used sensitivity, specificity, and accuracy analyses to compare the OT’s discharge recommendations on initial evaluation to the physician’s discharge instructions. Accuracy was significantly varied between younger and older adults, depending on discharge location.
Primary Author and Speaker: Kevin Pritchard
Contributing Authors: Ickpyo Hong
PURPOSE: Occupational therapy (OT) practitioners in the acute care setting are experiencing expanding roles in facilitating safe community discharges due to payment and healthcare policy changes (Pritchard, Fisher, Rudnitsky, Ramirez, 2019). Previous research identified OT as a cost-effective method to mitigate hospital readmission but did not demonstrate how OT practitioners reduce readmissions (Rogers et al., 2017). Discharge planning plays an important role in preventing readmissions because there is an increased risk for patient readmissions if acute care physical therapists’ (PT) discharge plan is not followed (Smith et al., 2010). However, this research overlooked OT discharge plans. Our study aims to assess the accuracy of initial OT discharge recommendations with consideration for patient age.
DESIGN: A retrospective secondary data analysis examined 10,167 acute care admissions at a single 894 bed metropolitan hospital from 7/1/2018 until 5/1/2019 using electronic health record (EHR) data queried from the Epic documentation system. Sample: Includes adults with an OT or PT consult during acute care admission (N=10,167). Patients who discharged to Long-term acute care OT (N=113) were excluded in addition to patients with missing data for discharge location OT (N=424). The final sample for OT (N=7,924) was achieved after excluding patients who only received PT services. 58.67% of OT patients were 65+ years old.
METHOD: Discharge locations were categorized as home, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). Patients discharging to long-term acute care (LTAC) were previously excluded because discharge to LTAC is predicated on medical status and not functional status. We defined the OT discharge recommendation as the discharge location recommended in the OT initial evaluation. Furthermore, actual discharge location was defined using the physician’s documented discharge instructions. Finally, we conducted sensitivity, specificity, and accuracy analyses on actual discharge setting with respect to initial OT discharge recommendations. This analysis was repeated for the cohort of patients under 65 years old and compared to the patients 65+ years old. The data management and statistical analyses were conducted using SAS Studio 5.1.
RESULTS: Accuracy for OT IRF discharge recommendations was significantly higher for older adults 0.920 (95% CI, 0.913-0.928) than younger adults 0.889 (95% CI, 0.878-0.900). In contrast, accuracy for OT SNF discharge recommendations was significantly higher for younger adults 0.923 (95% CI, 0.914-0.933) than older adults 0.836 (95% CI, 0.825-0.846). Accuracy for OT Home discharge recommendations did not significantly different between age groups.
CONCLUSION: For OTs making discharge recommendations to IRF and SNF, there is a statistically significant difference in discharge accuracy associated with whether the patients are 65+ years old or younger than 65 years old. In future research, age-related factors such as insurance coverage, social support, and functional status should further be considered as barriers or facilitators to discharging a patient to the appropriate or recommended location. Finally, the role of discharge accuracy could be further examined as it relates to mitigating 30-day hospital readmission.
IMPACT STATEMENT: This research adds an understanding of OT discharge accuracy to previous literature on PT discharge accuracy using a large sample size. Rehabilitation departments can use this methodology to identify their OT discharge accuracy and create process improvement initiatives around improving this metric.
References
Pritchard, K. T., Fisher, G., McGee Rudnitsky, K., & Ramirez, R. D. (2019). Health Policy Perspectives—Policy and payment changes create new opportunities for occupational therapy in acute care. American Journal of Occupational Therapy, 73, 7302109010. https://doi.org/10.5014/ajot.2018.732002
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2017). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 74, 668–686. https://doi.org/10.1177/1077558716666981
Smith, B. A., Fields, C. J., & Fernandez, N. (2010). Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Physical Therapy, 90(5), 693-703.
