Date Presented 04/6/21
This study explores predictors of occupational competence and hospital readmission for clients with chronic conditions in acute care. Self-care function (Î2 = 0.43, p = .01) and environmental impact (Î2 = –.38, p = .01) significantly predict occupational competence. Functional cognition (OR = 2.19, p = .04) and occupational competence (OR = 0.81, p = .02) significantly predict hospital readmission. OTs should consider standardized measures of these predictors to facilitate successful discharge home.
Primary Author and Speaker: Melanie Tkach
Additional Authors and Speakers: John R. Patro, Emily Gavin
PURPOSE: This study explores how functional status, self-care function, functional cognition, and environmental impact predict occupational competence (OC) and hospital readmission for clients with chronic conditions. It also investigates occupational therapists’ perceptions on the acceptability, appropriateness, and feasibility of standardized measures in acute care. Evaluations currently include chart reviews, client interviews, impairment-based testing, and clinical observation of activities of daily living. This approach may not identify how impairments impact self-management of chronic conditions nor adequately capture clients’ treatment and discharge needs. Standardized measures that examine impairments during occupational performance may help occupational therapists (OTs) predict therapy needs and outcomes more objectively. However, the acceptability, appropriateness, and feasibility of these measures have not been established in acute care. This study highlights key occupational therapy (OT) domains that significantly influence OC and hospital readmissions. It supports the use of standardized measures to facilitate successful discharge home.
DESIGN: This observational study used consecutive sampling to recruit participants 18 or older who were admitted to the hospital with CABG, CHF, COPD, AMI, PNA, THA, or TKA (n = 52). Individuals in long-term care, intensive care, hospice care, or with moderate to severe cognitive impairment as indicated by the Montreal Cognitive Assessment were excluded.
METHODS: The Boston University Activity Measure of Post-Acute Care (AM-PAC), Craig Hospital Inventory of Environmental Factors-Short Form, Executive Function Performance Test, and Occupational Self Assessment-Short Form were administered during the hospital stay. Follow-up calls were conducted 30-40 days after discharge to identify hospital readmissions. OTs in acute care (n = 3) completed scales of acceptability, appropriateness, and feasibility for standardized measures in the study. OC data were analyzed with multiple regression, hospital readmissions data with logistic regression, and OTs’ perceptions with descriptive statistics.
RESULTS: Self-care function was a significant positive predictor (β = 0.43, p = 0.01) and environmental impact was a significant negative predictor (β = -0.38, p = 0.01) of OC. Individuals who were more dependent in self-care tasks and those who perceived more environmental barriers in daily life had lower levels of OC. These variables accounted for 24% of the variance in OC. Functional cognition was a significant positive predictor (OR = 2.19, p = 0.04) and OC was a significant negative predictor (OR = 0.81, p = 0.02) of hospital readmission. Individuals with lower levels of OC and those with greater impairments in functional cognition were more likely to be readmitted. The OT discharge recommendation, an overall determination of functional status, did not significantly predict either outcome variable. OTs rated the AM-PAC as an acceptable, appropriate, and feasible measure for acute care.
CONCLUSIONS: Self-care function and environmental impact predict OC in individuals with chronic conditions. OC and functional cognition predict hospital readmission for this population. Standardized measures of these predictors, especially the AM-PAC, should be considered in OT evaluations to compliment the current approach, demonstrate therapy needs, and facilitate successful transitions home. Further research should improve the generalizability of results and examine the efficacy of standardized measures in acute care. With more objective information, OTs can implement more effective treatment and discharge recommendations to ensure clients transition home to manage chronic conditions without frequent readmissions.
References
American Occupational Therapy Association. (2018). Occupational therapy in acute care [PDF document]. Retrieved from https://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Acute-Care.pdf
Britton, L., Rosenwax, L., & McNamara, B. (2015). Occupational therapy practice in acute physical hospital settings: Evidence from a scoping review. Australian Occupational Therapy Journal, 62(6), 370-377. https://doi.org/10.1111/1440-1630.12227
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Higher hospital spending on occupational therapy is associated with lower readmission rates. Medical Care Research and Review, 74(6), 668-686. https://doi.org/1077558716666981.
Taylor, R.R. (2017). Kielhofner’s Model of Human Occupation (5th ed.). Philadelphia, PA: Wolters Kluwer.
