243 Physical Therapy: Impact on Emergency Department Revisit Rates Among Seniors With a Ground-Level Fall

Abstract

Falls are the leading cause of morbidity, mortality, and emergency department (ED) visits among Americans aged 65 and older. However, a number of studies have demonstrated that seniors adopting physical therapy (PT) or exercise regimens following a fall can reduce the risk of future falls. Based on prior research, incorporating PT services (eg, information, diagnosis, and referral) for seniors presenting to the ED for a fall may help reduce future fall-related ED visits within this population. Thus, our goal was to examine differences in ED revisit rates among seniors who present to the ED for a ground-level fall and receive PT services compared to those who do not receive similar services. We leveraged Centers for Medicare and Medicaid Services (CMS) Inpatient and Outpatient base claims and revenue center Standard Analytical Files (SAFs) from the 2012-2013 Limited Data Sets (LDS) to evaluate Medicare claims for those 65 and older. We compared claims for 30- and 60-day fall-related ED revisits between those that did and did have PT services associated with a fall-related index ED visit. A “fall-related ED visit” was defined as an ED claim including an ICD-9-CM E-Code indicating a ground-level fall. Furthermore, we included only outpatient visits for the index ED visit based on prior research suggesting this population would derive greater protective benefits from PT services compared to observational and inpatient populations (among those whose injury severity and/or prevalence of complicating comorbidities is assumed higher). We also excluded weekend ED visits, considering PT services are generally less likely to be available on the weekends. Overall, there were 409,618 unique senior Medicare outpatient claims for fall-related ED visits in 2012-2013. Overall 30-day and 60-day ED revisits among all index ED visits for a ground-level fall was 2.43% (9,937) and 3.56% (14,573) respectively. Of the 409,618 unique outpatient claims for a fall-related ED visit, we identified 14,338 claims for PT services associated with the index ED visit. Among claims with PT services, revisit rates were 1.67% (240) within 30 days and 2.61% (374) within 60 days, compared to 2.45% (9,697) within 30 days and 3.59% (14,199) within 60 days among those that did not receive PT service in the ED. Based on further analyses, our results demonstrate a significant difference in revisit rates between the PT and non-PT cohort, at both 30 (p<0.0001) and 60 days (p<0.0001). We found that both 30- and 60-day ED revisit rates following ED visits for a ground-level fall were significantly lower among seniors who received PT services during their index ED visit compared to those who did not. According to our findings, expanding PT services in the ED including providing relevant information, diagnosis, and referrals for future outpatient PT services may reduce future fall-related ED utilization among seniors. Additional analyses will assess this trend in more depth, including evaluating these data for potential confounders or interaction effects.