Relating Acute Care Rehabilitation Use and Discharge Disposition Among Individuals Hospitalized for COVID-19

Abstract

<h3>Research Objectives</h3> To examine the extent to which acute care rehabilitation predicts discharge to post-acute care (PAC) in hospitalized COVID-19 patients. To identify social determinants that influence discharge to PAC for hospitalized COVID-19 patients. <h3>Design</h3> Secondary analysis of de-identified electronic health record (EHR) data obtained from 14 hospitals during January 2020 through April 2021. The dependent variable was discharge disposition (post-acute care or home). Independent variables included age, sex, ethnic/race minority status, presence of significant other, education level, income, insurance type, rural-urban-frontier residence, acute care occupational therapy (OT) and physical therapy (PT), ICU stay. Descriptive statistics and binary logistic regression were employed. <h3>Setting</h3> Fourteen acute care hospitals that are part of a single health network in Colorado. <h3>Participants</h3> 5,654 individuals were admitted and diagnosed with COVID-19 during the observation window. To be included in our analyses, cases had to meet the following criteria: survival to discharge, discharged to home or PAC, complete data for variables of interest. After applying these criteria, 979 individuals were excluded resulting in a final sample size of 4,675 individuals. <h3>Interventions</h3> Receipt of acute care OT or PT. <h3>Main Outcome Measures</h3> The primary outcome (dependent variable) was discharge disposition, which we categorized as "discharged to Post-Acute Care (PAC)" or "home". <h3>Results</h3> Age (Odds ratio, OR = 1.03), Medicare (OR = 2.21), receipt of acute care OT (OR = 3.41), receipt of acute care PT (OR = 5.05), and ICU stay (OR = 1.49) significantly predicted discharge to inpatient PAC. Sex, race/ethnicity, significant other status, residence type, education level, and income level were not significant predictors of discharge disposition. <h3>Conclusions</h3> Individuals who were older, Medicare beneficiaries, received OT or PT, and had an ICU stay were the most likely hospitalized COVID-19 patients to be discharged to inpatient PAC. Contrary to pre-pandemic studies that demonstrate the influence of significant others, residence location (e.g., rural), income, and education level have on discharge disposition, our findings suggest these factors mattered less in the context of COVID-19. <h3>Author(s) Disclosures</h3> The authors have no conflicts.