Abstract
Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. This cohort study included the electronic health records and administrative claims data of 30 746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). Of 30 746 patients, 15 507 (50.4%) were men, 26 198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.
Highlights
Pneumonia is a leading cause of morbidity, mortality, and hospitalization in US adults.[1,2] Nearly 1 million older adults are hospitalized each year for community-acquired pneumonia, and more than one-third die within a year.[3]
Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98)
We examined the association of therapist visits in the acute care setting and the risk of 30-day hospital readmission or death in a cohort of patients with pneumonia or influenza-related conditions
Summary
Pneumonia is a leading cause of morbidity, mortality, and hospitalization in US adults.[1,2] Nearly 1 million older adults are hospitalized each year for community-acquired pneumonia, and more than one-third die within a year.[3] Pneumonia is a common reason for hospital readmission, among older adults, who often experience a functional decline during the index admission.[4,5,6,7,8] Studies have identified an inverse association between functional status and risk of hospital readmission.[9,10,11,12] In addition, there is a growing body of literature on the detrimental effects of acute care hospitalization on functional independence.[13,14,15,16] Loyd et al[14] reported that 30% of adults aged 65 years and older who were hospitalized in medical-surgical acute care experienced hospital-associated disability, defined as loss of independence in activities of daily living (ADLs) following acute hospitalization.[14] These findings underscore the importance of hospital-based programs that identify adults at risk of hospital-associated disability and that promote mobility and activity to prevent hospital-associated disability
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