Occupational Therapy Utilization Research Articles

Examining outpatient occupational therapy utilization among children and youth with special health care needs in South Carolina: A structural equation model of individual- and community-level factors

BackgroundChildren and youth with special health care needs (CYSHCN) comprise 23 % of the pediatric population in South Carolina (SC), compared to state prevalences of 13.6 %–24 % nationwide. While occupational therapy (OT) is critical to maximizing CYSHCN's participation in daily activities, there are significant disparities in rehabilitation access in the Southeast region. ObjectiveThis study examines associations between patient-and community-level factors and outpatient OT utilization. MethodsThis study analyzes OT utilization data among CYSHCN (N = 1913) in a health system in SC from 07/01/2022-06/31/2023, merged with Child Opportunity Index 2.0 zip-code level social drivers of health (SDOH) data. SDOH are non-medical factors that affect individual's long-term health, with estimates ranging from “very low” to “very high” opportunity. Structural equation modeling was conducted to understand complex associations between observed and latent variables in a real-world context. ResultsCYSHCN were diagnosed with congenital (40.77 %), developmental (37.87 %), and neurological/neuromuscular conditions (21.36 %). CYSHCN who were non-Hispanic Black or Hispanic and were hospitalized were associated with living in lower opportunity areas. CYSHCN with private or military/other insurance/self-pay were associated with living in higher opportunity areas than Medicaid-insured CYSHCN. CYSHCN who were female and ≥12 years demonstrated lower OT utilization. CYSHCN who participated in speech and/or physical therapy demonstrated higher OT utilization. OT utilization increased with each increase in SDOH. ConclusionWith these findings, healthcare providers may consider accessibility barriers, including transportation, when referring CYSHCN to OT services. Further research is needed to examine the impact of household-level SDOH on OT access across SC.

Facility-Level and Racial Disparities in Access to Inpatient Psychiatric Occupational Therapy Services in the Veterans Health Administration.

Veterans receiving inpatient psychiatric services with limitations in activities of daily living (ADLs) benefit from occupational therapy, yet disparities in access are unknown. To investigate whether ADL limitations, an indicator of occupational therapy need, was associated with inpatient psychiatric occupational therapy utilization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. Secondary analysis of VHA data. Modified Poisson regression modeled occupational therapy utilization as a function of ADL limitations, facility characteristics, and covariates. Interactions estimated whether the relationship between ADL limitations and occupational therapy utilization differed across facility characteristics. VHA inpatient psychiatric setting. Veterans receiving VHA inpatient psychiatric care from 2015 to 2020 (N = 133,844). Occupational therapy utilization. Veterans with ADL limitations were more likely to receive occupational therapy. Veterans receiving care in facilities with higher complexity and greater inpatient psychiatric care quality were more likely to receive occupational therapy. Additionally, Black veterans were less likely to receive occupational therapy relative to their White, non-Hispanic counterparts. Interactions indicated that the extent to which ADL limitations drove access to occupational therapy utilization was weaker within facilities with higher complexity and care quality. Veterans with ADL limitations were more likely to access inpatient psychiatric occupational therapy, suggesting that such services are generally allocated to veterans in need. However, findings indicate disparities in access across patient-level (e.g., Black race) and facility-level (e.g., facility complexity) factors, informing efforts to eliminate barriers to accessing these valuable services. Plain-Language Summary: This is the first study, to our knowledge, to examine disparities in access to inpatient psychiatric occupational therapy in the Veterans Health Administration (VHA). The study findings show that access to inpatient psychiatric occupational therapy is partly driven by the needs of the patient. However, nonclinical factors, such as a patient's race and the characteristics of the facility at which they receive care (complexity, number of psychiatric beds available, and the quality of psychiatric care), are also important drivers of access. Identifying factors influencing access to these valuable services is the first step in developing strategies that reduce barriers to access for veterans in need.

Association of Inpatient Occupational Therapy Utilization With Reduced Risk for Psychiatric Readmission Among Veterans.

The authors sought to investigate whether utilization of inpatient occupational therapy (OT) was associated with reduced risk for 30-day psychiatric readmission in the Veterans Health Administration (VHA). The authors conducted a secondary analysis of VHA medical record data for veterans who received inpatient psychiatric care from 2015 to 2020 (N=176,889). Mixed-effects logistic regression was used to model psychiatric readmission within 30 days of discharge (yes or no) as a function of inpatient psychiatric OT utilization (none, one, two, three, or four or more encounters) and other care utilization (e.g., previous psychiatric hospitalization), as well as clinical (e.g., primary diagnosis), sociodemographic (e.g., race-ethnicity), and facility (e.g., complexity) characteristics. Sensitivity analyses were conducted to evaluate the robustness of findings (e.g., stratification by discharge disposition). Relatively few veterans received inpatient psychiatric OT (26.2%), and 8.4% were readmitted within 30 days. Compared with veterans who did not receive inpatient psychiatric OT, those with one (OR=0.76), two (OR=0.64), three (OR=0.67), or four or more encounters (OR=0.64) were significantly (p<0.001) less likely to be readmitted within 30 days. These findings were consistent across all sensitivity analyses. Veterans who received inpatient OT services were less likely to experience psychiatric readmission. A clear dose-response relationship between inpatient psychiatric OT and readmission risk was not identified. These findings suggest that OT services may facilitate high-value inpatient psychiatric care in the VHA by preventing readmissions that stymie recovery and incur high costs. Future research may establish the causality of this relationship, informing policy regarding increased access to inpatient psychiatric OT.

Abstract P388: Higher Social Vulnerability Was Associated With Less Community-Based Rehabilitation Utilization After Stroke

Background: Timely rehabilitation care significantly improves function and mobility after stroke, but barriers exist in access and utilization. The impact of neighborhood social determinants of health is not fully understood. Our study aims to estimate the association between Social Vulnerability Index (SVI), a measure of a community's need for support, and post-stroke rehabilitation utilization. Methods: This study is an observational, secondary analysis of the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 41 North Carolina hospitals from 2016-2019. This analysis included 4765 individuals (51.2% female; 74.8% Whites; mean age 69.9) discharged directly home after stroke and linked to administrative claims. Utilization of physical or occupational therapy was obtained from outpatient, carrier file and home health claims. Geocoded participant addresses were linked to 2018 summary SVI percentile ranking and its four sub-domains at the Census tract level. Generalized estimation equations with cluster of Census tract and hospital were used to estimate the association between quintiles of SVIs and incidence proportion of rehabilitation use within 30 days. Covariates included patients’ socio-demographics, clinical characteristics, and comorbidities. Results: The overall proportion of rehabilitation use by 30 days was 38.6%, ranging from 34.6-46.5% across SVI quintiles. In multivariable analysis, quintiles of higher summary SVI were associated with lower rehabilitation use compared with the least vulnerable quintile (RD and 95% CI, Q5 vs Q1: -0.098 [-0.147 to -0.049]; Table). There was a significant decreasing trend across quintiles (P-trend &lt; 0.001). Similar results were observed for SVI sub-domains except for minority status and language. Conclusion: Higher social vulnerability was associated with less post-stroke rehabilitation use. The finding is useful to identify communities for targeted interventions to improve access and utilization to rehabilitation.

SOCIOECONOMIC DISPARITIES IN PHYSICAL AND OCCUPATIONAL THERAPY HOME HEALTH CARE VISITS FOR PEOPLE WITH DEMENTIA

Abstract People living with Dementia (PLWD) utilize Home Health Care (HHC) services such as Physical Therapy (PT) and Occupational Therapy (OT), but little is known about service utilization patterns among PLWD from different socioeconomic backgrounds. We aimed to identify disparities in service utilization in PLWD in a HHC setting across socioeconomic backgrounds using a measure of geographic socioeconomic deprivation, the Area Deprivation Index (ADI). ADI is a composite measure of census variables describing socioeconomic disadvantage, reported as national percentile rank. This secondary analysis utilized data collected February 2017–May 2022 in a dementia symptom management clinical trial at a large, urban, Medicare certified nonprofit HHC agency in New Jersey. Demographic and service utilization data from 153 dyads of PLWD and caregivers was collected. PLWD’s area codes were used to calculate ADI. ADI national percentile was divided into quartiles, and PT and OT utilization for the highest quartile was compared to the three lowest quartiles using Poisson regression, consistent with previous literature. The highest quartile group was defined as ADI above the 36.5th percentile. ADI varied from 2nd to 73rd percentile, with a median of 24th percentile. Analysis controlled for pre-existing comorbidities using pre-trial Charlson Comorbidity Index scores, classified as high (&amp;gt;5), medium (3-4), or low (1-2). High ADI classification was associated with a 50.2% decrease in OT utilization (IRR=.498, CI=.348-.713), and 39.4% decrease in PT utilization (IRR=.606, CI=.485-.759). Further investigation of disparities in PT and OT utilization in HHC is needed, given the disproportionate burden of disease on socioeconomically distinct populations.

How to Enable Participation until the End of Life? A Survey of German Occupational Therapists Working in Palliative Care.

In palliative care, the needs of people with life-limiting illnesses must be addressed with the support of a multidisciplinary team. Occupational therapy is a profession that focuses on activity and participation. In Germany, there are no surveys to date that demonstrate the work of occupational therapists in palliative care and which problems can occur in this field. The aim of this study is to describe the work and problems of occupational therapists in German palliative care. The survey consists of 17 questions and could be conducted anonymously. Descriptive statistics and a thematic analysis of the free text responses were used to analyze data. Respondents were German occupational therapists who are members of the "German Association of Occupational Therapy". A total of 281 valid responses were evaluated, of which 120 respondents work in the context of palliative care. Most of them provide needs-based therapies (74%), train relatives (69%), or help patients with positioning (69%) or relaxation therapy (66%). Four themes were developed in the free text responses that describe problems in the utilization of occupational therapy in palliative care. The evaluation shows that occupational therapy in palliative care offers a variety of possible applications and approaches. The findings urgently need to be implemented in daily practice to improve the status of occupational therapists. This requires appropriate billing modalities and clear guidelines. There is still a significant need for research and training in this area.

Unmet Need for Outpatient Occupational Therapy Services Among Veterans With Mild Traumatic Brain Injury in the Veterans Health Administration: The Role of Facility Characteristics

ObjectiveTo investigate whether participation restrictions, an indicator of need for occupational therapy (OT), was associated with outpatient OT utilization in the Veterans Health Administration (VHA) among Veterans with mild traumatic brain injury (mTBI), and whether this relation differs by facility characteristics. DesignIn a secondary analysis of national VHA data, we used modified Poisson regression to model OT utilization (yes/no) as a function of participation restrictions (Mayo-Portland Adaptability Inventory Participation Index [M2PI]), facility characteristics, and covariates. Facility characteristics included complexity, geographic region, and self-reported access to specialty care. Covariates included prior OT utilization, sociodemographic factors, injury characteristics, and spatial access (eg, drive time). Interactions estimated whether the relation between participation restrictions and OT utilization differed across facility characteristics. SettingOutpatient setting in the VHA. Participants8684 Veterans with a clinician-confirmed mTBI who received outpatient VHA care between 2012 and 2020 (N=8684). InterventionsNone. Main Outcome Measure(s)OT utilization was measured within a year of M2PI administration using VHA administrative data. ResultsMany Veterans who did not receive OT reported participation limitations, indicating unmet need for OT (eg, 67% with leisure restrictions). Participation restrictions were associated with increased likelihood of receiving OT (risk ratio [RR]=1.01; 95% confidence interval [CI]=1.006-1.019), suggesting a tendency for Veterans’ OT-related needs to be satisfied. However, interactions indicated that this was not the case among Veterans receiving care in lower complexity facilities, and those in the South. Veterans with longer drive times were less likely to receive OT (RR=0.82; 95% CI=0.744-0.904). ConclusionsParticipation restrictions were associated with OT utilization, yet many Veterans with mTBI who may have benefited did not receive such care. Specific barriers to accessing OT (eg, OT practitioner supply) should be investigated. Novel care models can ensure access to OT services among Veterans seeking care at less-resourced and/or geographically distant VHA facilities.

A Quality Improvement Study to Improve the Utilization of Occupational Therapy and Physiotherapy Services in a Level 4 Neonatal Intensive Care Unit and Neurodevelopmental Follow-Up Clinics

Background: Neonates admitted to the neonatal intensive care unit (NICU) are at risk of neuromotor and behavioral impairments, and therapy services can optimize their neurodevelopment. Physiotherapy (PT) and Occupational therapy (OT) services are available in the NICU of Women’s Wellness and Research Center, and as per the guidelines, physicians should refer the neonates for appropriate services. Baseline analysis of 1-month data revealed that 25%, 36%, 62%, and 10% of eligible neonates were not referred to (1) inpatient OT, (2) inpatient PT, (3) baby therapy, and (4) neonatal neurodevelopmental clinic, respectively. The study’s objective is to increase the number of babies being referred, by reducing the number of eligible neonates not being referred to 4 available therapy services to 50% of the baseline data after 1 month of implementation. Methods: A Plan-Do-Study-Act cycle guided the interventions. The 1st phase identified stakeholders’ challenges for not referring the babies to appropriate services. Based on their feedback, the referral criteria were revised. The 2nd phase involved implementing the revised criteria. Steps included (a) stakeholders’ education on the revised criteria and making it available all the time, (b) daily triage and huddle to inform stakeholders of the needed referrals, and (c) establishing communication pathways. Results: Exceeding the targets, all eligible and 75% of the eligible neonates for neonatal neurodevelopmental and baby therapy clinics, respectively, were referred. For inpatient OT and PT services, 22% (targeted 12.5%) and 20% (targeted 18%) of the eligible neonates were missed. Conclusion: Within 1 month, we decreased the number of nonreferrals to all 4 therapy services. Inpatient PT and OT referrals need more focus.

Missed Opportunities to Ease Suffering: An Explanatory Model of Occupational Therapy Utilization in End-of-Life Care.

Background: With disease progression, a terminally ill person may experience loss of physical and cognitive skills required to perform everyday activities. Such functional loss can erode autonomy and cause existential suffering. Supported engagement in everyday activities may help terminally ill people stay involved in living and cope with dying. Occupational therapy enables people to engage in valued activities at the end of life, yet remains under-utilized. Objectives: To address the perceived under-utilization of end-of-life care occupational therapy, the authors investigated how utilization of occupational therapy in end-of-life care is determined from the perspective of decision-makers and occupational therapists and then developed a model of the process. Methods: Using a grounded theory method, authors conducted two semi-structured interviews with 20 decision-makers and 21 occupational therapists. Theoretical sampling followed by paradigm analysis, yielded a data-grounded model. Results: The authors developed The Model of Occupational Therapy Utilization in End-of-Life Care. Service utilization was primarily contingent upon the decision-makers' awareness of occupational therapy's role in end-of-life care and further influenced by place of care cost constraints and participants' ability to adjust focus of the occupational therapy to accommodate the patient's dying process. Conclusion: Limited awareness of occupational therapy's role in end-of-life care warrants research on whether modification of model constructs may increase awareness and utilization. Education is indicated to teach providers about suffering due to functional loss and how to adjust focus of occupational therapy to sustain occupational participation through decline, across different care settings, and along a range between rehabilitation-focused to participation-focused outcomes.

Occupational therapy for people with Parkinson’s disease in Israel: A SWOT analysis

Background Despite the important role that occupational therapy (OT) plays in management of Parkinson’s disease (PD), few patients with PD in Israel seek such treatment. Aims To capture the opinions of internal and external (to the profession) informants regarding OT’s role in the management of PD, to identify factors that may affect the utilization of OT, and to identify potential strategies for promoting such use. Material and Methods Fifty-two occupational therapists and nine neurologists who specialize in movement disorders completed online questionnaires containing both closed and open-ended questions. An analysis of strengths, weaknesses, opportunities, and threats (SWOT) was performed on the responses, and text analyses were performed on the responses to the open-ended questions. Results Identified strengths included respondents’ self-confidence in treating patients with PD, and collaboration with multidisciplinary teams. Weaknesses included lack of specific training, low frequency of seeing patients with PD, overlapping treatment objectives with other healthcare professions, and lack of familiarity with guidelines. Patients’ and physicians’ limited acquaintance with OT, and referral rates were acknowledged as both opportunities and threats. Conclusions/Significance Strategies for promoting the use of OT among Parkinson’s patients include specific training and increased awareness of OT for referring physician and patients.

"You've Got to Do Something": Developing Occupational Therapists' Role in End-of-Life Care.

Occupational therapists support the occupational participation of people who are dying yet remain underutilized in end-of-life care. The purpose of this article was to explore how occupational therapists develop their role in end-of-life care to provide strategies to address underutilization. Using a grounded-theory method, semi-structured interviews were conducted with 21 occupational therapists. Three themes emerged which demonstrate participants' role development process. Participants' experiences with dying (Close Experience of Loss) often instilled the importance of end-of-life care. Led by these convictions (Willing to Do It), participants developed skills for end-of-life care. Reflecting on their experiences and treatment outcomes (Making a Difference), participants self-validated their role. The Model of Occupational Therapists' Role Development in End-of-Life Care captured this process. Personal experiences and critical self-reflection may provide an adaptive means to drive role development and appropriately increase end-of-life care occupational therapy utilization.

Accessibility to Occupational Therapy Services for Hereditary Transthyretin Amyloidosis.

This study was designed to investigate the global utilization of occupational therapy (OT) services by patients with hereditary transthyretin amyloidosis (ATTRv) in Spain. The main objective was to find out whether these patients have access to OT services and the types of interventions being offered to them, together with their satisfaction and real benefits as users. We developed an online questionnaire which was distributed to patients with ATTRv in Spain through patient associations. Seventy-four patients with a diagnosis of ATTRv residing in Spain participated in the study. Thirteen had already used OT services at least once, felt that OT interventions improved their quality of life, would recommend OT services to others, and would return to see an occupational therapist. However, 61 had never used this type of service before. Of these, 35 knew what OT is and 13 declared that they considered that OT interventions in ATTRv could be positive for them. The results suggest that the use of OT services by ATTRv patients is low, mainly because of the lack of information about the occupational profile of individuals with this disease. The low response rate obtained for the survey limits generalization, and thus further research to confirm these preliminary findings is needed.

Physical and occupational therapy utilization and associated factors among adults with cerebral palsy: Longitudinal modelling to capture distinct utilization groups

BackgroundAdults with cerebral palsy (CP) experience functional declines. Clinical rehabilitation may preserve function for this population. ObjectiveTo identify longitudinal physical/occupational therapy use and associated factors among adults with CP, to inform health promotion strategies. MethodsA retrospective cohort study including adults ≥ 18 years of age with CP was performed using a random 20% Medicare fee-for-service dataset. Participants with continuous medicare enrolment from 01/01/2016-12/31/2018 were included: 2016 was the one-year baseline period; 2017–2018 was the two-year follow-up. Therapy included an indication of physical, occupational, or other forms of therapy. Two-year therapy use patterns were identified using group-based trajectory modeling. Multivariable multinomial logistic regression models identified associations between baseline characteristics with trajectory groups. ResultsOf 17,441, 7231 (41.5%) adults with CP had therapy use across the three-year period, and six longitudinal therapy trajectories were identified: the majority (42.5%) were low-consistent users, 13.4% moderate-consistent users, 4.4% high-consistent users, and the remaining variable users. Associations between baseline characteristics (e.g., age, sex, comorbidities) with trajectory groups varied. For example, using the low-consistent users as the reference, Black versus White were 49% less likely, Northeast versus South residency were 7.52-fold more likely, and co-occurring neurologic conditions versus CP only were up to 118% more likely to be high-consistent users (all, P < 0.05). Bone fragility and some chronic comorbidities were associated with moderate consistent users. ConclusionsThe majority of adults with CP were not using physical/occupational therapy. Of those that did, there were unique longitudinal trajectories which associated differently with demographics and comorbidities.

Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors

Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.

Activities of Daily Living Performance and Acute Care Occupational Therapy Utilization: Moderating Factors.

Hospitalized patients who have difficulty performing activities of daily living (ADLs) benefit from occupational therapy services; however, disparities in access to such services are understudied. To investigate whether need (i.e., limited ADL performance) predicts acute care occupational therapy utilization and whether this relationship differs across sociodemographic factors and insurance type. A secondary analysis of electronic health records data. Logistic regression models were specified to determine whether ADL performance predicted use of occupational therapy treatment. Interactions were included to investigate whether the relationship between ADL performance and occupational therapy utilization varied across sociodemographic factors (e.g., age) and insurance type. A total of 56,022 adults admitted to five regional hospitals between 2014 and 2018 who received an occupational therapy evaluation. None. Outcomes and Measures: Occupational therapy service utilization, Activity Measure for Post-Acute Care "6-Clicks" measure of daily activity. Forty-four percent of the patients evaluated for occupational therapy received treatment. Patients with lower ADL performance were more likely to receive occupational therapy treatment; however, interaction terms indicated that, among patients with low ADL performance, those who were younger, were White and non-Hispanic, had significant others, and had private insurance (vs. public) were more likely to receive treatment. These differences were smaller among patients with greater ADL performance. Greater need was positively associated with receiving occupational therapy services, but this relationship was moderated by age, minoritized status, significant other status, and insurance type. The findings provide direction for exploring determinants of disparities in occupational therapy utilization. What This Article Adds: Acute care occupational therapy utilization is driven partly by patient need, but potential disparities in access to beneficial services may exist across sociodemographic characteristics and insurance type. Identifying potential determinants of disparities in acute care occupational therapy utilization is the first step in developing strategies to reduce barriers for those in need.

Change in Activity Performance Mediates the Relationship between Occupational Therapy Utilization and Discharge Disposition among Adults with Traumatic Brain Injuries

A retrospective cross-sectional study was conducted on 435 adults with TBI who received occupational therapy services in an acute care trauma center hospital. Outcome measures were (1) occupational therapy utilization based on billed minutes of occupational therapy evaluation and treatment (low vs. high); (2) Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" to assess activities of daily living level of assistance; and (3) Discharge disposition (community vs. institution). Community discharge included home and supported living facilities. Institutional discharge involved long term care, rehabilitation facility, short term hospital, and skilled nursing facility. Results indicated that change in ADL performance, between admission and discharge, partially mediated the relationship between occupational therapy utilization and community discharge (OR= 0.80, p = .003). High occupational therapy utilization (vs. low) was associated with greater change in ADL performance (β = 0.39, p < .001). Greater change in ADL performance was associated with lower odds of community discharge (OR= 0.96, p <.001). Independent of change in ADL performance, higher occupational therapy utilization was associated with significantly lower odds for community discharge (OR = 0.57, p = 0.023). In conclusion, patients who received more occupational therapy were less likely to be community discharged, as mediated by change in ADL performance. This result can provide direction for future research exploring acute care occupational therapy utilization and discharge disposition.

Occupational Therapy Utilization and Post-Acute Discharge Destination among Adults with Traumatic Brain Injury: The Mediating Effect of Changes in Activity Performance

<h3>Research Objectives</h3> Community discharge is viewed as a favorable outcome following acute care hospitalization. Occupational therapy (OT) utilization is associated with higher community discharges. However, patient-level factors that mediate the relationship between OT utilization and discharge disposition is not well-understood. We sought to investigate whether activities of daily living (ADL) performance change mediates the relationship between OT utilization and discharge destination among adults with TBI. <h3>Design</h3> In a secondary analysis of de-identified electronic health records data, we used path analysis to determine the relationship between 1) OT utilization and ADL performance change; 2) ADL performance change and discharge disposition; and 3) OT utilization and discharge disposition, while adjusting for ADL performance change. We calculated the indirect effect to examine whether ADL performance change mediated the relationship between OT utilization and discharge destination. <h3>Setting</h3> Five acute care hospitals within a single health system. <h3>Participants</h3> 435 adults who received OT services. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> OT utilization units; Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks"; Discharge disposition (community vs. institution). <h3>Results</h3> ADL performance improvement mediated the relationship between OT utilization and community discharge (OR= 0.80, p = .003). High OT utilization was associated with greater ADL performance improvement (β = 0.39, p < .001). Unexpectedly, greater ADL performance improvement was associated with lower odds of community discharge (OR= 0.96, p < .001). <h3>Conclusions</h3> While improved ADL performance mediated the relationship between OT utilization and discharge disposition, the directionality of the relationship was unanticipated. Particularly, greater OT utilization was associated with greater ADL performance improvement, but such improvement was associated with lesser odds of community discharge. Results may inform efforts aimed at ensuring good quality of OT services delivered to individuals with TBI to maximize safe community discharge. <h3>Author(s) Disclosures</h3> None.

Independent and Interactive Effects of Activity Performance, Sociodemographic Factors, and Insurance Type Upon Acute Care Occupational Therapy Utilization

<h3>Research Objectives</h3> Hospitalized patients with difficulty performing activities of daily living (ADL) may benefit from occupational therapy (OT) services. However, disparities in access to acute care OT are poorly understood. We sought to investigate whether need (i.e., ADL limitations) predicts acute care OT utilization, and whether this relationship differs across sociodemographic factors and insurance type. <h3>Design</h3> In a secondary analysis of electronic health records data, we applied logistic regression models to determine whether ADL performance predicted acute care OT utilization. Interactions between ADL performance and both sociodemographic factors (e.g., age; race/ethnicity; significant other status) and insurance type were included to investigate whether the relationship between ADL performance and OT utilization varied across patient characteristics. <h3>Setting</h3> Five regional hospitals from a single health system. <h3>Participants</h3> 56,022 adults admitted between 2014 and 2018 who received an OT evaluation. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Acute care OT treatment utilization; Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks" measure of ADLs. <h3>Results</h3> 44% of patients evaluated for OT received subsequent treatment. Patients with lower ADL performance were more likely to receive OT treatment (odds ratio = 1.08, 95% confidence interval = 1.08, 1.09). However, interaction terms indicated that among patients with low ADL performance, those who 1) were younger; 2) were white, non-Hispanic; 3) had significant others; and 4) had private insurance (vs. public) were more likely to receive treatment. These differences diminished in patients with greater ADL performance, who had similarly low probabilities of receiving OT. <h3>Conclusions</h3> Patients with greater need were more likely to receive acute care OT, but this relationship was moderated by age, minority status, significant other status, and insurance type. Findings provide direction for exploring determinants of disparities in OT utilization. <h3>Author(s) Disclosures</h3> None.

Occupational Therapist Treatment of Patients in the Neurological Critical Care Unit: Utilization and Patient Characteristics.

Occupational therapy use in the neurological critical care unit (NCCU) may relate to patient factors, but data about these relationships remain unpublished. To examine how patient factors predict NCCU occupational therapy use and intervention types. Retrospective cohort study of electronic health records data from adults admitted to the NCCU between May 2013 and September 2015. NCCU in a large, urban academic hospital. Adults (age ≥18 yr; N = 1,134) admitted to the NCCU. Using length of stay (LOS), number of comorbidities, Glasgow Coma Scale (GCS) score, gender, age, and racial-ethnic minority status as independent variables, separate regression models identified predictors for each dependent variable: receipt of NCCU occupational therapy, occupational therapy onset (days after admission), and receipt of self-care or home management (ADL-Home); functional activities or cognitive training (Func-Cog); and therapeutic exercise (Ther-Ex). Four hundred twenty patients (37.0%) received occupational therapy in the NCCU. Receipt of occupational therapy was positively associated with LOS, number of comorbidities, GCS score, and age. Earlier occupational therapy onset was associated with higher GCS score and shorter LOS. Receipt of ADL-Home or Func-Cog interventions was significantly predicted by number of occupational therapy sessions, but patients with longer LOS were less likely to receive ADL-Home interventions. Receipt of Ther-Ex interventions became less likely as GCS score increased. Patients are more likely to receive occupational therapy services if they are older and have a longer NCCU LOS, more comorbidities, and a higher level of consciousness. What This Article Adds: A patient's level of consciousness is clearly associated with occupational therapy utilization and hospital outcomes, but it should not be the only factor considered when prioritizing patients for NCCU occupational therapy services. Compared with patients who were more awake and alert, patients with a lower level of consciousness had a later onset of occupational therapy, which suggests an opportunity for NCCU occupational therapists to collaborate with physicians in the modification of sedation protocols to enable early rehabilitation.

Occupational Therapy Utilization in Veterans With Dementia: A Retrospective Review of Root Cause Analyses of Falls Leading to Adverse Events.

Falls in persons with dementia are associated with increased mortality. Occupational therapy (OT) is a rehabilitation discipline, which has, among its goals, the promotion of safety and fall prevention in older adults and those with dementia. The purpose of this study was to evaluate root cause analysis (RCA) data to identify causes of falls with adverse events in patients with dementia who were referred to or receiving OT services within the Veterans Health Administration (VHA). This study used retrospective review of RCAs within the National Center for Patient Safety database for the VHA. The RCA database was searched using these terms: falls with adverse events, dementia, and OT. Descriptive statistical analysis of demographic information, location, occurrence of orthopedic fracture, and mortality was used. All root causes were qualitatively categorized using thematic analysis of determined causes. Eighty RCAs were included in analysis. Mean age of veterans included was 80 years; 96% were male; 76% resulted in hip fracture; and 20% died as a result of the fall. Occupational therapy evaluations occurred within 7 days of admission to VHA and falls most frequently occurred within 4 days of OT evaluation. Most common causes included inappropriate or lack of equipment (21%), need for falls/rehabilitation assessment (20%), compliance/training to fall protocol of all staff (19%), and behavior/medical status (17%). Earlier identification for OT evaluation need may improve access to services, and use of proper equipment to decrease frequency of falls may improve patient safety for older adults with dementia.