Utilization Of Rehabilitation Services Research Articles

Enhancing stroke care in Ghana: A systematic review of stroke rehabilitation services

ObjectiveIn Ghana, the shifting demographics of stroke incidence towards young adults have prompted the expansion of stroke care and rehabilitation efforts. Nevertheless, the precise impact of stroke rehabilitation remains unclear. We conducted a systematic review to explore the landscape and effects of stroke rehabilitation in Ghana. MethodWe identified articles on stroke rehabilitation services in Ghana through searches of PubMed, Scopus, Embase, and Web of Science from inception until February 2024. The Critical Appraisal Skills Programme (CASP) Qualitative Checklist was employed to assess the risk of bias in the included studies, supplemented by qualitative synthesis. ResultsAmong the 213 articles screened, 8 were deemed suitable for review. These studies primarily focused on two groups: stroke survivors (n = 335) and healthcare professionals (HCPs) (n = 257). Many stroke survivors reported significant benefits from telerehabilitation, with increased participation in rehabilitation activities correlating with improved physical and cognitive outcomes. The findings also underscored a lack of knowledge about stroke rehabilitation among HCPs, alongside variations in the availability of protocols and guidelines for stroke management across different hospital levels. ConclusionsThe review reveals several challenges in stroke rehabilitation in Ghana, including disparities in HCPs' perceptions and utilization of rehabilitation services. The findings emphasize the need for comprehensive, patient-centered approaches, standardized training for HCPs, improved resource allocation, and the integration of telehealth to overcome barriers and enhance stroke rehabilitation in Ghana. These insights hold significance not only for Ghana but also for guiding strategies in similar contexts worldwide, aiming to improve stroke rehabilitation outcomes.

Exploring the Current Status of the Rehabilitation and Welfare Programs for Women with Severe Mental Illness

Abstract: Mental illness is a pervasive public health concern affecting a significant portion of the global population, with women facing distinct challenges due to gender disparities and societal factors. This paper explores the specific hurdles encountered by mentally ill women, particularly in developing countries like India, where misconceptions, legal vulnerabilities, and lack of support programs exacerbate their vulnerability. Homelessness further compounds these challenges, with a substantial proportion of homeless individuals grappling with mental health disorders. Efforts to address these issues include government initiatives to establish specialized wards and rehabilitation homes for mentally ill homeless women, alongside welfare programs aimed at providing financial assistance and job opportunities. However, gaps persist in the availability and utilization of rehabilitation services, particularly for women. By prioritizing mental health literacy, reducing stigma, and integrating gender-responsive strategies into policies and programs, we can strive towards a future where mental health is prioritized, and all individuals, regardless of gender, have the opportunity to thrive.

Knowledge and Awareness of Physiotherapy among Cancer Survivors

Background: Despite the established benefits of physiotherapy in oncology care, there remains a substantial gap in the awareness and utilization of rehabilitation services among cancer patients. The role of physiotherapy in improving the quality of life and functional independence of cancer survivors is well-documented, yet the integration of these services into standard cancer care protocols is not uniformly practiced. Objective: This study aimed to assess the level of awareness and the barriers to physiotherapy among oncology patients in a tertiary care hospital, with an emphasis on understanding the gender-specific differences in awareness and interest in physiotherapy services. Methods: A six-month cross-sectional survey was conducted at a tertiary care hospital in Sindh, employing a non-probability convenience sampling technique to recruit 318 participants. The sample size was determined using Raosoft sampling software, with a 95% confidence level, 5% margin of error, and 50% response distribution. Data were collected through self-administered questionnaires, focusing on patients' awareness of and interest in physiotherapy, and analyzed using SPSS version 25.0, with chi-square tests applied to assess statistical significance. Results: The study found that only 17.3% of participants were aware of physiotherapy services, with significant gender differences in awareness (p=0.013) and interest (p=0.326) observed. Barriers to physiotherapy utilization included pain (91.5%), fatigue (90.6%), and financial constraints (78.9%). A stark 84.6% of patients reported not being informed about physiotherapy during their treatment. Conclusion: The low level of awareness and significant barriers to accessing physiotherapy among cancer patients highlight the critical need for enhanced educational programs and improved communication between oncology and rehabilitation professionals. Addressing these gaps is essential for integrating physiotherapy into cancer care, thereby improving patient outcomes and quality of life.

Utilization of rehabilitation services in violent versus nonviolent traumatic spinal cord injury

AbstractBackgroundViolence is the third leading cause of spinal cord injury (SCI) in the United States, and people with violence‐related SCI have worse long‐term outcomes compared to other traumatic SCI etiologies. Little is known, however, about the underlying reasons for these differences. Access to and utilization of rehabilitation services may differ in this population, but their outpatient care has not been previously investigated.ObjectiveTo evaluate differences in utilization patterns of outpatient rehabilitation services between people with violence‐related SCI and other traumatic SCI etiologies.DesignRetrospective cohort study.SettingAcademic tertiary care hospital system.PatientsA total of 41 patients with violence‐related SCI residing in King County at the time of injury who completed inpatient rehabilitation (IPR) in our institution were identified from the hospital trauma registry and matched with 41 control patients with nonviolent traumatic SCI.InterventionsNot applicable.Main Outcome Measure(s)The number of appointments attended, canceled, and missed during the first year after discharge from IPR were obtained by chart review for physical medicine & rehabilitation (PM&R) physicians and therapy services.ResultsPeople with violence‐related SCI had decreased follow‐up with outpatient rehabilitation services after IPR discharge compared to non‐violent traumatic SCI, including PM&R (2.50 ± 2.44 vs. 3.76 ± 2.21 visits, β = −1.28, p = .017), physical therapy (8.91 ± 11.02 vs. 17.57 ± 15.26, β = −9.79, p = .009), occupational therapy (4.28 ± 7.90 vs. 10.04 ± 14.42, β = −6.18, p = .033), and recreational therapy (0.293 ± 0.955 vs. 1.37 ± 2.86, β = −1.07, p = .035). The rate of missed appointments was also higher among people with violence‐related SCI compared to controls for PM&R (25.2% ± 28.5% vs. 9.9% ± 16.5%, β = 14.6%, p = .014) and physical therapy (26.0% ± 32.0% vs 4.2% ± 13.2%, β = 22.1%, p = .009).ConclusionsIndividuals with violence‐related SCI had fewer follow‐up appointments with PM&R physicians and other allied health professionals and were more likely to miss scheduled appointments compared to other traumatic SCI etiologies. Decreased outpatient follow‐up may affect long‐term outcomes for people with violence‐related SCI.

[Determinants of use of rehabilitation services before entering disability pension: Time series analysis of insured members of the German Pension Insurance Federation in Berlin and Brandenburg].

The age-standardized application rate for medical rehabilitation services of the German Pension Insurance Association has been declining since 2009. Two of the most frequent reasons for applying for rehabilitation services represent musculoskeletal disorders and mental disorders. The aim of this analysis was to identify factors influencing the utilization of rehabilitation services in the federal states of Berlin and Brandenburg. The explorative time series analysis is based on a research dataset of the German Pension Insurance Federation. Insured persons of the German Pension Insurance Federation from the federal states of Berlin and Brandenburg with a diagnosis of musculoskeletal disorders or mental disorders were included. Descriptive differences in targeted and prognostic parameters were calculated using chi-square and t-test statistics. Predictive parameters for the utilization of medical rehabilitation services were calculated using binary, logistic regression analyses. A total of 11,257 insured cases were examined. For the population of insured persons from Berlin, the use of medical rehabilitation services showed significant prognostic variables for gender, age at retirement, marital status, level of education, occupational requirement level, total accumulated earning points, gross pension level, status of a temporary pension, health insurance status, and diagnosis group. For Brandenburg, significant prognostic variables were found for age at retirement, marital status, nationality, education level, occupational requirement level, total accumulated earning points, status of a temporary pension, occupational sector, and diagnosis group. In Berlin and Brandenburg mental disorders and sociodemographic parameters are associated with an increased probability of not claiming medical rehabilitation services before the onset of reduced earning capacity. It remains to be investigated which mechanisms cause people with mental disorders to make no use of medical rehabilitation services. Future analyses should examine isolated interaction mechanisms for the utilization of medical rehabilitation services, especially in the case of existing F-diagnoses. In addition, explanations for different influencing variables between states remain to be explored.

Characterization of SUS-treated amputees at the Itanhaém Municipal Rehabilitation Center from 2012 to 2020

Introduction and aim. Analyzing the factors related to amputations and understanding which factors are changeable can assist in the development of public policies for the prevention and education of the population. Objective: To describe the main etiological characteristics and symptoms after amputation in the Unified Health System (Sistema Único de Saúde – SUS) patients in order to contribute to the information for treatment planning by the multiprofessional team for these patients. Material and methods. Retrospective study from 2012 to 2020, evaluating data from all amputation cases seen at the Itanhaém Municipal Rehabilitation Service, SP. Results. 76 cases were studied, mostly middle-aged men, Caucasian, smokers, hypertensive, type II diabetics, some with dyslipdemia, cardiopathies, and the main cause of amputation was infection after wound. Conclusion. The population needs to be warned about the risk of amputation due to infected wounds in patients with difficulty in controlling their comorbidities. Patients who have undergone amputation, should be oriented towards an early utilization of rehabilitation services, and municipalities should prepare their medical and rehabilitation professionals for the treatment of characteristic symptoms that amputees report and prosthetization.

Barriers to the Utilization of Low-Vision Rehabilitation Services among Over-50-Year-Old People in East and Southeast Asian Regions: A Scoping Review.

East and Southeast Asia (ESEA) are facing age-related eye health issues. Low-vision rehabilitation (LVR), which is a special rehabilitation service for individuals with vision impairment, is a promising solution for these health issues; however, poor accessibility to LVR services has been reported globally, including ESEA. Therefore, this scoping review aimed to summarize and understand the barriers to accessing LVR services in ESEA. In total, 20 articles were ultimately considered eligible for this scoping review after an electronic database search using MEDLINE (PubMed), Web of Science, Academic Search Ultimate (EBSCO), and Ichushi-Web (Japanese medical literature database), and an independent review by two reviewers. Twenty-one potential barrier factors were identified in the full-text review. Notably, age, education, economic status, "previous experience using eye care service", and "knowledge, information, and awareness" were the possible barrier factors that were examined for their association with LVR utilization, with supportive evidence in many eligible studies. We also identified research gaps relating to geographical and ethnic diversity, the scope of LVR services, and barriers among eligible articles. Therefore, by conducting further studies addressing the research gaps identified in this scoping review, these findings can be used to make LVR services more accessible to people in ESEA.

Sociodemographic and clinical characteristics associated with utilization of rehabilitation services in breast cancer survivors.

286 Background: Breast cancer treatment is increasingly efficacious, but commonly results in functional morbidity and decreased quality of life for survivors.Rehabilitation services, including physical and occupational therapy, are recommended by clinical practice guidelines to counteract these impairments, yet these supportive services may be underutilized. Little is known about how use of rehabilitation services may vary by patient-level characteristics. Methods: Data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was used to identify women aged ≥66 years diagnosed with stage 0-III breast cancer between 2011-2016. Rehabilitation services (evaluation/treatment by a physical and/or occupational therapist) delivered in the initial phase of care (0-11 months post-diagnosis) were identified via outpatient or physician visit claims. Descriptive statistics compared rehabilitation usage by patient sociodemographics and clinical characteristics (age, race, dual eligibility status, rural/urban residence, cancer stage, subtype, treatment type). Associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs). Results: Of 55,539 breast cancer survivors, 33% (n=18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, 21% Medicare/Medicaid dually enrolled, and 82% had HR+ breast cancer. Clinically, 88% of survivors had received chemotherapy, 69% lumpectomy, and 27% mastectomy. In adjusted models, patients aged >75 vs. ≤75 and dual-eligible beneficiaries vs. those with other insurance were 6% (RR 0.94, 95% CI 0.92-0.96) and 4% (0.96, CI 0.93-0.99) less likely to have received rehabilitative services, respectively. Patients with at least a high school education vs. less than high school, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively. Patients with invasive vs. in situ cancer and those who received surgical treatment vs. none were 13% (1.13, CI 1.06-1.21) and 15% (1.15, CI 1.02-1.32) more likely to have received rehabilitative services, respectively. Conclusions: Rehabilitation services use differed by patient sociodemographic and clinical characteristics, with the largest differences seen for survivors of differing educational and treatment statuses. Further research is needed on barriers for, access to, and delivery of rehabilitation services, specifically for women with breast cancer who are less educated, older-aged, non-White, or Medicare/Medicaid dual eligible.

The Effect of COVID-19 Pandemic on Households' Utilization of Rehabilitation Services: National Evidence from Iran Health System.

The coronavirus disease-2019 (COVID-19) pandemic has affected the pattern of utilization of healthcare services. This study aimed to investigate the utilization of rehabilitation services before and after the COVID-19 pandemic in the health system of Iran. This descriptive-analytical study used data from the Household Income and Expenditure Surveys of the Iran Statistics Center in 2018-2019 (before COVID-19) and 2020 (after COVID-19). The patterns of utilization and expenditures of rehabilitation services before and after this pandemic were investigated in different household sub-groups. The multilevel logistic regression model was used to investigate the effect of COVID-19 on the utilization of health services by households. Although 258 (0.66%) households used rehabilitation services before the COVID-19 pandemic, only 175 (0.47%) households utilized them after the pandemic. Additionally, the average total rehabilitation costs per utilized household were 3,438,185 Iranian Rials (IRR) in 2018-2019 and 2,996,511 IRR in 2020-2021. Sex, age, education, size of household, place of residence, health insurance coverage, and income significantly affected the utilization of rehabilitation services by households during the study period (p < 0.001). Furthermore, the average use of rehabilitation services decreased by 22% (odds ratio = 0.78, p < 0.01) after the pandemic. In Iranian households, the utilization and average expenditure of rehabilitation services significantly decreased after the COVID-19 pandemic. These findings strongly recommend health system policymakers to develop comprehensive plans to address future shocks arising from pandemics and other emergencies.

Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study

BackgroundAround the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan. MethodologyThis qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes. ResultsTwo themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers. ConclusionRehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.

Barriers and enablers of utilization of low-vision rehabilitation services among over-50-year-old people in East and Southeast Asian regions: a scoping review protocol.

This scoping review aims to explore and describe the barriers and enablers of low-vision rehabilitation service utilization among people over 50-years-old in East and Southeast Asia. Vision impairment is strongly associated with aging. East and Southeast Asia are experiencing a rapidly growing aging population and the eye-related health burdens associated with this. Despite the benefits of low-vision rehabilitation services, they are extremely underutilized in the region. Identifying the barriers and enablers of service utilization could be a crucial first step in making the services more accessible and, ultimately, easing the burden of this health issue. This review will include published articles that examine the barriers and/or enablers of low-vision rehabilitation service utilization. Inclusion criteria are people aged 50 years and older living in East and Southeast Asia; low-vision rehabilitation services (defined as any kind of intervention that aims to mitigate the impacts of disability induced by eye-related health conditions); no comparator; and information on barriers and/or enablers for service utilization. A literature search of 4 databases as well as an additional manual search will be conducted to identify eligible articles. Two independent reviewers will assess the articles for inclusion. Data extraction will focus on general information of the study, demographic or descriptive information of the study population, eye condition being studied, means of low-vision rehabilitation, and the barriers and/or enablers of service utilization. The information will be tabulated to depict the categories of barriers and enablers that influence access to services. Open Science Framework https://osf.io/8y2wp.

Utilization and Cost of Outpatient Rehabilitation Services for Pediatric Patients Treated for Acute Lymphoblastic Leukemia Using a Commercial Claims Database

ObjectiveTo investigate the temporal trends and factors associated with outpatient rehabilitation utilization and costs for pediatric acute lymphoblastic leukemia (ALL). DesignDeidentified administrative claims data and longitudinal health information on patients representing a mixture of ages, ethnicities, and geographic regions across the United States were accessed using Optum Labs Data Warehouse. Regression models were constructed to assess associations of outpatient rehabilitation with age, sex, race and ethnicity, year of diagnosis, and region. SettingOutpatient rehabilitation. Participants1000 Patients aged 1-30 years with a new diagnosis of ALL between 1993 and 2017 and continuous insurance coverage (N=1000). InterventionNot applicable. Main Outcome MeasuresOutpatient rehabilitation service utilization and cost based on reimbursed charge codes, summarized over 36 months after cancer diagnosis. ResultsIn 1000 patients, utilization of outpatient rehabilitation services increased from 20% in 1993-2002 to 55% in 2013-2017. In the earliest era examined, physical and/or occupational therapy was provided to 18% and increased to 54% in the latest years. Speech service utilization remained between 5%-8% across timepoints. Inflation-adjusted cost for provision of services did not change significantly across time and remained low, accounting for a median of 1.3% (Q1, Q3 0.3, 3.4) of total treatment cost in 1993-2002 and decreasing to a median 0.4% (Q1, Q3, 0.1, 1.0) in 2013-2017. Age 1 to 5 years at ALL diagnosis was associated with increased rehabilitation visit number and cost, and treatment in the Midwest was associated with increased likelihood of outpatient rehabilitation service utilization compared to other geographic regions. ConclusionsOutpatient rehabilitation services are being increasingly provided to patients with ALL at a relatively low cost per patient, yet geographic variability in care utilization is evident. These services do not add excessively to the overall cost of leukemia care and thus cost containment should not be an excuse to limit access.

Impact of socioeconomic position on the utilization of rehabilitation services among the Chinese older adults disabled by injury.

This study aimed to explore the utilization of rehabilitation services and associated socioeconomic position (SEP) factors among Chinese older adults disabled by injury. Data from the second China National Sample Survey on Disability (CSSD) were used in this study. Chi-square test was used to analyze the significant differences between groups, and binary logistic regression model was used to calculate the odds ratios and 95% confidence intervals for socioeconomic factors associated with utilization of rehabilitation services among Chinese older adults disabled by injury. Among the older adults disabled by injury in the CSSD, the gap between demand and utilization of medical treatment, assistive devices and rehabilitation training were around 38, 75, and 64%, respectively. This study revealed two relationship patterns ("high-low-high" and "low-high-low") among SEP, prevalence of injury-caused disability and odds of utilization of rehabilitation services among the Chinese older adults disabled by injury, that is, the older adult with higher SEP have a lower prevalence of injury-caused disability, but a higher odds of utilization of rehabilitation services; conversely, the older adults with lower SEP have a relatively higher prevalence but a lower odds of utilization of rehabilitation services. There is a large gap between the high demand and low utilization of rehabilitation services among the Chinese older adults disabled by injury, especially for those living in the central or western regions or rural areas, without insurance or disability certificate, having the annual household per capita income lower than the national average or lower educational level. Strategies to improve the disability manage system, to strengthen the chain of "information discovery-information transmission-rehabilitation services supply-continuous health monitoring and management" for the older adults disabled by injury are warranted. In view of the poor and illiterate groups among the disabled older adults, to enhance medical aids and popularize the scientific information to compensate for the lack of affordability and awareness of rehabilitation services utilization is essential. In addition, it is necessary to further expand the coverage and improve the payment system of medical insurance for rehabilitation services.

Long-term function, quality of life and healthcare utilization among survivors of pediatric out-of-hospital cardiac arrest

BackgroundSurvival following pediatric out-of-hospital cardiac arrest (OHCA) has improved over the past 2 decades but data on survivors’ long-term outcomes are limited. We aimed to evaluate long-term outcomes in pediatric OHCA survivors more than one year after cardiac arrest. MethodsOHCA survivors <18 years old who received post-cardiac arrest care in the PICU at a single center between 2008–2018 were included. Parents of patients <18 years and patients ≥18 years at least one year after cardiac arrest completed a telephone interview. We assessed neurologic outcome (Pediatric Cerebral Performance Category [PCPC]), activities of daily living (Pediatric Glasgow Outcomes Scale-Extended, Functional Status Scale (FSS)), HRQL (Pediatric Quality of Life Core and Family Impact Modules), and healthcare utilization. Unfavorable neurologic outcome was defined as PCPC > 1 or worsening from pre-arrest baseline to discharge. FindingsForty four patients were evaluable. Follow-up occurred at a median of 5.6 years [IQR 4.4, 8.9] post-arrest. Median age at arrest was 5.3 [1.3,12.6] years; median CPR duration was 5 [1.5, 7] minutes. Survivors with unfavorable outcome at discharge had worse FSS Sensory and Motor Function scores and higher rates of rehabilitation service utilization. Parents of survivors with unfavorable outcome reported greater disruption to family functioning. Healthcare utilization and educational support requirements were common among all survivors. ConclusionsSurvivors of pediatric OHCA with unfavorable outcome at discharge have more impaired function multiple years post-arrest. Survivors with favorable outcome may experience impairments and significant healthcare needs not fully captured by the PCPC at hospital discharge.

Utilization and Cost of Outpatient Rehabilitation Services for Pediatric Patients Treated for Acute Lymphoblastic Leukemia

Utilization and Cost of Outpatient Rehabilitation Services for Pediatric Patients Treated for Acute Lymphoblastic Leukemia

Low Vision Rehabilitation Service Utilization Before and After Implementation of a Clinical Decision Support System in Ophthalmology

Electronic clinical decision support systems apply clinical guidelines in real time and offer a new approach to improve referral and utilization of low vision rehabilitation (LVR) care. To characterize patients and factors associated with LVR service utilization with and without the use of an electronic health record (EHR) clinical decision support system (CDSS) alert. Quality improvement study using EHR data to compare patients who did and did not utilize LVR service after referral between November 6, 2017, and October 5, 2019, (primary) and to assess overall service utilization rate from September 1, 2016, to April 2, 2021, regardless of referral status (secondary). Participants in the primary analysis were patients at a large ophthalmology department in an academic medical center in the US who received an LVR referral recommendation from their ophthalmologist according to the CDSS alert. The secondary analysis included patients with best documented visual acuity (BDVA) worse than 20/40 before, during, and after the CDSS implementation. Data were analyzed from August 2021 to April 2022. Number and locations of referral recommendations for LVR service according to the CDSS alert in the primary analysis; active CDSS implementation in the secondary analysis. LVR service utilization rate was defined as the number of patients who accessed service among those who were referred (primary) and among those with BDVA worse than 20/40 (secondary). EHR data on patient demographics (age, sex, race, ethnicity) and ophthalmology encounter characteristics (numbers of referral recommendations, encounter location, and BDVA) were extracted. Of the 429 patients (median [IQR] age, 71 [53 to 83] years; 233 female [54%]) who received a CDSS-based referral recommendation, 184 (42.9%) utilized LVR service. Compared with nonusers of LVR, users were more likely to have received at least 2 referral recommendations (12.5% vs 6.1%; χ21 = 5.29; P = .02) and at an ophthalmology location with onsite LVR service (87.5% vs 78.0%; χ21 = 6.50; P = .01). Onsite LVR service (odds ratio, 2.06; 95% CI, 1.18-3.61) persisted as the only statistically significant factor after adjusting for patient demographics and other referral characteristics. Among patients whose BDVA was worse than 20/40 before, during, and after the CDSS implementation regardless of referral status, the LVR service utilization rate was 6.1%, 13.8%, and 7.5%, respectively. In this quality improvement study, ophthalmologist referral recommendations and onsite LVR services at the location where patients receive other ophthalmic care were significantly associated with service utilization. Ophthalmology CDSSs are promising tools to apply clinical guidelines in real time to improve connection to care.

The effect of a disability-targeted cash transfer program on universal health coverage and universal access to education: a nationwide cohort study of Chinese children and adolescents with disabilities

To achieve improved outcomes for children and adolescents with disabilities, it is central to have universal health coverage (UHC) and universal access to education. This study investigates whether a disability-targeted cash transfer (CT) program is associated with improved access to healthcare and education for children and adolescents with disabilities. We used nationwide survey data of two million children and adolescents living with disabilities, who aged 8-15 years when entering the cohort between January 1, 2015, and December 31, 2019. With a quasi-experimental study design, we compared the outcomes between CT beneficiaries who newly received CT benefits during the study period and non-beneficiaries who were disabled but never received CT using logistic regressions after propensity score matching with a 1:1 ratio. Outcomes of interest were utilization of rehabilitation services in the past year, medical treatment if the individual had illness in the past two weeks, school attendance if not in school at the start of the study, and reported financial hardship to access these services. Of the total cohort, 368,595 children and adolescents fit the inclusion criteria, including 157,707 new CT beneficiaries and 210,888 non-beneficiaries. After matching, CT beneficiaries showed 2.27 (95% confidence interval [CI]: 2.23, 2.31) higher odds of utilizing rehabilitation services and 1.34 (95% CI: 1.23, 1.46) higher odds of getting medical treatment compared to non-beneficiaries. CT benefits were also significantly associated with less report of financial barrier to access rehabilitation services (odds ratio [OR]: 0.63, 95% CI: 0.60, 0.66) and medical treatment (OR: 0.66, 95% CI: 0.57, 0.78). Moreover, CT program was associated with higher odds of school attendance (OR: 1.99, 95% CI: 1.85, 2.15) and lower odds of reporting financial difficult to access education (OR: 0.41, 95% CI: 0.36, 0.47). Our results suggest that the receipt of CT was associated with improved access to health and educational resources. This finding provides supporting evidence for the identification of efficient and feasible interventions to move toward UHC and universal education under the Sustainable Development Goals. This research was supported by Sanming Project of Medicine in Shenzhen (NO.SZSM202111001), China National Natural Science Foundation (Grant/Award Number: 72274104, 71904099) and Tsinghua University Spring Breeze Fund (20213080028).

Race, ethnicity, and utilization of outpatient rehabilitation for treatment of post COVID-19 condition.

IntroductionOutpatient rehabilitation is recommended in the treatment of post coronavirus disease 2019 (COVID‐19) condition. Although racial and ethnic disparities in the incidence and severity of COVID‐19 have been well documented, little is known about the use of outpatient rehabilitation among patients with post COVID‐19 condition.ObjectiveTo examine factors associated with outpatient rehabilitation use following COVID‐19 and to ascertain whether differential incidence of sequelae explain variation in post COVID‐19 rehabilitation utilization by race and ethnicity.DesignCase–control study.SettingCommunity.ParticipantsU.S. adults with COVID‐19 during 2020 in the TriNetX database.InterventionN/A.Main Outcome MeasuresReceipt of outpatient rehabilitation services within 6 months of COVID‐19 diagnosis and incidence of post COVID‐19 condition symptoms (weakness, fatigue, pain, cognitive impairment, mobility difficulties, and dyspnea).ResultsFrom 406,630 laboratory‐confirmed COVID‐19 cases, we identified 8724 individuals who received outpatient rehabilitation and matched 28,719 controls. Of rehabilitation users, 43.3% were 40 years old or younger, 54.8% were female, 58.2% were White, 17.9% were African American/Black, 2.1% were Asian, 13.0% were Hispanic, 39.2% had no comorbidities, and 40.3% had been hospitalized for COVID‐19. Dyspnea (20.4%), fatigue (12.4%), and weakness (8.2%) were the most frequently identified symptoms. Although there were no racial differences in the incidence of the six post COVID‐19 condition symptoms considered, African American/Black individuals were significantly less likely than their White counterparts to receive outpatient rehabilitation (odds ratio [OR] = 0.89; 95% confidence interval [CI]: 0.84–0.96; p = .003). Hispanic individuals had higher outpatient rehabilitation utilization (OR = 1.22; 95% CI: 1.11–1.33; p < .001) and a significantly higher incidence of post COVID‐19 fatigue.ConclusionsIn this large nationally representative study, African American/Black race was associated with lower utilization of outpatient rehabilitation services despite a similar incidence of post COVID‐19 condition symptoms. Further research is needed to better understand access barriers to rehabilitation services for post COVID‐19 condition recovery care and address racial inequalities in receipt of care.

Socioeconomic inequality in rehabilitation service utilization for schizophrenia in China: Findings from a 7-year nationwide longitudinal study.

AimsFew studies have focused on the utilization of rehabilitation services among people with schizophrenia. In this study, we aimed to examine the trend of pharmacological and psychotherapy service utilization among adults with schizophrenia and to identify the associated socioeconomic factors.MethodsData were obtained from the Second National Sample Survey on Disability in 2006 and from the follow-up investigation in 2007–2013. Individuals with schizophrenia were ascertained by the combination of self-reports and on-site diagnosis by psychiatrists. Random effect logistic regression models were applied to examine the socioeconomic disparity in service utilization and the time trend in the association.ResultsOverall, the percentage of individuals using pharmacological treatment services increased from 23.7 in 2007 to 55.0% in 2013, and the percentage of individuals using psychotherapy services increased from 11.4 to 39.4%. Living in rural areas, being illiterate, living in families with lower income and being uninsured were less likely to receive pharmacological treatment and psychotherapy. The pace of growth in service utilization was higher among individuals with rural residence, illiteracy or low-income status than among their counterparts with advantaged backgrounds.ConclusionsThis study demonstrated an upward trend in pharmacological treatment and psychotherapy service utilization and a downward trend in socioeconomic disparity among Chinese adults with schizophrenia. Future studies to explore the reasons for the observed changes and to identify policies for improving the health service access of this vulnerable group are warranted.

Musculoskeletal Conditions and Secondary Cardiovascular Morbidity Increase Veterans' Rehabilitation and Orthopaedic Service Utilization.

BackgroundMusculoskeletal conditions often affect patients’ mobility and ability to participate in health behaviors such as exercise, potentially affecting their systemic health. The purpose of this research is to determine how frequently cardiac-related comorbidities present in a veteran population with musculoskeletal service-connected disability and how this affects musculoskeletal health care utilization. MethodologyA retrospective cohort of Iraq and Afghanistan Veterans who received a Veterans Affairs (VA) disability determination for service-connected musculoskeletal disability were categorized according to the diagnosis of cardiac comorbidity including diabetes mellitus, hyperlipidemia, hypertension, and obesity, and atherosclerosis disease documented by ICD-9 codes in the VA administrative data. Among veterans with musculoskeletal service-connected disability, logistic regression was modeled to determine if musculoskeletal clinic utilization was associated with also having a cardiac comorbid condition. ResultsVeterans with musculoskeletal disability had a comorbid cardiac disorder 43% of the time. Post-traumatic arthritis was the only musculoskeletal condition positively associated with comorbid cardiac conditions. Veterans with comorbid cardiac diagnoses had 26-37% higher odds of receiving care by physical and occupational therapy, physical medicine, and orthopaedic surgery clinics compared to veterans without comorbid cardiac disease.ConclusionsVeterans in this cohort with musculoskeletal service-connected disability, plus cardiac conditions had greater clinic use for musculoskeletal and rehabilitation services compared to those without cardiac conditions. These results have implications for the rehabilitation and other health service needs of a new generation of veterans.