title: Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care.
abstract: To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.
  
  
  
  Retrospective cohort analysis of Medicare claims (2010-2013) linked to hospital-level and county-level data.
  
  
  
  Acute care hospital and community.
  
  
  
  Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.
  
  
  
  Not applicable.
  
  
  
  Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.
  
  
  
  Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.
  
  
  
  Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.
authors.affiliation: Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA. Electronic address: janet_freburger@pitt.edu.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Freburger
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Dongmei
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Johnson
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; Department of Family Medicine, University of North Carolina, Chapel Hill, NC.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Fraher
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D009788:Occupational Therapy / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data; D026741:Physical Therapy Modalities / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D044469:Racial Groups; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D000071939:Stroke Rehabilitation / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States
keywords: Continuity of patient care; Healthcare; Occupational therapists; Physical therapists; Rehabilitation; Stroke