Effects of an electronic health record‐based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi‐experimental study

Abstract

Objective To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. Data Sources EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021). Study Design We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR‐PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30‐day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR‐PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. Data Extraction We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. Principal Findings In the PA hospitals, patients with EHR‐PT referrals had an 11.4 percentage‐point decrease in their 30‐day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30‐day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR‐PT referrals in PA had a 26.2 percentage‐point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR‐PT referrals and hospital LOS in PA. Conclusions Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.

Association between physical therapy frequency and postacute care for a national cohort of patients hospitalized with pneumonia

“…Our failure to observe a reduced probability of death with more therapy contrasts with studies by Freburger et al, 2 Chou et al, 30 and Momosaki et al 31 who reported an inverse relationship between physical therapy and death. Freburger et al observed a 14% reduction in the odds for their combined outcome of readmission or death when patients had >6 visits compared to patients with no physical therapy.…”

Relevance and use of health policy, health systems and health services research for strengthening rehabilitation in real-life settings: methodological considerations

“…An example of this type of HPSSR is a study by Chou et al which employed a regression discontinuity design (RDD) to assess the impact of automated physical therapy referrals on rehospitalization or mortality for patients with stroke in 23 acute care hospitals in two different geographical regions. 21 Investigators employed a cut-off value/arbitrary threshold to make decisions on whether to provide a specific intervention/health service, in this case physical therapy. The RDD design allows investigators to the measure treatment effect and the impact of an intervention/health service by comparing those individuals above and below the predetermined cut-off value.…”