Occupational Therapy and the IMPACT Act: Part 2. A Systematic Review of Evidence for Functional Status, Medication Reconciliation, and Skin Integrity Interventions

Abstract

Importance: Interventions that promote function, medication reconciliation, and skin integrity assist occupational therapy practitioners in demonstrating professional value, improving quality, and reducing health care costs. Objective: In this systematic review, we focus on three outcome areas of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014: functional status, medication reconciliation, and skin integrity. Data Sources: We conducted a search of the literature published between 2009 and 2019 in CINAHL, Cochrane, MEDLINE, PsycINFO, OTseeker, and Scopus. We also hand searched the systematic reviews and meta-analyses in our search results for articles that met our inclusion criteria. Study Selection and Data Collection: This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Findings: We found 47 articles that address the three outcome areas. Regarding functional status, low strength of evidence is available for cognition and functional mobility interventions to support functional performance, moderate strength of evidence supports interventions for vision, and moderate evidence supports task-oriented and individualized interventions to promote activities of daily living (ADL) outcomes among people with neurological conditions. Strong strength of evidence supports individualized occupational therapy interventions focusing on medication adherence. Low strength of evidence was found for occupational therapy interventions to reduce pressure ulcers and promote skin integrity. Conclusion and Relevance: The evidence supports occupational therapy interventions to improve functional status in ADLs and medication management. Additional research is needed that examines the outcomes of occupational therapy interventions for other areas of function and skin integrity. What This Article Adds: We found evidence to support occupational therapy interventions that align with value-based measures in the three outcome areas of interest. The effectiveness of these interventions highlights the viability of occupational therapy as an essential profession and the worth of occupational therapy to the public, potential clients, and payers.

Health Services Research and Occupational Therapy: Ensuring Quality and Cost-Effectiveness

“…Lockwood and Porter (2022) conducted a metaanalysis and found low-quality evidence that occupational therapy reduced 1-mo readmission rates among hospitalized adult clients compared with standard care. Two review articles (Feldhacker et al, 2022;Molitor et al, 2022) describe how occupational therapy interventions can improve client outcomes in areas aligned with the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 (Pub. L. 113-185).…”

“…L. 113-185). These reviews found mixed evidence for readmission prevention across chronic conditions (Molitor et al, 2022) and low strength of evidence to support occupational therapy interventions to reduce pressure ulcers or promote skin integrity (Feldhacker et al, 2022) This special issue also includes three articles consisting of secondary data analyses to examine relationships between occupational therapy care and quality outcomes. Kubiak and Sklar (2022) found that clients with spinal cord injury who exercised monthly had fewer hospital readmissions during the first year after discharge from inpatient rehabilitation than those who did not exercise.…”