Read Full Text: Higher Hospital Spending on Occupational Therapy Is Associated with Lower Readmission Rates (Paid article, but we thought it was important to cover)
Journal: Medical Care Research and Review
Year Published: 2017
Ranked 77th on our 2015-2020 list of the 100 most influential OT-related articles
My first thought after I read this article was that I need to share it with our hospital’s CEO. (She’s awesome!)
My second thought was that every OT needs a copy of this article to display on their desk like an inspirational poster 
It’s that huge.
This is the largest (and most important, in my opinion) study we’ve examined so far in the Club. The authors looked at data from 1,194,251 Medicare patients, and they found that OT was the only category of spending where higher investment was associated with lower readmission rates across three different diagnoses: heart failure, pneumonia, and acute myocardial infarction
Let’s get the lay of the land and look at the two big-picture concepts that guided the authors in this article: social determinants of health and post-hospital syndrome.
Finally! We get to talk about social determinants of health!
If the phrase “social determinants of health” is new to you, don’t worry—the concept will be familiar. In fact, I would even say that other professions use the phrase “social determinants of health” when referencing what we OTs do.
Social determinants of health take into account the complex circumstances in which individuals live. It’s important that we recognize that these factors can impact people’s health. Knowing what kind of environment people to which people will discharge, and what their needs will be once they get there, is just as important as knowing their vital signs. Here is a nice overview of this concept, for further reading.
The authors of this article identified that OT affects both clinical determinants of health and social determinants of health.
For this particular study, the authors considered clinical determinants of health such as:
- Severity of illness
- Comorbidities
- Vitals
- Labs
- Functional status
They considered that social determinants of health can include the following factors:
- Sociodemographics (age, race, religion, gender)
- Socioeconomics (social support, financial health, housing situations)
- Behavioral factors
- Sociocognitive status
- Neighborhood characteristics
As you look at the lists above, you’ll see that traditional healthcare puts A LOT of focus on clinical determinants of health, but few professions bridge the two. (Hello, OT :-))
Also, every OT should know about “post-hospital syndrome.”
The second factor that guided the authors of this article is “post-hospital syndrome.”
Post-hospital syndrome refers to a period of time following discharge when a patient is particularly susceptible to certain risk factors, such as significant impairments in functional status, that can lead to rehospitalization.
Here’s a more recent article on post-hospital syndrome, and here’s another helpful read: “The illness is bad enough. The hospital may be even worse.”
I’m embarrassed to say that I’ve worked in a hospital and observed this phenomenon—but I never knew what it was called. Perhaps if I had, I would have had a better way to communicate the importance of OT.
Ok, now that we have the lay of the land—and we understand the big picture of what the authors were examining—we’re ready to look at this week’s article and see why OT is a worthwhile investment of hospital dollars.
What was the research question being studied in this trial?
Previous studies have looked at how increased spending impacts the quality of care provided by hospitals. But, there hasn’t been much research on whether increasing financial investment in specific healthcare categories makes a tangible difference in quality of care.
The authors expected that higher spending on occupational therapy would be associated with lower readmission rates. They presumed this would be the case because they recognized that OT affects both clinical determinants of health and social determinants of health—and they also understood that OT interventions can address post-hospital syndrome.
Who was included in this study?
The researchers decided to include patients who had been hospitalized for 3 different diagnoses, including:
- Heart failure
- Pneumonia
- Acute myocardial infarction
The researchers needed to compile spending data during patients’ hospitalizations and compare it to those same patients’ readmission rates. To do so, they looked specifically at Medicare patients, as their information was available through CMS Hospital Compare and Medicare Provider Analysis and Review (MedPAR).
Ultimately, the researchers pulled data from 1,194,251 patients from thousands of hospitals.
What spending categories did the researchers look at?
Here are the spending categories the researchers studied to see if increased investment in specific categories correlated with lower readmission rates.
- Accomodations
- Lab
- Pharmacy
- Medical/surgical supplies
- Cardiology
- Radiology
- Inhalation therapy
- Emergency room
- Operating room
- Other services
- Physical therapy
- Blood
- ESRD (dialysis)
- Occupational therapy
- Anesthesia
- Speech pathology
- Outpatient services
- Clinic visits
What were the results?
There was only one category where higher spending had a significant association with lower readmission rates, across all three diagnoses:
OCCUPATIONAL THERAPY!!
On average, OT only represented 0.3% of spending and the majority (72-79%) of patients did not receive it. (These two low numbers initially sound like bad news, but the authors see them as indicators of how increasing OT services is very achievable from a financial standpoint. In other words, even if hospital spending on OT was doubled, it wouldn’t significantly impact total hospital spending…but it would have the potential to prevent very costly readmissions!)
What did the authors conclude/discuss?
I’ll just go ahead and let the author’s own words sink in for you:
“We found that higher spending on OT services is a cost-effective approach to improving patient care and reducing readmissions, since OT has the potential to lower readmissions across multiple conditions without significantly increasing overall hospital spending.”
The authors discussed how OT focuses on a vital issue related to readmissions:
Can the patient safely discharge to his or her own home environment?
As stated above, we are uniquely poised to do this because we focus on function, and our holistic lens lends us to consider social determinants of health. Our care also uniquely addresses risk factors associated with post-hospitalization syndrome.
The authors go on to explore supporting research related to the role of OT, along with SIX of our interventions that potentially lower readmissions.
(Honestly, almost the whole discussion section is about OT—so, as much as I want to just quote the entire section, I’ll direct you to the article.)
Takeaways for OT practitioners
(These are my personal takeaways, and were not mentioned in the article.)
1.) Share this study with decision-makers to help explain our cost-effectiveness and value to patients.
Something that the coronavirus has taught me is that in times of change, we OTs need to be consistently and effectively communicating our value to policy-makers, leaders at our workplaces, and even our clients.
Studies like this make that job a whole lot easier
For those of you who work in acute and post-acute care, this article should absolutely be part of your toolkit. And, even if you are in another practice area, this article is still worth a full read, because it captures so nicely how our holistic lens makes a difference in the lives of our patients.
2.) We can also use this article to sharpen and simplify how we describe OT.
There will be times when we can share full research articles with decision-makers like I just mentioned—but, for the vast majority of our advocacy, we will need to simplify the findings and messages of this article.
The great part about this article, though, is that seeing “an outsider’s” perspective and description of OT gave me new insight into language that might be helpful in describing our wonderful profession. In fact, I just updated my “Guide to Occupational Therapy” to reflect language from this article, and I even linked to it in the intro!
3.) Take heart! The future is valued-based care, and this article establishes our place in that model.
I know we are living in uncertain times. I also don’t fully know how we will ever get out of these fee-for-service models that incentivize health care institutions to invest in the wrong kind of care.
But, I do believe we will see a massive shift toward value-based care in the next decades.
It only makes sense that we should be investing in cost-effective healthcare interventions that provide long-term outcomes for our patients. This is exactly what OTs strive to do each day, and I believe that we are poised to thrive in the new healthcare economy that is coming. So, even though today is rough, take heart and keep up the good work.
Listen to my takeaways in podcast form:
Find platforms for listening to the OT Potential Podcast here.
(Possibly) Earn CEUs/PDUs for reading this article.
Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.
And, here’s the full APA citation you many need:
Rogers, A. T., Bai, G., Lavin, R. A., & Anderson, G. F. (2016). Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates. Medical Care Research and Review, 74(6), 668–686. doi: 10.1177/1077558716666981