Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia

Question Is the amount of physical and occupational therapy received by patients with pneumonia associated with 30-day hospital readmission or death? Findings In this cohort study of 30746 patients with pneumonia or influenza-related conditions discharged from 12 acute care hospitals in western Pennsylvania, there was a significant inverse association between the amount of therapy received and the risk of 30-day hospital readmission or death. Meaning In this study, the amount of therapy received by patients with pneumonia or influenza-related conditions in the acute care setting was associated with decreases in the risk of 30-day hospital readmission or death. This cohort study evaluates whether the use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. Importance Pneumonia often leads to functional decline during and after hospitalization and is a leading cause of hospital readmissions. Physical and occupational therapists help improve functional mobility and may be of help in this population. Objective To evaluate whether use of physical and occupational therapy in the acute care hospital is associated with 30-day hospital readmission risk or death. Design, Setting, and Participants This cohort study included the electronic health records and administrative claims data of 30746 adults discharged alive with a primary or secondary diagnosis of pneumonia or influenza-related conditions from January 1, 2016, to March 30, 2018. Patients were treated at 12 acute care hospitals in a large health care system in western Pennsylvania. Data for this study were analyzed from September 2019 through March 2020. Exposures Number of physical and occupational therapy visits during the acute care stay categorized as none, low (1-3), medium (4-6), or high (>6). Main Outcomes and Measures Outcomes were 30-day hospital readmission or death. Generalized linear mixed models were estimated to examine the association of therapy use and outcomes, controlling for patient demographic and clinical characteristics. Subgroup analyses were conducted for patients older than 65 years, for patients with low functional mobility scores, for patients discharged to the community, and for patients discharged to a post-acute care facility (ie, skilled nursing or inpatient rehabilitation facility). Results Of 30746 patients, 15507 (50.4%) were men, 26198 (85.2%) were White individuals, and the mean (SD) age was 67.1 (17.4) years. The 30-day readmission rate was 18.4% (5645 patients), the 30-day death rate was 3.7% (1146 patients), and the rate of either outcome was 19.7% (6066 patients). Relative to no therapy visits, the risk of 30-day readmission or death decreased as therapy visits increased (1-3 visits: odds ratio, 0.98; 95% CI, 0.89-1.08; 4-6 visits: odds ratio, 0.89; 95% CI, 0.79-1.01; >6 visits: odds ratio, 0.86; 95% CI, 0.75-0.98). The association was stronger in the subgroup with low functional mobility and in individuals discharged to a community setting. Conclusions and Relevance In this study, the number of therapy visits received was inversely associated with the risk of readmission or death. The association was stronger in the subgroups of patients with greater mobility limitations and those discharged to the community.