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 from 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=4,859 in PA hospitals, n=1,749 in OH hospitals) who completed their inpatient stay.
PRINCIPAL FINDINGS
In the PA hospitals, patients with EHR-PT referrals had a 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. This article is protected by copyright. All rights reserved.