Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study |
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| Authors: | Aileen Chou PT DPT Joshua K. Johnson DPT PhD Daniel B. Jones PhD Tracey Euloth MPT Beth A. Matcho PT Andrew Bilderback MS Janet K. Freburger PT PhD |
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| Affiliation: | 1. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;2. Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA;3. Graduate School of Public and International Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA;4. UPMC Rehabilitation Services, Pittsburgh, Pennsylvania, USA;5. Wolff Center, UPMC, Pittsburgh, Pennsylvania, USA |
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| 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. |
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| Keywords: | functional status measurement observational data/quasi-experiments aging/elderly/geriatrics health care organizations and systems rehabilitation services |
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