Occupational Therapy Practitioners’ Role in Postacute Care Community Transition

PURPOSE: The goal of postacute care (PAC) is for the patient to return to a previous level of independence and transition back to the community to avoid long-term institutionalization and readmission into the health care system. However, there is large variation in discharge to community rates across PAC settings and poor transitions are common, resulting in readmissions. However, the recent passage of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 now marks PAC discharge to community as a reported quality measure that requires interdisciplinary collaboration. Given this context of recently implemented quality measures, occupational therapy (OT) practitioners must demonstrate their unique contribution to facilitating patients’ safe return to the community. Thus, the purpose of this study was to identify OT’s contribution in preparing patients for a successful transition to the community from PAC.

DESIGN: This study used a mixed-methods approach. Using purposive sampling, OT practitioners were recruited to participate in focus groups and interviews. Sampling was sought to maximize variation in experience, geographic region, and PAC setting. Additionally, a 2-yr (2013–2014) retrospective electronic medical record (EMR) cohort of all hip fracture PAC admissions to three PAC facilities was created to ascertain the frequency with which OT prioritized best practices were documented within a PAC rehabilitation stay.

METHOD: Six focus groups and one-on-one interviews were conducted with OT practitioners (N = 18). Procedures for analyzing the data were rooted in grounded theory. Strategies of rigor related to qualitative methods were used throughout the study. OT practitioners consistently discussed the importance of their role in preparing patients for their discharge home. Thus, a secondary analysis was conducted to identify their perspectives on facilitating a successful transition back to the community. The qualitative software ATLAS.ti (Berlin, Germany) was used to organize and facilitate data analysis. EMR data were extracted using REDCap (Nashville, TN), a web-based HIPAA-compliant database for data collection. Clinical notes for daily OT treatment sessions for a full PAC stay were evaluated for documentation of preparing patients for discharge (n = 77).

RESULTS: OT practitioners often described contributing to discharge planning through completing home safety evaluations, providing access to adaptive devices, instructing patients on how to navigate their home and community environment, training caregivers, and providing resources and supports for patients. However, EMRs commonly lacked discrete fields that captured any of the above best practices. If documented, these practices were found in narrative fields. Most of the content in EMR narrative fields included recommendations for durable medical equipment (n = 35) and home modifications (n = 23); there was only one record that documented the initiation of a conversation with patients regarding how to adapt and navigate their home and community environment after discharge.

CONCLUSION: Our findings demonstrate the unique contributions OT practitioners make to enhance successful community transitions. Yet, the EMRs did not capture the range of areas that OT practitioners address in planning a patient’s community discharge.

IMPACT STATEMENT: It is essential that OT practitioners demonstrate their value within PAC. In order to do this, practitioners must explicitly document their unique contribution, as well as its relationship to desired outcomes. This study highlights the gap in EMR documentation, whose setup may limit the ability to document said practices. Thus, OT best practices need to be integrated into documentation so the profession can demonstrate its unique contribution.

References

Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104–191, 42 U.S.C. § 300gg, 29 U.S.C §§ 1181–1183, and 42 U.S.C. §§ 1320d–1320d9.

Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, 128 Stat. 1952 et seq.