Proposed Benefit of Increased Occupational Therapy Utilization to Decrease Hospital Readmissions of U.S. Veterans

PURPOSE: The purpose of this study was to formally investigate and identify trends among veterans at the Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) who received occupational therapy services compared with those who did not and their hospital readmission rate and to present recommendations for and benefits of effective use of occupational therapy services within the veteran population.

“Occupational therapy plays an important role in facilitating early mobilization, restoring function, preventing further decline, and coordinating care, including transition and discharge planning” (American Occupational Therapy Association [AOTA], 2012, para. 1). Additionally, occupational therapy’s holistic perspective seeks to assist individuals with a disability or deficit to regain functional independence, adapt their environment, or recover tasks to fit the needs of the person (AOTA, 2016).

The loss of independence within the veteran population is gravely devastating because veterans are often driven, resilient achievers and gain their self-identity from defending our country. “Although many service members easily adjust to life after deployment, others with and without injuries struggle to resume family life, work, and community engagement” (Radomski & Brininger, 2014, p. 379). Subsequently, the advancement of clinical care of the veteran population hinges on understanding the benefits of occupational therapy’s scope of practice.

METHOD: For this retrospective chart review design study, participants were 500 veterans admitted to MEDVAMC between January 2012 and January 2014. Data were collected through electronic medical records of veterans who were readmitted to Houston MEDVAMC within 90 days of initial discharge. This information was converted from raw data to an anonymous contrast and comparison of findings. Institutional review board approvals were obtained for this access and use of medical record data through Baylor College of Medicine, the University of St. Augustine for Health Sciences, and MEDVAMC Research and Development Committee.

RESULTS: Over half of these veterans (n = 262) were readmitted within 90 days, whereas the remainder (n = 238) were not readmitted in the time period reviewed. Of the veterans who were not readmitted within 90 days of discharge, approximately 25% (n = 60) received occupational therapy treatment and follow-up, whereas approximately 75% (n = 178) did not receive occupational therapy treatment or follow-up. Of the veterans who did experience readmission within 90 days of discharge from acute care, approximately 17.5% (n = 46) had received occupational therapy treatment and follow-up in acute care, whereas approximately 82.4% (n = 216) had not received occupational therapy services. In a final comparison, 25% of veterans who did not experience readmissions received occupational therapy services in acute care, whereas only 17.5% of veterans readmitted to MEDVAMC within 90 days received occupational therapy services. Occupational therapy services provided a 7% reduction in readmission rates of these veterans.

CONCLUSION: This study did not attempt to make a correlation between occupational therapy services and hospital readmissions but rather serves as a precursor to future research on the benefits of receiving occupational therapy in acute care. Barriers included lack of occupational therapy referrals and limited sample size, yielding small percentage differences. Occupational therapy intervention within 24 hours of admission promotes cost-effectiveness and functional outcomes. For example, average readmission cost per day for one patient is $2,732.67; with occupational therapy intervention, a 7% reduction in daily cost = $191.29, resulting in annual savings of $69,820.85 per veteran.

IMPACT STATEMENT: This study identified a need for continued research to make a comparison between hospital readmission rates and occupational therapy services for veterans in acute care.

References

American Occupational Therapy Association. (2012). Fact sheet: Occupational therapy’s role in acute care. Retrieved from http://www.aota.org/∼/media/Corporate/Files/AboutOT/Professionals/WhatIsOT/RDP/Facts/Acute-Care.pdf

American Occupational Therapy Association. (2016). What is occupational therapy? Retrieved from http://www.aota.org/conference-events/otmonth/what-is-ot.aspx

Carey, K., & Stefos, T. (2016). The cost of hospital readmissions: Evidence from the VA. Health Care Management Science, 19, 241–249. https://doi.org/10.1007/s10729-014-9316-9

Radomski, M. V., & Brininger, T. L. (2014). Occupational therapy for service member and veteran recovery, resilience, and reintegration: Opportunities for societal contribution and professional transformation. American Journal of Occupational Therapy, 68, 379–380. https://doi.org/10.5014/ajot.2014.013060