Therapy Decreases Readmission, Death for Pneumonia and Flu

Janet Freburger, PT, PhD

More therapy for patients with pneumonia or influenza (flu)-related conditions is associated with decreases in the risk of 30-day hospital readmission or death.

The findings added to the evidence on the effectiveness of therapy in the acute care setting for the treatment of pneumonia and flu-related conditions.

Janet Freburger, PT, PhD, and colleagues examined electronic health records (EHRs) and administrative claims data for a large healthcare system in western Pennsylvania to evaluate whether use of physical and occupational therapy in the acute care hospital was associated with 30-day hospital readmission risk or death. The team identified adults at least 18 years old who were discharged from 1 of 12 acute care hospitals with a primary or secondary diagnosis of pneumonia or flu-related conditions.

Billing data were examined to identify the number of physical and occupational therapy visits during the patient’s inpatient stay. Visits were categorized into 4 groups: no visits, 1-3 visits (low), 4-6 visits (medium), and more than 6 visits (high).

The investigators created a dichotomous outcome variable to indicate same-system hospital readmission within 30 days of discharge or death within 30 days or discharge with or without an in-system readmission.

Overall, the sample consisted of 30,746 adults with pneumonia or flu-related conditions who survived their inpatient stay. Discharge rates ranged from 849-4639 for the entire study period based on the hospital. There were almost equal men to women involved in the study.

Those who received therapy were more likely to be older and insured by Medicare than those who had no visits (mean age, 1-3 visits vs no visits: 70.3 years old vs 58.8 years old; insured by Medicare, 1-3 visits vs no visits: 65.5% vs 48.3%. Such patients also had longer stays (mean length of stay, 4-6 visits vs no visits: 8.2 days vs 5.3 days), were more likely to be in the intensive care unit (1-3 visits vs no visits: 26.6% vs 16.7%), had more comorbidities (mean Elixhauser comorbidity index, 1-3 visits vs no visits: 4.9 vs 1), and had greater illness severity (1-3 visits vs no visits with extreme illness severity: 25.4% vs 17.8%) and risk of mortality (1-3 visits vs no visits extreme risk of mortality: 20.7% vs 11.5%).

Unadjusted readmission and death rates increased with therapy use (30-day readmissions: 1-3 visits, 18.3%; 4-6 visits, 19.6%; more than 6 visits, 21.7%; death within 30 days: 1-3 visits, 3.9%; 4-6 visits, 4.2%; and greater than 6 visits, 5.3%).

Of the 39.2% discharged home, the team reported 18.4% of patients had an in-system hospital readmission in 30 days, 3.7% died within 30 days, and 19.7% had an in-system hospital readmission or died within 30 days.

Freburger and the investigators noted having at least 4 therapist visits compared with no visits was associated with a decreased risk of 30-day hospital readmission or death (1-3 visits: OR, .98; 95% CI, .89-1.08; 4-6 visits: OR, .89; 95% CI, .79-1.01; more than 6 visits: OR, .86; 95% CI, .75-.98). Such findings were statistically significant. The dose-response relationship was not statistically significant.

The study, “Variation in Acute Care Rehabilitation and 30-Day Hospital Readmission or Mortality in Adult Patients With Pneumonia,” was published online in JAMA Network Open.