Daily Physical Therapy in the Hospital Reduces Need for Post-acute Care

Research Objectives: To determine the effect of physical therapy (PT) treatment frequency on discharge disposition among hospitalized adults.

Design: An emulated trial design comparing the effect of PT intensity on the risk of patient discharge to home vs. post-acute care (PAC). The risk of discharge to home under each PT intensity was estimated using a parametric g-computation approach that modeled the patient’s hospital stay including whether the patient remained in the hospital or was discharged on each day, the daily AM-PAC score, receipt of PT, daily JH-HLM score, and discharge location (models adjusted for baseline and prior days information). Using these models, we simulated 50 realizations of each patient’s hospitalization under the three physical therapy intensities; the estimated risk of discharge home is the proportion of patients across the 50 realizations that discharged home.

Setting: Acute hospitals in the Johns Hopkins Health System

Participants: Adult hospital patients with an AM-PAC raw score of 13-21 within 48 hours of admission and whom received at least one PT session.

Interventions: PT visit frequency defined as low ( < 3 per week), medium (3-5 per week) and high (6-7 per week)

Main Outcome Measures: Discharge disposition (Home vs. PAC)

Results: The study included 25,205 patients who were on average (standard deviation) 65 (16) years of age and majority female (52%) and white (58%). They were admitted to a medicine (50%), surgical science (21%), neuroscience (18%), oncology (5%), surgery (4%) or orthopedic (2%) unit. On average, patients received their first PT visit by day 4 (4) of hospitalization and spent 10 (5) days hospitalized. Sixty-four percent were discharged home. We estimated that if all patients had received low or medium PT intensity, 64% would be discharged home; whereas 71% would be discharged home if all were to receive high intensity PT.

Conclusions: We estimate an almost 7% increase in the proportion of people being discharged home if PT were to be provided 6 or 7 days a week for hospitalized adults. Therapy provided three days per week costs about $265, therefore six days a week would be an additional $265. The median cost for a PAC stay is between $9,034 and $11,073. If 7% fewer patients needed inpatient PAC, we could effectively reduce the net cost by between $367 and $510 per patient ([$9034 × 0.07] – $265 or [$11,073 × 0.07] – $265).

Author(s) Disclosures: none