Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions.

IMPORTANCE: Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. OBJECTIVE: To evaluate how acute occupational therapy service delivery factors affect readmission risk. DESIGN: Cross-sectional, retrospective study. SETTING: Single academic medical center. PARTICIPANTS: Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. RESULTS: Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). CONCLUSIONS AND RELEVANCE: For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy's role in the U.S. quality-focused health care system.

Race/Ethnicity and Retention in Traumatic Brain Injury Outcomes Research: A Traumatic Brain Injury Model Systems National Database Study.

OBJECTIVE: To investigate the contribution of race/ethnicity to retention in traumatic brain injury (TBI) research at 1 to 2 years postinjury. SETTING: Community. PARTICIPANTS: With dates of injury between October 1, 2002, and March 31, 2013, 5548 whites, 1347 blacks, and 790 Hispanics enrolled in the Traumatic Brain Injury Model Systems National Database. DESIGN: Retrospective database analysis. MAIN MEASURE: Retention, defined as completion of at least 1 question on the follow-up interview by the person with TBI or a proxy. RESULTS: Retention rates 1 to 2 years post-TBI were significantly lower for Hispanic (85.2%) than for white (91.8%) or black participants (90.5%) and depended significantly on history of problem drug or alcohol use. Other variables associated with low retention included older age, lower education, violent cause of injury, and discharge to an institution versus private residence. CONCLUSIONS: The findings emphasize the importance of investigating retention rates separately for blacks and Hispanics rather than combining them or grouping either with other races or ethnicities. The results also suggest the need for implementing procedures to increase retention of Hispanics in longitudinal TBI research.

Allegation of ethnic minorities from 1993-2008: an Equal Employment Opportunity Commission (EEOC) study.

BACKGROUND: Approximately 25% of working-aged Americans with disabilities work full or part time, yet still face discrimination despite the passing of the American's with Disabilities Act (ADA) over 20 years ago. OBJECTIVES: To determine if the proportion of allegations of ADA Title I workplace discrimination with merit closed at any year between 1993 and 2008 differs among Whites, African Americans, Hispanics, and Asians; to determine if there was a change over time from 1993 to 2008 in merit closure rate within each race/ethnicity group; and to determine whether changes over time between 1993 and 2008 in the merit closure rate differ among the race/ethnicity groups. METHODS: Logistic regression was used for this cross-sectional panel study to model the merit closure rate for each ethnic group from 1993 to 2008 using 318,587 charging parties from the EEOC database. RESULTS: All ethnic groups exhibited significant changes over time in the merit closure rate. There were significant differences in the closure rates among the race/ethnicity groups specifically at closure years 1995-2000, 2002, 2003, and 2006. Finally, there was evidence that the trends in merit closure rates over time differed significantly among the race/ethnicity groups. CONCLUSIONS: There was significant evidence that the proportion of claims closed with merit was significantly different among the racial/ethnicity groups.

Do racial/ethnic differences exist in post-injury outcomes after TBI? A comprehensive review of the literature.

PRIMARY OBJECTIVES: (1) To describe demographic and injury characteristics that are prominent among African Americans and Hispanics with TBI; (2) To determine if racial differences exist in regard to post-injury outcomes; (3) To highlight potential causes of racial/ethnic disparities in TBI rehabilitation and post-acute services; (4) To suggest recommendations to equalize outcomes; and stimulate future TBI research. METHODS AND PROCEDURES: Using MEDLINE, PyschINFO, CINAHL and InfoTrac databases, 39 peer-reviewed journal articles were found that met the following inclusion criteria: research studies that reported data for African Americans and Hispanics with TBI, outcomes from both primary and secondary analyses including paediatric patients with TBI and caregivers. MAIN OUTCOME AND RESULTS: African Americans and Hispanics have worse functional outcomes and community integration and are less likely to receive treatment and be employed than Whites post-TBI. Emerging research detects racial and ethnic differences in marital stability, emotional/neurobehavioural complications and QOL outcomes; however, more research is needed to corroborate significant findings. African American and Hispanic caregivers express more burden, spend more time in caregiving role, have fewer needs met and use different types of coping strategies than White counterparts. CONCLUSION: The racial and ethnic differences noted in this literature review are an indicator that minorities are at disproportionate risk for poorer outcomes. Post-acute interventions should specifically target minorities to diminish inequities that exist.