Outpatient Physical Therapy Attendance by Older Adults After Emergency Department Discharge Was a Predictor for Lower 30-Day Revisits-But Demographic Factors Affected Attendance.

Abstract

Objective: Given the high risk of functional loss and revisits among older adults presenting to the emergency department (ED), there is a need to understand how post-ED discharge outpatient physical therapy affects outcomes. This study sought to examine patient demographics and their association with outpatient physical therapy utilization after ED discharge and physical therapy attendance with 30-day ED revisits among older adults discharged to home.

Methods: In this retrospective cohort study, we analyzed data from 1395 older adults (65 years old and older) who had a referral to outpatient physical therapy upon discharge from 15 EDs between January 2021 and December 2022. Descriptive statistics and multivariate logistic regression were used to evaluate the likelihood of attending outpatient physical therapy and the odds of a 30-day ED revisit.

Results: Of the sample, 39.3% attended outpatient physical therapy. Older adults in the first and second neighborhood income quintile had a 51% lower odds of attending outpatient physical therapy than those in the fourth quintile. Patients with a diagnosis of vertigo had a 67% higher odds of attending outpatient physical therapy (OR = 1.67; 95% CI = 1.21-2.29) than those with back pain. Older adults who did not attend outpatient physical therapy within 30 days of ED visit had a 88% higher odds of returning to the ED than those who did attend (OR = 1.88; 95% CI = 1.34-2.64). Older adults in the first and second income quintile had a 66% higher odds of revisiting the ED than those in the fourth quintile.

Conclusion: Outpatient physical therapy attendance after ED discharge was a predictor of revisit within 30 days. Patient diagnosis of vertigo and higher median household income were predictors of higher outpatient physical therapy attendance. However, a diagnosis of falls or mobility concerns and a lower household income status were associated with lower attendance.

Impact: Physical therapy after ED discharge has the potential to reduce 30-day ED revisit but requires strategies to improve access equity across diagnostic groups and household income levels.

Lay summary: This study found that outpatient physical therapy attendance after discharge from the ED was a predictor of lower ED revisits within 30 days among older adults. However, factors such as socioeconomic status, age, and diagnosis negatively affected the ability to attend physical therapy.