Examining the Relationship Between Home Care Rehabilitation Therapy Services and Healthcare Utilization Among Those with Multimorbidity in Ontario, Canada

Abstract

Individuals that experience multimorbidity are higher healthcare users and at an increased risk for poor health outcomes and functional decline. Rehabilitation therapists (occupational and physical therapists) can help these individuals with complex health challenges to address their functional needs and negotiate successful transitions in health care. Research was needed to determine the association between home care rehabilitation therapy and healthcare utilization outcomes. The overarching aim of this dissertation was to explore the association of home care rehabilitation therapy on unplanned acute health care utilization outcomes (i.e., hospitalizations and emergency department visits) for individuals with multimorbidity that were recently discharged from the hospital. This dissertation addresses this aim through three studies: a rapid review and two retrospective cohort studies. The rapid review synthesized the existing literature about home care rehabilitation therapy services for individuals with multimorbidity. The key findings from this review were that existing literature focused primarily on physical therapy interventions addressing functional impairment, and that system-level impact of therapeutic interventions was poorly addressed due to an emphasis in the literature on those with multimorbid musculoskeletal conditions. Studies two and three were retrospective cohort studies using health administrative data from ICES. In the first cohort study, we explored the association of home care rehabilitation therapy on healthcare utilization outcomes for individuals with multimorbidity that were recently discharged from an acute care hospital. In the second cohort study, this population was considered within the context of a discharge from an inpatient rehabilitation unit setting. The results of these two studies demonstrate that home care rehabilitation therapists are seeing clients that are medically complex (4+ chronic conditions), and require more help across areas of activities of daily living, cognition, and pain. Overall, there is a significant reduction in hospital readmission and emergency department use among those receiving rehabilitation therapy compared to those receiving other home care services, irrespective of discharge location. These findings suggest that rehabilitation therapists are instrumental in successful discharges to a home environment that benefit both the client and the healthcare system. These findings provide the foundation to explore the role of rehabilitation beyond single condition clinical guidelines.