Occupational therapy in acute care: Predictors of occupational competence and hospital readmission

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PURPOSE: This dissertation explored predictors of occupational competence and hospital readmission for individuals with chronic health conditions in acute care. It also investigated occupational therapists’ perspectives on the implementation of standardized assessments in the hospital. METHODS: Individuals with an admitting diagnosis of Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Coronary Artery Bypass Graft, Total Hip Arthroplasty, Total Knee Arthroplasty, and Pneumonia (n = 52) were evaluated with measures of self-care function, environmental impact, functional cognition, and occupational competence. A phone call or medical records review was conducted 30-40 days after discharge to obtain hospital readmissions data. A feasibility group was conducted with occupational therapists who work in acute care (n = 3); they completed measures of assessment acceptability, appropriateness, and feasibility for the standardized assessments utilized in the study. RESULTS: Self-care function was a significant positive predictor of occupational competence (β = 0.43, p = 0.01), and environmental impact was a significant negative predictor (β = -0.38, p = 0.01) of occupational competence. These variables accounted for 24% of the variance in occupational competence. Occupational competence was a significant negative predictor of hospital readmission (OR = 0.81, p = 0.02), and functional cognition was a significant positive predictor of hospital readmission (OR = 2.19, p = 0.04). Relationships between other predictors and outcome variables failed to reach significance. Therapists rated the Activity Measure of Post-Acute Care (AM-PAC) as the most acceptable, appropriate, and feasible measure for acute care, but results should be interpreted with caution.
CONCLUSIONS: Self-care function and environmental impact predict occupational competence in individuals with chronic health conditions, whereas occupational competence and functional cognition predict hospital readmission for this population. These variables should be considered in occupational therapy evaluations and treatments to promote optimal client outcomes. Based on therapist perceptions, the AM-PAC may be a reasonable measure to assess outcomes in acute care. Results demonstrate that occupational therapists have the knowledge, skills, and tools needed to promote positive outcomes for individuals with chronic health conditions in acute care. Further research is needed to improve the generalizability of results and examine the efficacy of standardized measures in this setting.

Occupational therapy, Acute care, Occupational competence: Hospital readmission, The model of human occupation