Key Points Question Is the amount of physical and occupational therapy received by patients with pneumonia associated with 30-day hospital readmission or death? Findings In this cohort study of 30 746 patients with pneumonia or influenza-related conditions discharged from 12 acute care hospitals in western Pennsylvania, there was a significant inverse association between the amount of therapy received and the risk of 30-day hospital readmission or death. Meaning In this study, the amount of therapy received by patients with pneumonia or influenza-related conditions in the acute care setting was associated with decreases in the risk of 30-day hospital readmission or death.

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Background Readmissions in patients with congestive heart failure are common and often preventable. Limited data suggest that patients discharged to a less intensive postacute care setting than recommended are likely to readmit. We examined whether postacute setting discordance (discharge to a less intensive postacute setting than recommended by a physical and occupational therapist) was associated with hospital readmission in patients with congestive heart failure. We also assessed sociodemographic and clinical predictors of setting discordance. Methods and Results Retrospective analysis of administrative claims and electronic health record data was conducted on 25 500 adults with a discharge diagnosis of congestive heart failure from 12 acute care hospitals in Western Pennsylvania. Generalized linear mixed models were estimated to examine the association between postacute setting discordance and 30‐day hospital readmission and to identify predictors of setting discordance. The 30‐day readmission and postacute setting discordance rates were high (23.7%, 20.6%). While controlling for demographic and clinical covariates, patients in discordant postacute settings were more likely to be readmitted within 30 days (adjusted odds ratio [OR], 1.12; 95% CI, 1.04–1.20). The effect was also seen in the subgroup of patients with low mobility scores (adjusted OR, 1.20; 95% CI, 1.08–1.33). Factors associated with setting discordance were lower‐income, higher comorbidity burden, therapist recommendation disagreement, and midrange mobility limitations. Conclusions Postacute setting discordance was associated with an increased readmission risk in patients hospitalized with congestive heart failure. Maximizing concordance between therapist recommended and actual postacute discharge setting may decrease readmissions. Understanding factors associated with post‐acute setting discordance can inform strategies to improve the quality of the discharge process.

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Objective To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. Data Sources EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017–February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019–July 2021). Study Design We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR‐PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30‐day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR‐PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. Data Extraction We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. Principal Findings In the PA hospitals, patients with EHR‐PT referrals had an 11.4 percentage‐point decrease in their 30‐day readmission or mortality rates (95% CI −0.57, −0.01) relative to the control. This effect was not observed in the OH hospitals for 30‐day readmission (β = 0.01; 95% CI −0.25, 0.26). Adults over 60 years old with EHR‐PT referrals in PA had a 26.2 percentage‐point (95% CI −0.88, −0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR‐PT referrals and hospital LOS in PA. Conclusions Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.