Saturday, June 22, 2024

Socioeconomic Factors Impact Rehabilitation Delivery in ICU Hospitalizations

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In a revealing cohort study published in JAMA Network Open, researchers have delved into the influence of social determinants of health (SDOH) on the provision of skilled rehabilitation services during intensive care hospitalizations among older adults. This study, which utilizes data from the National Health and Aging Trends Study linked with Medicare claims spanning 2011 to 2018, provides crucial insights into how socioeconomic factors could shape the delivery of essential rehabilitation services like physical therapy (PT) and occupational therapy (OT) in critical care settings.

Study Design and Demographics

The research targeted older adults who were hospitalized and required intensive care. Factors such as dual eligibility for Medicare and Medicaid, education levels, income brackets, English proficiency, and rural or urban residence were studied to assess their impact on rehabilitation services. Analysis covered a substantial sample of 1,618 ICU hospitalizations, noting that a significant portion of these patients faced socioeconomic disadvantages.

Rehabilitation Outcomes and Socioeconomic Disadvantages

Key findings indicated disparities in the delivery of PT and OT services, with only 68.5% of hospitalized patients receiving any form of these therapies. Notably, individuals with dual Medicare and Medicaid eligibility, as well as those residing in rural areas, showed lower odds of receiving PT or OT. Patients with limited English proficiency (LEP) experienced a notably lower rate of therapy delivery. The outcomes suggest that socioeconomic status and barriers directly correlate with the extent and quality of rehabilitation received during critical hospital stays.

Implications of Findings

• Dual eligibility for Medicare and Medicaid significantly lowers the likelihood of receiving PT or OT.
• Rural residence decreases access to in-hospital rehabilitation services.
• Limited English proficiency is linked to reduced rates of therapy delivery.

Conclusive Insights

The study underscores the need for healthcare policies and practices to recognize and address the influence of SDOH on rehabilitation services in ICU settings. It calls for further investigation into the factors leading to these disparities to enhance equity in healthcare delivery. By understanding and mitigating the impact of socioeconomic and demographic factors, healthcare providers can better tailor their services to meet the diverse needs of all patients, especially the socioeconomically disadvantaged.

Original Article: JAMA Netw Open. 2024 May 1;7(5):e2410713. doi: 10.1001/jamanetworkopen.2024.10713.

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