Examining the Relationship Between Home Care Rehabilitation Therapy Services and Healthcare Utilization Among Those with Multimorbidity in Ontario, Canada
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.009 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".