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Are Social Determinants of Health Associated With Onset of Rehabilitation Services in Patients Hospitalized for
Rayyan A Bukhari1, James E Graham, Adam R Kinney
1Department of Occupational Therapy Colorado State University, Fort Collins, Colorado (Mr Bukhari and Dr Graham); Department of Occupational Therapy, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia (Mr Bukhari); VA Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, Colorado (Dr Kinney); Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora (Dr Kinney); UCHealth, University of Colorado Hospital, Anschutz Medical Campus, Aurora (Ms Hoffman); and Rocky Mountain University of Health Professions, Provo, Utah (Dr Malcolm).
Objective:
To examine the impact of community-level social determinants of health (SDoH) on the onset of occupational therapy (OT) and physical therapy (PT) services among individuals hospitalized for traumatic brain injury (TBI).
Setting:
14 acute care hospitals in the state of Colorado.
Participants:
We studied 5825 adults with TBI.
Design:
In a secondary analysis of de-identified electronic health record data, we performed multivariable logistic and linear regressions to calculate odds ratios (ORs) and 95% CIs for the likelihood of receiving services and duration to initiation of services among those who received them.
Main Measures:
Community-level SDoH, receipt of rehabilitation services, and onset of rehabilitation services.
Results:
Multivariable logistic and linear regressions revealed that those in top quartiles for community income were associated with duration to OT services, ranging from OR = 0.33 [05% CI, 0.07, 0.60] for quartile 2 to 0.76 [0.44, 1.08] for quartile 4 compared with those with the lowest quartile. Only the top quartile differed significantly for duration to PT services (0.63 [0.28, 0.98]). Relative to those with below the median community percentage of high school degree, those with above the median were associated with duration to PT services only (-0.32 [-0.60, -0.04]). Neither community percentage with bachelor's degree nor rural-urban designation was associated with duration to either therapy service.
Conclusion:
Further research is needed to determine whether our SDoH variables were too diffuse to capture individual experiences and impacts on care or whether community-level education and income, and rurality, truly do not influence time to therapy for patients hospitalized with TBI. Other, individual-level variables, such as age, comorbidity burden, and TBI severity, demonstrated clear relationships with therapy onset. These findings may help therapists evaluate and standardize equitable access to timely rehabilitation services.
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