Occupational Therapy Utilization and Post-Acute Discharge Destination among Adults with Traumatic Brain Injury: The Mediating Effect of Changes in Activity Performance

Research Objectives Community discharge is viewed as a favorable outcome following acute care hospitalization. Occupational therapy (OT) utilization is associated with higher community discharges. However, patient-level factors that mediate the relationship between OT utilization and discharge disposition is not well-understood. We sought to investigate whether activities of daily living (ADL) performance change mediates the relationship between OT utilization and discharge destination among adults with TBI. Design In a secondary analysis of de-identified electronic health records data, we used path analysis to determine the relationship between 1) OT utilization and ADL performance change; 2) ADL performance change and discharge disposition; and 3) OT utilization and discharge disposition, while adjusting for ADL performance change. We calculated the indirect effect to examine whether ADL performance change mediated the relationship between OT utilization and discharge destination. Setting Five acute care hospitals within a single health system. Participants 435 adults who received OT services. Interventions None. Main Outcome Measures OT utilization units; Activity Measure for Post-Acute Care (AM-PAC) "6-Clicks"; Discharge disposition (community vs. institution). Results ADL performance improvement mediated the relationship between OT utilization and community discharge (OR= 0.80, p = .003). High OT utilization was associated with greater ADL performance improvement (β = 0.39, p Conclusions While improved ADL performance mediated the relationship between OT utilization and discharge disposition, the directionality of the relationship was unanticipated. Particularly, greater OT utilization was associated with greater ADL performance improvement, but such improvement was associated with lesser odds of community discharge. Results may inform efforts aimed at ensuring good quality of OT services delivered to individuals with TBI to maximize safe community discharge. Author(s) Disclosures None.