Racial Differences in Hospital-Associated Disability and Acute and Post-Acute Care Physical Therapy Utilization

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PROJECT SUMMARY Hospital-associated disability (HAD), defined as the new loss of ability to complete one or more activities of daily living without assistance at hospital discharge, occurs in nearly one-third of all hospitalized patients. HAD and low mobility during hospitalization are associated with readmissions, permanent disability, new institutionalization, death and escalating healthcare costs. While access to physical therapy (PT) is critical for functional improvement, my preliminary data from a single site suggests Black patients face disparities in both functional impairments and PT referrals. However, it is currently unclear whether this is true across sites, whether social vulnerability affects these outcomes, or why this occurs. Therefore, this proposal aims to characterize the association of Black race and social vulnerability with development of HAD and referral for acute and post-acute physical therapy across a set of Chicago area academic medical centers. I also aim to explore racial differences in perspectives on mobility loss and participation in PT. I hypothesize that Black race and social vulnerability are associated with HAD and physical rehabilitation use. I will test my hypothesis in three aims: Aim 1) I will assess differences, by race and Area Deprivation Index (ADI), a measure of social vulnerability, in HAD and inpatient physical therapy referrals in three academic medical centers across Chicago conferring a socioeconomically diverse patient sample; Aim 2) Across these medical centers, I will also determine differences by race and ADI, in rates of recommendation for discharge to post-acute care (PAC) facilties for PT and actual discharge to PAC facilities for PT when recommended; Aim 3) I will use qualitative methods to explore patients’ experiences with mobility loss and participation in PT during hospitalization; and interdisciplinary care team documentation for Black vs. White patients. My long-term goal is to develop a model to predict HAD risk and likelihood of benefit from skilled physical rehabilitation during hospitalization to reduce the burden of HAD on diverse populations of patients. To accomplish this, I have developed an exceptional interdisciplinary team of mentors (Drs. Meltzer, Arora, Lagu) and advisors (Drs. Peek, Chin, Jayaraman, Gibbons) who have a track record of NIH-funding and successful mentorship of early career investigators. I have formulated an in-depth career development plan to gain expertise in health disparities research (Chin, Peek, Meltzer), disability and physical rehabilitation in hospitalized patients, (Arora, Lagu, and Jayaraman), and incorporation of race and social determinants in statistical modeling to reduce bias (Gibbons, Peek, Chin). Completion of this proposal will train me to address each level of influence (individual, interpersonal, community, societal) within the “healthcare system” domain of influence outlined in the NIMHD’s research framework. Equipped with advanced skills and knowledge in health disparities research methodology and the role of race and racism in healthcare, I will be able to design unbiased risk prediction tools and physical rehabilitation protocols and lead their culturally-tailored implementation in diverse populations in future R01 level applications.