The impact of outpatient rehabilitation services on physical function and potential risk of unplanned healthcare utilization.

Abstract

e23142 Background: Unplanned healthcare use is associated with increased costs and poorer clinical outcomes, making it a critical target for oncology value-based care models. Poor physical function (PF) is an indicator of up to two-fold increased risk of unplanned healthcare use. Outpatient rehabilitation services are recommended to optimize PF, and as a result, could reduce risk of unplanned healthcare use. However, the paucity of data linking rehabilitation data with other health services data is a barrier to understanding the impact of rehabilitation on unplanned healthcare use. To approximate the impact of rehabilitation care, we compared PF scores of a large cohort seen in rehabilitation to the PF thresholds associated with increased risk of unplanned hospitalization. Methods: Rehabilitation medical record data was extracted for cases with breast, lung, colorectal, prostate, multiple myeloma, leukemia, and lymphoma who attended cancer rehabilitation 2022 to 2024, completed pre/post outcomes, and were identified as high risk for unplanned healthcare use at baseline (N = 1,185). High risk was identified as PROMIS-PF T-score < 35. Change in PF was examined using mixed-effect models adjusted for age, cancer type, surgery within two years, and time. Estimated marginal mean (EMM) change in PF was compared to the established minimal important change (MIC, 2 points). Unplanned healthcare risk reduction was determined as the proportion of cases with post-rehabilitation PF T-score above 35. Results: Cases were 63.91±12.75 years old, mostly female (78.1%) and 33.2% had received surgery in the past two years. Rehabilitation services were attended for a median of 8.72 weeks (IQR: 4.98 to 14.93). Common needs included: muscle weakness or atrophy (52.2%), limitations in daily activity or mobility (32.7%), pain (27.0%), lymphedema or edema (20.4%), musculoskeletal impairment or disorder (18.35%), fatigue (16.2%), and neuropathy (9.5%). PF scores improved significantly from pre- to post-rehabilitation ( p < .001). EMM change surpassed the MIC overall and for each diagnosis type (Table 1). Risk reduction ranged 42% (lung) to 72% (breast) by cancer type. Conclusions: PF improved significantly after rehabilitation, equating to 42% to 72% reduced risk of unplanned healthcare use by cancer type. By optimizing PF, integration of cancer rehabilitation services in value-based care models may reduce unplanned healthcare use. PF scores and estimated unplanned healthcare risk reduction. N Initial Final Change Estimated risk reduction Breast 725 31.14, 0.20 37.23, 0.20 6.09, 0.28 60.3% Colorectal 58 31.12, 0.73 37.97, 0.73 6.85, 1.01 72.4% Leukemia 52 28.56, 1.00 33.80, 1.00 5.23, 1.07 48.1% Lung 119 30.81, 0.58 35.42, 0.58 4.61, 0.65 42.0% Lymphoma 68 29.66, 0.89 35.17, 0.89 5.52, 0.87 50.0% Multiple myeloma 91 29.85, 0.74 36.27, 0.74 6.42, 0.75 59.3% Prostate 72 31.90, 1.24 37.44, 1.24 5.54, 0.97 59.7%