HOME SWEET HOME: BREAKING DOWN BARRIERS IN PEDIATRIC HOME-BASED PHYSICAL THERAPY

Purpose/Hypothesis: To review the prevalence of missed homecare physical therapy (PT) visits and determine reason for these missed visits at a single center.

Number of Subjects: 234 unique children

Materials/Methods: A retrospective cohort study was completed to examine missed visit data of children receiving PT services through the homecare department of a large pediatric hospital in the Midwest. Data were extracted from the electronic health record of children receiving homecare PT from January 2022 to October 2022. Four researchers manually coded uncategorized reasons for missed visits into 11 main themes. Themes were attained following a combination of inductive and deductive coding. Consensus coding was performed for each missed visit reason by pairs of researchers. Where consensus was not met, a third reviewer provided tie-breaking input. Descriptive statistics summarized demographic data and reasons for missed visits.

Results: 5643 PT home visits were documented as attended and missed across 234 individual subjects. Overall, 27.9% (n=1575) of home PT visits were missed by 186 unique children who had an average age of 4.7 years (SD: 4.5 years). Children with missed visits were primarily of White race (39.8%), American ethnicity (75.3%), and had a primary neurological diagnosis (38.2%). Of the missed visits, the majority were missed due to therapist absence (25.4%), patient illness (not requiring hospitalization) (19.5%), family member illness (11.5%), and patient hospitalization (8.5%). Other reasons for missed visits included the child not being home (7.9%), unspecified reasons (5.9%), no-shows or unconfirmed appointments (3.8%), conflicting family member’s appointment (3.6%), patient sleeping (3.3%), and family observed holidays (2.7%).

Conclusions: This study highlights a substantial number of children miss home PT visits, with over one quarter of scheduled visits not being attended. Analysis of missed visit reasons highlighted that therapist absence, child illness, and family illness are the most common causes. These findings demonstrate the unique challenges faced in delivering consistent homecare PT services for children with medical complexity. Future work should aim to address these barriers which is essential to improving continuity of care and outcomes for children receiving home PT.

Clinical Relevance: Understanding the prevalence and underlying reasons for missed home PT visits is of great importance for healthcare providers and administrators. By identifying the primary factors contributing to missed home PT visits, targeted interventions can be developed to improve attendance and thereby ensure a more consistent delivery of PT services. Potential strategies may include improving therapist coverage, providing family support, and early detection of child illness through multidisciplinary collaboration. Enhancing the consistency of home PT services will benefit children by ensuring they receive the necessary dosage of therapy to support their development and wellbeing.