Abstract
IMPORTANCE: Veterans with occupational performance (e.g., activities of daily living [ADL]) limitations who are receiving inpatient psychiatric care may benefit from outpatient occupational therapy upon discharge, but access disparities have not been investigated. OBJECTIVE: To investigate whether ADL limitations, an indicator of need, are associated with outpatient occupational therapy utilization after inpatient psychiatric hospitalization in the Veterans Health Administration (VHA) and whether this relationship differs by facility characteristics. DESIGN: Secondary analysis of VHA medical record data. Modified Poisson regression was used to model outpatient occupational therapy utilization (yes or no) as a function of ADL limitations, facility characteristics, and sociodemographic and clinical characteristics. Interactions were used to estimate whether the relationship between ADL limitations and outpatient occupational therapy utilization differs across facility characteristics. SETTING: VHA outpatient setting. PARTICIPANTS: Veterans who received VHA inpatient psychiatric care from 2015 to 2020 and lived ≥90 days after discharge (N = 117,679). INTERVENTION: None. OUTCOMES AND MEASURES: Outpatient occupational therapy utilization ≤90 days of inpatient psychiatric discharge. RESULTS: Only 13% of Veterans received outpatient occupational therapy services after discharge, and ADL limitations were not associated with receipt of occupational therapy. Veterans receiving care in facilities of lower complexity and those with greater care quality were more likely to receive occupational therapy. Black and Hispanic Veterans were less likely to receive occupational therapy. CONCLUSIONS AND RELEVANCE: Our findings suggest potentially unmet need for outpatient occupational therapy among Veterans discharged from VHA inpatient psychiatric care, laying the foundation for efforts aimed at promoting equitable access. Plain-Language Summary: This is the first study to examine potential disparities in access to outpatient occupational therapy services among Veterans recently discharged from Veterans Health Administration inpatient psychiatric care. The findings suggest a potentially unmet need for these beneficial services in this population. This study lays the foundation for scientific, clinical, and policy efforts aimed at promoting equitable access to outpatient occupational therapy services among Veterans in need, ensuring successful occupational performance and overall well-being among all members of this high-risk population.