Developing a Referral Protocol for Community-Based Occupational Therapy Services in Taiwan: A Logistic Regression Analysis

• Published in: PloS one Vol. 11; no. 2; p. e0148414
• Main Authors: Mao, Hui-Fen, Chang, Ling-Hui, Tsai, Athena Yi-Jung, Huang, Wen-Ni, Wang, Jye
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.02.2016; Public Library of Science (PLoS)
• Subjects: Activities of Daily Living; Adult; Aged; Aged, 80 and over; Aging; Algorithms; Analysis; Area Under Curve; Biology and Life Sciences; Caregivers; Clients; Cognitive ability; Communities; Community; Community Health Services - organization & administration; Dementia; Dementia - physiopathology; Dementia disorders; Disabilities; Disabled people; Disabled Persons; Emotional behavior; Female; Gerontology; Health aspects; Health care; Health sciences; Humans; Intellectual disabilities; Logistic Models; Long term health care; Long-Term Care; Male; Mathematical models; Medical personnel; Medicine; Medicine and Health Sciences; Mental disorders; Mental Disorders - physiopathology; Middle Aged; Multivariate Analysis; Occupational therapy; Occupational Therapy - methods; Older people; People and Places; People with disabilities; Personal grooming; Physical therapy; Population; Prediction models; Quality of life; Range of Motion, Articular; Referral and Consultation; Regression analysis; Rehabilitation; Rehabilitation - methods; Reviews; ROC Curve; Skills; Society; Statistical analysis; Surveys; Taiwan; Therapy; Young Adult; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0148414

Because resources for long-term care services are limited, timely and appropriate referral for rehabilitation services is critical for optimizing clients' functions and successfully integrating them into the community. We investigated which client characteristics are most relevant in predicting Taiwan's community-based occupational therapy (OT) service referral based on experts' beliefs. Data were collected in face-to-face interviews using the Multidimensional Assessment Instrument (MDAI). Community-dwelling participants (n = 221) ≥ 18 years old who reported disabilities in the previous National Survey of Long-term Care Needs in Taiwan were enrolled. The standard for referral was the judgment and agreement of two experienced occupational therapists who reviewed the results of the MDAI. Logistic regressions and Generalized Additive Models were used for analysis. Two predictive models were proposed, one using basic activities of daily living (BADLs) and one using instrumental ADLs (IADLs). Dementia, psychiatric disorders, cognitive impairment, joint range-of-motion limitations, fear of falling, behavioral or emotional problems, expressive deficits (in the BADL-based model), and limitations in IADLs or BADLs were significantly correlated with the need for referral. Both models showed high area under the curve (AUC) values on receiver operating curve testing (AUC = 0.977 and 0.972, respectively). The probability of being referred for community OT services was calculated using the referral algorithm. The referral protocol facilitated communication between healthcare professionals to make appropriate decisions for OT referrals. The methods and findings should be useful for developing referral protocols for other long-term care services.