Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States

2018 ◽  
Vol 99 (6) ◽  
pp. 1060-1066 ◽  
Author(s):  
Laura Coots Daras ◽  
Melvin J. Ingber ◽  
Anne Deutsch ◽  
Jennifer Gaudet Hefele ◽  
Jennifer Perloff
Keyword(s):  
United States ◽  
Hospital Readmission ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Geographic Region ◽  
Rehabilitation Facilities ◽  
Profit Status

Abstract TP160: What Matters Most? Predictors of Poststroke Functional Outcomes From Inpatient Rehabilitation Facilities Across the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
James J García ◽  
Karlita L Warren ◽  
Fengmei Gong ◽  
Honggang Wang
Keyword(s):  
United States ◽  
Length Of Stay ◽  
Functional Outcomes ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Sociodemographic Factors ◽  
Administrative Database ◽  
Cross Sectional ◽  
Rehabilitation Facilities ◽  
Stroke Type

Introduction: Stroke is one of the leading cause of disability and death in the United States (Benjamin et al., 2018). Inpatient rehabilitation is the gold standard treatment for post-acute care (Weinstein et al., 2016). Data indicate a discharge to inpatient rehabilitation facilities (IRFs) following the acute stroke phase has increased (Buntin, Colla, & Escarce, 2009). The inpatient milieu provides a unique opportunity to examine predictors of functional outcomes using a captive sample. Thus, the current study aim is to identify factors associated with poststroke functional outcomes throughout inpatient rehabilitation. Method: This is a cross-sectional and retrospective analysis of data extracted from an administrative database during years 2005-2016 from 244,286 stroke patients across 30% of IRFs in the U.S. Inclusion criteria were patients at or above the age 18 with stroke as an admitting diagnosis using ICD 9/10 codes 430-438/I60-I69. Dependent variables were: admission Total FIM, Total FIM efficiency, discharge Total FIM, and length of stay (LOS). Results: Using separate regression analyses, marital status, admit year, type of admission, race/ethnicity, insurance type, sex, age, number of complications, number of comorbidities, and stroke type, emerged as significant predictors of functional outcomes throughout inpatient rehabilitation. Moreover, those with greater comorbidities and complications were associated with lower admission FIM total score, less total FIM efficiency, lower discharge FIM total score, and a longer LOS. Compared to NHWs, racial/ethnic people were associated with lower FIM scores throughout inpatient rehabilitation and a longer length of stay. Discussion: In this robust national dataset, data indicate clinical and sociodemographic factors are significantly associated with poststroke functional outcomes throughout inpatient rehabilitation. Implications are discussed within a framework of social determinants of health.

Limitation of Private Attending Pediatricians' Neonatal Intensive Care Privileges in Level III Institutions Throughout the United States

PEDIATRICS ◽  
1994 ◽  
Vol 94 (2) ◽  
pp. 190-193
Author(s):  
Rita G. Harper ◽  
Concepcion G. Sia ◽  
Regina Spinazzola ◽  
Raul A. Wapnir ◽  
Shahnaz Orner ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care ◽  
Health Care Providers ◽  
Curriculum Design ◽  
Neonatal Intensive Care ◽  
District Of Columbia ◽  
The United States ◽  
Geographic Region ◽  
Neonatal Intensive Care Units ◽  
Care Providers

Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small (≤10) as well as large (≥60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices.

scholarly journals FSMB Census of Licensed Physicians in the United States, 2018

2019 ◽  
Vol 105 (2) ◽  
pp. 7-23 ◽  
Author(s):  
Aaron Young ◽  
Humayun J. Chaudhry ◽  
Xiaomei Pei ◽  
Katie Arnhart ◽  
Michael Dugan ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Medical School ◽  
Census Data ◽  
Medical Schools ◽  
The United States ◽  
Geographic Region ◽  
Physician Workforce ◽  
Care Needs ◽  
State Medical Boards

ABSTRACT There are 985,026 physicians with Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO) degrees licensed to practice medicine in the United States and the District of Columbia, according to physician census data compiled by the Federation of State Medical Boards (FSMB). These qualified physicians graduated from 2,089 medical schools in 167 countries and are available to serve a U.S. national population of 327,167,434. While the percentage of physicians who are international medical graduates have remained relatively stable over the last eight years, the percentage of physicians who are women, possess a DO degree, have three or more licenses, or are graduates of a medical school in the Caribbean have increased by varying degrees during that same period. This report marks the fifth biennial physician census that the FSMB has published, highlighting key characteristics of the nation's available physician workforce, including numbers of licensees by geographic region and state, type of medical degree, location of medical school, age, gender, specialty certification and number of active licenses per physician. The number of licensed physicians in the United States has been growing steadily, due in part to an expansion in the number of medical schools and students during the past two decades, even as concerns of a physician shortage to meet health care demands persist. The average age of licensed physicians continues to increase, and more licensed physicians appear to be specialty certified, though the latter finding may reflect more comprehensive reporting. This census was compiled using the FSMB's Physician Data Center (PDC), which collects, collates and analyzes physician data directly from the nation's state medical and osteopathic boards and is uniquely positioned to provide a comprehensive snapshot of information about licensed physicians. A periodic national census of this type offers useful demographic and licensure information about the available physician workforce that may be useful to policy makers, researchers and related health care organizations to better understand and address the nation's health care needs.

Relationship of Exercise and Hospital Readmission After Spinal Cord Injury: A Secondary Analysis

2021 ◽  
Vol 76 (1) ◽  
Author(s):  
Stephanie Kubiak ◽  
Elliot Sklar
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hospital Readmission ◽  
Low Cost ◽  
Hospital Readmissions ◽  
Secondary Analysis ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Exercise Participation ◽  
Cord Injury

Importance: After spinal cord injury (SCI), as many as 45% of people experience at least one hospital readmission within 1 yr. Identification of feasible low-cost interventions to reduce hospital readmissions after SCI is needed. Objective: To explore whether a relationship exists between routine exercise and hospital readmission rates 1 yr after SCI. Design: We conducted a secondary analysis of data from the SCIRehab Project, a prospective cohort study. Setting: Five SCI inpatient rehabilitation facilities across the United States. Participants: Participants were people age 12 yr and older who had sustained an SCI, were admitted to a participating inpatient rehabilitation facility, completed the 12-mo postinjury interview, and reported exercising either monthly or not at all since discharge (N = 520). Outcomes and Measures: The SCIRehab Project conducted 12-mo post–inpatient rehabilitation discharge interviews. As part of the interviews, self-reported hospital readmissions and exercise frequencies since discharge (self-reported number of months, average days per week, and average minutes per day of exercise participation) were collected and analyzed. Results: A χ2 analysis determined that a significant correlation (φ = −.091, p = .038) exists between monthly exercise and hospital readmissions 1 yr postinjury. Compared with those who did not exercise, participants who exercised monthly had 8.4% fewer hospital readmissions. Conclusions and Relevance: A relationship exists between exercise and hospital readmission, but follow-up research is needed to determine whether regular exercise reduces hospital readmissions among this population. What This Article Adds: After discharge, 44% of the participants did not exercise during the first year after injury. Identifying or implementing accessible community exercise programs is an area of opportunity for occupational therapy practitioners and future researchers to explore.

scholarly journals Community-Acquired Pneumonia due to Streptococcus pneumoniae: When to Consider Coinfection with Active Pulmonary Tuberculosis

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Ruslan Garcia
Keyword(s):  
United States ◽  
Mycobacterium Tuberculosis ◽  
Streptococcus Pneumoniae ◽  
Pulmonary Tuberculosis ◽  
The United States ◽  
Geographic Region ◽  
Community Acquired Pneumonia ◽  
Radiographic Findings ◽  
Delay In Diagnosis ◽  
Active Pulmonary Tuberculosis

Community-acquired pneumonia (CAP) is an important cause of hospitalizations in adults. In the United States, Streptococcus pneumoniae is the most frequently identified bacterial pathogen responsible for CAP. Other etiologic pathogens of CAP vary based on the geographic region. Mycobacterium tuberculosis is an uncommon cause of CAP in the United States, while it is a principal cause in many African and Asian countries. Coinfection with Streptococcus pneumoniae and Mycobacterium tuberculosis is rare and has only been reported in the setting of underlying HIV infection in areas of high tuberculosis prevalence. Here, we report a case of CAP in the absence of HIV, where Streptococcus pneumoniae was identified on admission and delay in diagnosis of concomitant active pulmonary tuberculosis led to inappropriate isolation. In addition to a high index of suspicion, epidemiologic and radiographic findings can be helpful to recognize tuberculosis as a cause of CAP even when other pathogens have already been identified.

scholarly journals Analyzing academic mobility of U.S. professors based on ORCID data and the Carnegie Classification

2020 ◽  
Vol 1 (4) ◽  
pp. 1451-1467
Author(s):  
Erija Yan ◽  
Yongjun Zhu ◽  
Jiangen He
Keyword(s):  
United States ◽  
The United States ◽  
Open Science ◽  
Geographic Region ◽  
Science Data ◽  
Academic Mobility ◽  
Carnegie Classification ◽  
Research Intensity ◽  
Rural Institutions ◽  
Urban Institutions

This paper uses two open science data sources—ORCID and the Carnegie Classification of Institutions of Higher Education (CCIHE)—to identify tenure-track and tenured professors in the United States who have changed academic affiliations. Through a series of data cleaning and processing actions, 5,938 professors met the selection criteria of professorship and mobility. Using ORCID professor profiles and the Carnegie Classification, this paper reveals patterns of academic mobility in the United States from the aspects of institution types, locations, regions, funding mechanisms of institutions, and professors’ genders. We find that professors tended to move to institutions with higher research intensity, such as those with an R1 or R2 designation in the Carnegie Classification. They also tend to move from rural institutions to urban institutions. Additionally, this paper finds that female professors are more likely to move within the same geographic region than male professors and that when they move from a less research-intensive institution to a more research-intensive one, female professors are less likely to retain their rank or attain promotion.

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