Mandated Quality of Care Metrics for Medicare Patients: Examining New or Worsened Pressure Ulcers and Rehabilitation Outcomes in United States Inpatient Rehabilitation Facilities

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.

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Telepsychiatry Use in Rural Areas in the United States

Journal of Information Technology Research ◽

10.4018/jitr.2020100101 ◽

2020 ◽

Vol 13 (4) ◽

pp. 1-13

Author(s):

Alberto Coustasse ◽

Morgan Ruley ◽

Tonnie C. Mike ◽

Briana M. Washington ◽

Anna Robinson

Keyword(s):

Mental Health ◽

United States ◽

Quality Of Care ◽

Rural Areas ◽

Care Delivery ◽

Mental Healthcare ◽

Healthcare Services ◽

The United States ◽

Access And Quality

Rural areas have experienced a higher than average shortage of healthcare professionals. Numerous challenges have limited access to mental health services. Some of these barriers have included transportation, number of providers, poverty, and lack of insurance. Recently, the utilization of telepsychiatry has increased in rural areas. The purpose of this review was to identify and coalesce the benefits of telepsychiatry for adults living in rural communities in the United States to determine if telepsychiatry has improved access and quality of care. The methodology for this study was a literature review that followed a systematic approach. References and sources were written in English and were taken from studies in the United States between 2004 and 2018 to keep this review current. Fifty-nine references were selected from five databases. It was found that several studies supported that telepsychiatry has improved access and quality of care available in rural environments. At the same time, telepsychiatry in mental healthcare has not been utilized as it should in rural adult populations due to lack of access, an overall shortage of providers, and poor distribution of psychiatrists. There are numerous benefits to implementing telepsychiatry in rural areas. While there are still barriers that prevent widespread utilization, telepsychiatry can improve mental health outcomes by linking rural patients to high-quality mental healthcare services that follow evidence-based care and best practices. Telepsychiatry utilization in rural areas in the United States has demonstrated to have a significant ability to transform mental health care delivery and clinician productivity. As technology continues to advance access, telepsychiatry will also advance, making access more readily available.

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