scholarly journals Are Stakeholder Prioritized Post-Acute Care Practices Documented and Do They Improve Outcomes?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 595-595
Author(s):  
Natalie Leland ◽  
Stephanie Rouch ◽  
Elizabeth Skidmore
Keyword(s):  
Acute Care ◽  
Medication Management ◽  
Hospital Readmissions ◽  
Inpatient Rehabilitation ◽  
Skilled Nursing ◽  
Caregiver Education ◽  
Assessment And Treatment ◽  
Acute Hospitals ◽  
Occupational And Physical Therapy ◽  
Post Acute Care

Abstract The receipt and intensity of rehabilitation services, such as occupational and physical therapy, have been associated with lower risk of readmissions. Yet, little is known about the care. This study quantified the frequency of documented post-acute care (PAC) stakeholder-prioritized practices and their associations with hospital readmissions. A PAC stakeholder advisory board (e.g., physicians, rehabilitation providers across settings) prioritized key practices to evaluate. Medicare claims and electronic medical records were used to construct an episode of care for patients age 65 or older. Eligible patients were discharged from one of nine acute hospitals to a PAC setting (i.e., inpatient rehabilitation, skilled nursing, home health) within one large health system between August 2016 and August 2018. Descriptive statistics characterized the cohort and frequency of documented practices. Logistic regression examined associations among the practices and readmissions, by setting. Stakeholders prioritized (a) education, (b) cognition assessment and treatment, and (c) medication management. Among these PAC patients (n=3,227) there was variation in documentation for each practice by setting. Documentation of medication management at any point during the stay ranged from less than 1% to 54% of patient stays among settings. There was a significant relationship between the practices and readmissions. Within inpatient rehabilitation, every additional day patient and caregiver education was documented by occupational therapy was associated with 21% lower odds of readmission (p<0.05). This study highlights the variability in documentation of stakeholder-prioritized practices across PAC and their associations with readmissions. Future work is needed to enhance the systematic delivery and documentation of these practices.

scholarly journals Post-acute care use patterns among Hospital Service Areas by older adults in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julianna M. Dean ◽  
Kimberly Hreha ◽  
Ickpyo Hong ◽  
Chih-Ying Li ◽  
Daniel Jupiter ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Service ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Service Area ◽  
Hospital Service ◽  
Medicare Beneficiaries ◽  
Skilled Nursing ◽  
Service Areas ◽  
Post Acute Care

Abstract Background Despite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use. Methods We extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients’ ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a “traveler”. We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived. Results Although 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding “travelers,” for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities. Conclusions Geographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries—the “traveler effect”.

Abstract 124: Post-acute Care Disposition To Home Or Acute Rehabilitation Helps Determine Favorable Clinical Outcome In The SENTIS Trial.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Samir R Belagaje ◽  
Kay Zander ◽  
Lisa Thackeray ◽  
Rishi Gupta
Keyword(s):  
Acute Stroke ◽  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Favorable Outcome ◽  
Stroke Severity ◽  
Skilled Nursing ◽  
Stroke Treatment ◽  
Discharge Disposition ◽  
Post Acute Care

Intro: A person with stroke has improved outcomes with post-acute care in an inpatient rehabilitation facility (IRF) or at home compared to those who are discharged to a skilled nursing facility (SNF). However, this research was conducted in an era before acute stroke treatment was fully developed and implemented. In this analysis of a recently completed acute intervention trial, we hypothesize that subjects with similar severity of strokes will have better 90 day outcomes if they are discharged to a IRF or home compared to a SNF. Methods: Using the data from SENTIS, a prospective, multi-center single-blind, randomized trial of use of NeuroFlo technology compared to standard acute stroke therapy, patient demographics, day 4 National Institutes of Health Stroke Scores (NIHSS), and 90 day modified Rankin scores (mRS) was obtained. Severity of stroke was classfied in 3 groups based on NIHSS: less than 8, 8-13, 14+. Disposition following acute hospital care was classified as home, IRF and SNF. A favorable outcome was defined as 90 day mRS ≤ 2. For each stroke severity class, the effect of each disposition on a favorable outcome was calculated. Results: A total of 292 patients were analyzed with a mean age of 65±14 with presenting NIHSS of < 8 in 94/297(31.6%), NIHSS 8-13 in 118/297(39.7%) and 14+ in 85/297(28.6%) of patients. Regardless of day 4 NIHSS, only 2 out of 28 (7.1%) patients who were discharged to SNF achieved a 90 day mRS ≤2, compared to 60/153 (39.2%) in the IRF group (OR 8.02 95%CI[1.83-35.11], p=0.0057). Table 1 shows the distribution of outcomes by post-acute care disposition and day 4 NIHSS. Conclusions: The day 4 NIHSS had an inverse relationship with the likelihood of a favorable outome. Subjects who were discharged home or to an IRF were significantly more likely to have a favorable outcome compared to those who were discharged to a SNF. This analysis supports prior data stating that discharge disposition plays a role in determining outcomes.

scholarly journals Impact of Self-Care and Mobility on One or More Post-Acute Care Transitions

2020 ◽  
Vol 32 (10) ◽  
pp. 1325-1334
Author(s):  
Chih-Ying Li ◽  
Amol Karmarkar ◽  
Yong-Fang Kuo ◽  
Allen Haas ◽  
Kenneth J. Ottenbacher
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Functional Score ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Rehabilitation Facilities ◽  
Inpatient Rehabilitation Facility ◽  
Post Acute Care

Objective: To investigate the association between functional status and post-acute care (PAC) transition(s). Methods: Secondary analysis of 2013–2014 Medicare data for individuals aged ≥66 years with stroke, lower extremity joint replacements, and hip/femur fracture discharged to one of three PAC settings (inpatient rehabilitation facilities, skilled nursing facilities, and home health agencies). Functional scores were co-calibrated into a 0–100 scale across settings. Multilevel logistic regression was used to test the partition of variance (%) and the probability of PAC transition attributed to the functional score in the initial PAC setting. Results: Patients discharged to inpatient rehabilitation facilities with higher function were less likely to use additional PAC. Function level in an inpatient rehabilitation facility explained more of the variance in PAC transitions than function level while in a skilled nursing facility. Discussion: The function level affected PAC transitions more for those discharged to an inpatient rehabilitation facility than to a skilled nursing facility.

scholarly journals Racial Disparities in 30-Day Outcomes Following Index Admission for COVID-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Vivek Nimgaonkar ◽  
Jeffrey C. Thompson ◽  
Lauren Pantalone ◽  
Tessa Cook ◽  
Despina Kontos ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Acute Care ◽  
Odds Ratio ◽  
Skilled Nursing Facility ◽  
Index Admission ◽  
Composite Outcome ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Black Patients ◽  
Post Acute Care

We investigated racial disparities in a 30-day composite outcome of readmission and death among patients admitted across a 5-hospital health system following an index COVID-19 admission. A dataset of 1,174 patients admitted between March 1, 2020 and August 21, 2020 for COVID-19 was retrospectively analyzed for odds of readmission among Black patients compared to all other patients, with sequential adjustment for demographics, index admission characteristics, type of post-acute care, and comorbidities. Tabulated results demonstrated a significantly greater odds of 30-day readmission or death among Black patients (18.0% of Black patients vs. 11.3% of all other patients; Univariate Odds Ratio: 1.71, p = 0.002). Sequential adjustment via logistic regression revealed that the odds of 30-day readmission or death were significantly greater among Black patients after adjustment for demographics, index admission characteristics, and type of post-acute care, but not comorbidities. Stratification by type of post-acute care received on discharge revealed that the same disparity in odds of 30-day readmission or death existed among patients discharged home without home services, but not those discharged to home with home services or to a skilled nursing facility or acute rehab facility. Collectively, the findings suggest that weighing comorbidity burdens in post-acute care decisions may be relevant in addressing racial disparities in 30-day outcomes following discharge from an index COVID-19 admission.

scholarly journals Quality of Post-Acute Care in Skilled Nursing Facilities That Disproportionately Serve Black and Hispanic Patients

2018 ◽  
Vol 74 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Maricruz Rivera-Hernandez ◽  
Momotazur Rahman ◽  
Dana B Mukamel ◽  
Vincent Mor ◽  
Amal N Trivedi
Keyword(s):  
Acute Care ◽  
Skilled Nursing Facilities ◽  
Nursing Facilities ◽  
Skilled Nursing ◽  
Hispanic Patients ◽  
Post Acute Care

Abstract WP356: Unbundling Care Transitions and Cost After Stroke: Results From the BPCI-Advanced Program

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Geri Sanfillippo ◽  
Brian Olkowski ◽  
Hermann Christian Schumacher ◽  
David Dafilou ◽  
Colleen Bowski ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Utilization ◽  
Care Coordination ◽  
Program Implementation ◽  
Care Transitions ◽  
Inpatient Rehabilitation ◽  
Hospital Length Of Stay ◽  
Early Supported Discharge ◽  
The Impact ◽  
Post Acute Care

Introduction: The Centers for Medicare and Medicaid Services bundled payment for care improvement advanced (BPCI-A) program incentivizes providers to better coordinate care, reduce expenses, and improve quality. The purpose of this study was to determine the impact of improving post-acute care coordination after stroke on quality and resource utilization in the BPCI-A program. Methods: Capital Health collaborated with post-acute providers to improve communication, identify criteria for early supported discharge to the community, expedite home health and outpatient services, reduce readmissions, and initiate advanced care planning. The redesigned post-acute care coordination program was implemented at Capital Health’s primary and comprehensive stroke center. Quality outcomes and resource utilization measures for patients enrolled in the BCPI-A program were compared to BPCI-A eligible patients prior to program implementation. Results: Forty-three patients enrolled in the BCPI-A program were compared to 77 patients eligible for enrollment. Clinical and demographic characteristics were similar (p>.05). After program implementation, 21.5% fewer patients were discharged to an inpatient rehabilitation facility (p=.024) and 14% more patients were discharged to inpatient hospice (p<.001). On average, post-acute cost decreased $16,608 per patient (p=.007) resulting in a $16,820 reduction in the 90-day cost per episode (p=.011). The 90-day hospital readmission rate decreased insignificantly by 14.1% from 23.4% to 9.3% (p=.056). Hospital cost, hospital length of stay and the 90-day mortality rate were unchanged (p>.05). Conclusion: The coordination of post-acute services facilitates care transitions after stroke. The identification of patients meeting criteria for early supported discharge to the community or admission to inpatient hospice helped reduce post-acute cost without increasing 90-day readmission or mortality.

scholarly journals Racial Differences in Post-Acute Utilization After Hip Fracture in Medicare Beneficiaries With ADRD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 59-59
Author(s):  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Amit Kumar ◽  
Meghan Warren ◽  
Patricia Pohl ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Racial Differences ◽  
Acute Care ◽  
Multinomial Logistic Regression ◽  
Ethnic Disparities ◽  
Inpatient Rehabilitation ◽  
Care Utilization ◽  
Racial Groups ◽  
Acute Care Utilization ◽  
Post Acute Care

Abstract BACKGROUND: The incidence of hip fracture in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. Care complexity, including extensive post-acute rehabilitation, increases substantially in patients with ADRD after hip fracture. However, there are no standardized post-acute care utilization models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute utilization varies by race/ethnicity, in this population. OBJECTIVES: To investigate racial differences in post-acute care utilization following hip fracture related hospitalization in patients with ADRD. METHODS: A secondary analysis was conducted on 120,179 older adults with ADRD with incident hip fracture, using 100% Medicare data (2016-2017). The primary outcome was post-acute discharge dispositions (skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home Health Care [HHC]) across various racial groups. Multinomial logistic regression examined the association between race and post-acute discharge dispositions after accounting for patient-level covariates. RESULTS: Compared to non-Hispanic Whites, minority racial groups have significantly lower odds of being discharged to SNF, IRF, or HHC, as compared to home. Adjusted odds ratio for Hispanics discharged to SNF was 0.28 (CI=0.24-0.31), to IRF was 0.46 (CI=0.39-0.52) and HHC was 0.64 (95% CI =0.54-0.75), as compared to home. CONCLUSION: ADRD patients have higher risk of hip fracture. Findings from this study will provide insight on how to reduce racial and ethnic disparities in post-acute care utilization in vulnerable populations and improve quality of care and health outcomes.

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