637 Disparities in Discharge Disposition: A Burn Model Systems National Database Study

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S163-S164
Author(s):  
Stephanie A Mason ◽  
Gretchen J Carrougher ◽  
Karen J Kowalske ◽  
Jeffrey C Schneider ◽  
Dagmar Amtmann ◽  
...  
Keyword(s):  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Model Systems ◽  
System Level ◽  
National Database ◽  
Discharge Destination ◽  
Post Discharge ◽  
Discharge Disposition ◽  
Discharge Care ◽  
Race Ethnicity

Abstract Introduction Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers. Methods Data were derived from the prospectively maintained Burn Model Systems national database. All participants admitted to one of five participating centers between 1994 and 2019, who survived to discharge with a known disposition, were included. The relationship between patient characteristics, injury factors and discharge to home, a skilled nursing facility (SNF), or inpatient rehabilitation was modeled using multinomial generalized estimating equations. Pre-specified stratified analyses were conducted to examine effect modification. Results We identified 4395 participants who met inclusion criteria. Participants were 74% White non-Hispanic (n=3269), 18% Black non-Hispanic (n=812), 3% Hispanic (n=122), 0.5% Asian (n=24), and 4% Other (n=168). Most were aged 18–64 years (68%, n=2998). Overall, 79% (n=3585) of participants were discharged home, 12% to inpatient rehabilitation (n=534), and 6% to SNF (n=276). After adjustment for patient characteristics and injury factors, there were no differences in discharge destination by race/ethnicity. However, subgroup analyses demonstrated effect modification by both center and burn size. At 2 centers, Black participants were significantly more likely to be discharged to SNF or inpatient rehabilitation (Center 1 OR 1.98, 95% CI 1.02–3.85; Center 2 OR 2.36, 95% CI 1.07–5.19). Similarly, among all participants with >20% TBSA, Black participants were more likely to be discharged to SNF or inpatient rehabilitation (OR 1.38, 95% CI 1.06–1.81). Across all groups, having insurance was associated with discharge to SNF or inpatient rehabilitation (OR 1.68, 95% CI 1.21–2.33). Conclusions Although no overall difference in discharge destination by race was identified, stratified analyses indicate disparities in discharge disposition at the patient and system level. At specific centers, and among those with >20% TBSA injury, Black participants are more likely to be discharged to SNF and inpatient rehabilitation than other ethnic groups. Applicability of Research to Practice Both patient and system level factors are associated with discharge to higher levels of post-discharge care, suggesting that further characterization of these factors is warranted. Such data can inform interventions and policy changes aimed at ensuring equitable access to appropriate post-discharge care.

Impact of Visual-Spatial Neglect on Stroke Functional Outcomes, Discharge Destination and Maintenance of Improvement Post-Discharge

2009 ◽  
Vol 72 (5) ◽  
pp. 219-225 ◽  
Author(s):  
Maria Stella Stein ◽  
David Maskill ◽  
Louise Marston
Keyword(s):  
Occupational Therapy ◽  
Functional Outcomes ◽  
Discharge Planning ◽  
Inpatient Rehabilitation ◽  
Functional Mobility ◽  
Spatial Neglect ◽  
Discharge Destination ◽  
Post Discharge ◽  
Visual Spatial

This study evaluated basic functional mobility in 25 patients with stroke and visual-spatial neglect during inpatient rehabilitation and early follow-up. Seven patients with neglect and 12 patients without neglect were discharged home and the rest to institutions. Patients without neglect achieved higher outcomes in a shorter time (mean 52 and 79 days respectively). All patients discharged home continued to improve at least up to 5 weeks post-discharge. The patients discharged to institutions achieved lower outcomes overall and quickly deteriorated to admission levels post-discharge. The results inform occupational therapy practice in the areas of assessment, discharge planning, destination and expected functional mobility outcomes in the community.

Abstract 2224: The Relationship Between Process and Outcomes for Stroke Post Prospective Payment in Inpatient Rehabilitation Facilities

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Suzanne R O'Brien ◽  
Gail Ingersoll ◽  
Ying Xue ◽  
Adam Kelly ◽  
Din Chen
Keyword(s):  
Inpatient Rehabilitation ◽  
Functional Independence ◽  
Assessment Instrument ◽  
Discharge Destination ◽  
Medicare Beneficiaries ◽  
Prospective Payment ◽  
Rehabilitation Facilities ◽  
Race Ethnicity ◽  
Stroke Type ◽  
The Relationship

Background and Objective: Previous studies have reported decreasing length of stay (LOS) for inpatient rehabilitation facilities (IRFs), with conflicting effects on discharge Functional Independence Measure (FIM) scores and discharge destination (DD). This study was the first to examine the post prospective payment system (PPS) period using Medicare data drawn from the national Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) database. The purposes were to examine trends over time for process and outcome factors, and to describe the relationships between process, LOS, and outcomes (discharge FIM scores and DD), for Medicare patients with stroke. Methods: The study included 371,211 Medicare Part A beneficiaries aged 65 and older with stroke, admitted to United States (US) IRFs between January 1, 2002 and June 30, 2007. Descriptive statistics and generalized estimating equations (GEE) modeling for clustered data were used for analysis. Continuous GEE evaluated LOS and discharge FIM scores, and binomial GEE evaluated LOS and DD (community verses institution). Covariates in models were: admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type. Time interactions with admission FIM scores, LOS, and discharge FIM scores (binomial model only) were examined. Results: During the study period, mean LOS decreased from 17.9 (SD=9.9) to 16.1(SD=8.3) days (p<. 0001), mean discharge FIM scores decreased from 80.1 (SD=24.5) to 76.5 (SD=24.5) points (p<. 0001), and rate of community discharge decreased from 66.6% to 61.2% (p<. 0001). LOS predicted discharge FIM scores (95% CI, .48, .52, p<.0001), but the relationship to community discharge was weak (OR .997, p=.007). Discharge FIM scores predicted discharge destination (OR 1.07, p<.0001). Covariates of admission FIM scores, age, gender, race/ethnicity, comorbidities, complications, and stroke type also predicted outcomes. Time interactions were present for LOS, admission FIM scores, and discharge FIM scores. Conclusions: During the first 5.5 years of PPS, declining trends were found for LOS, discharge FIM scores, and rate of community discharge for Medicare beneficiaries with stroke. LOS was a strong predictor for discharge FIM scores, but weak for DD. Discharge FIM scores were a better predictor of DD than LOS. Effects of covariates on discharge FIM scores and DD have clinical implications for IRF stroke rehabilitation in the US. Because of the reduced time for treatment, dose of IRF rehabilitation for Medicare beneficiaries may not be achieving expected results in the post-PPS period.

Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT

Gerontology ◽  
2020 ◽  
Vol 66 (6) ◽  
pp. 542-548
Author(s):  
Wendy L. Cook ◽  
Penelope M.A. Brasher ◽  
Pierre Guy ◽  
Stirling Bryan ◽  
Meghan G. Donaldson ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Geriatric Care ◽  
Small Sample ◽  
Community Dwelling ◽  
Post Discharge ◽  
Mobility Performance ◽  
Discharge Care ◽  
Comprehensive Geriatric Care

<b><i>Background:</i></b> Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. <b><i>Objective:</i></b> To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. <b><i>Methods:</i></b> A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3–12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0–12) at 12 months. <b><i>Results:</i></b> We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (<i>n</i> = 26) and usual care (UC, <i>n</i> = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI –0.3 to 2.0, <i>p</i> = 0.13). Adverse events were similar in the 2 groups. <b><i>Conclusion:</i></b> The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.

scholarly journals Real-World Utilization of Oral Anticancer Agents Costs in Older Adults with Metastatic Renal Cell Carcinoma in the United States

Kidney Cancer ◽  
2021 ◽  
pp. 1-13
Author(s):  
Lauren E. Wilson ◽  
Lisa Spees ◽  
Jessica Pritchard ◽  
Melissa A. Greiner ◽  
Charles D. Scales ◽  
...  
Keyword(s):  
United States ◽  
Anticancer Agents ◽  
Patient Characteristics ◽  
The United States ◽  
Socioeconomic Indicators ◽  
Economic Implications ◽  
Southern Us ◽  
Race Ethnicity ◽  
Nationally Representative ◽  
Oral Anticancer Agents

Background: Substantial racial and socioeconomic disparities in metastatic RCC (mRCC) have persisted following the introduction of targeted oral anticancer agents (OAAs). The relationship between patient characteristics and OAA access and costs that may underlie persistent disparities in mRCC outcomes have not been examined in a nationally representative patient population. Methods: Retrospective SEER-Medicare analysis of patients diagnosed with mRCC between 2007–2015 over age 65 with Medicare part D prescription drug coverage. Associations between patient characteristics, OAA receipt, and associated costs were analyzed in the 12 months following mRCC diagnosis and adjusted to 2015 dollars. Results: 2,792 patients met inclusion criteria, of which 32.4%received an OAA. Most patients received sunitinib (57%) or pazopanib (28%) as their first oral therapy. Receipt of OAA did not differ by race/ethnicity or socioeconomic indicators. Patients of advanced age (>  80 years), unmarried patients, and patients residing in the Southern US were less likely to receive OAAs. The mean inflation-adjusted 30-day cost to Medicare of a patient’s first OAA prescription nearly doubled from $3864 in 2007 to $7482 in 2015, while patient out-of-pocket cost decreased from $2409 to $1477. Conclusion: Race, ethnicity, and socioeconomic status were not associated with decreased OAA receipt in patients with mRCC; however, residing in the Southern United States was, as was marital status. Surprisingly, the cost to Medicare of an initial OAA prescription nearly doubled from 2007 to 2015, while patient out-of-pocket costs decreased substantially. Shifts in OAA costs may have significant economic implications in the era of personalized medicine.

106 Frailty Assessment in the Burn Population: A Single Center Retrospective Review

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S71-S72
Author(s):  
Erin Wolf Horrell ◽  
Ronnie Mubang ◽  
Sarah A Folliard ◽  
Robel Beyene ◽  
Stephen Gondek ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Level Of Care ◽  
Post Discharge ◽  
Patients Âgés ◽  
Injury Characteristics ◽  
Frail Patients ◽  
Discharge Care ◽  
Patients Experience

Abstract Introduction Burn morbidity and mortality increases with advancing age. Frailty is characterized by reduced homeostatic reserves and is associated with an increased biological age compared to chronological age. Our primary aim was to determine whether frailty as assessed on admission would be predictive of outcomes in the burn population. Methods We conducted a single institution 7-month retrospective chart review of all admitted acute burn patients ages 45 and older. Patient and injury characteristics were collected and compared using standard statistical analysis. Frailty scores were assessed upon admission using the FRAIL Scale. Results Eighty-five patients met inclusion criteria and were able to complete the FRAIL assessment. Patient and injury characteristics are listed in Table 1. Mean burn size was 6.7%TBSA (95%CI 4.9–8.4%). 34 patients (40%) were classified as robust (FRAIL score 0), 26(30.6%) as pre-frail (FRAIL score 1-Patients in the pre-frail/frail cohort received more palliative care consultations (p=.096) and had a longer length of stay (3.3d vs 7.55d p = .002), while prefrail patients had a similar LOS to frail patients (7.46 vs 7.64d p =.938). Patients in the pre-frail/frail cohort were also more likely to be discharged to a higher level of care than they were admitted from(p=.032) with prefrail patients experience an escalation in level of care more frequently than frail patients. The distribution by age by half-decade ranges is in Figure 1. By age 55–59, the majority of patients were prefrail or frail. Conclusions We demonstrated that frailty as assessed by the FRAIL score was predictive of increased length of stay and an escalation in post discharge care. In addition, patients characterized as pre-frail experience outcomes similar to frail patients and should be managed as such. Given the prevalence of frailty and prefrailty in the younger group of patients, we advocate for routine frailty screening beginning at age 55.

scholarly journals User-centered design of discharge warnings tool for colorectal surgery patients

2017 ◽  
Vol 24 (5) ◽  
pp. 975-980 ◽  
Author(s):  
Aanand D Naik ◽  
Molly J Horstman ◽  
Linda T Li ◽  
Michael K Paasche-Orlow ◽  
Bryan Campbell ◽  
...  
Keyword(s):  
Colorectal Surgery ◽  
Reading Level ◽  
Heuristic Evaluation ◽  
User Centered Design ◽  
Post Discharge ◽  
Patient Centered ◽  
Discharge Care ◽  
8Th Grade ◽  
Grade Reading Level ◽  
User Centered

Abstract Objectives: Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after colorectal surgery. Materials and Methods: User-centered design of a discharge warnings tool consisted of iterative health literacy review and a heuristic evaluation with human factors and clinical experts as well as patient end users to establish content validity and usability. Results: Literacy evaluation of the prototype suggested &gt;12th-grade reading level. Subsequent revisions reduced reading level to 8th grade or below. Contents were formatted during heuristic evaluation into 3 action-oriented zones (green, yellow, and red) with relevant warning lexicons. Usability testing demonstrated comprehension of this 3-level lexicon and recognition of appropriate patient actions to take for each level. Discussion: We developed a discharge warnings tool for colorectal surgery using staged user-centered design. The lexicon of surgical discharge warnings could structure communication among patients, caregivers, and clinicians to improve post-discharge care.

scholarly journals Racial Differences in Post-Acute Transition After Hip Fracture in Medicare Patients With ADRD

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 666-667
Author(s):  
Indrakshi Roy ◽  
Amol Karmarkar ◽  
Amit Kumar ◽  
Meghan Warren ◽  
Patricia Pohl ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Racial Differences ◽  
Home Health Care ◽  
Multinomial Logistic Regression ◽  
Skilled Nursing Facility ◽  
Ethnic Disparities ◽  
Inpatient Rehabilitation ◽  
Patient Characteristics ◽  
Nursing Facility ◽  
Skilled Nursing

Abstract The incidence of hip fractures in patients with Alzheimer’s disease and related dementias (ADRD) is 2.7 times higher than it is in those without ADRD. However, there are no standardized post-acute transition models for patients with ADRD after hip fracture. Additionally, there is a lack of knowledge on how post-acute transitions vary by race/ethnicity. Using 100% Medicare data (2016-2017) for 120,179 older adults with ADRD, we conduct multinomial logistic regression, to examine the association between race and post-acute discharge locations (proportion discharged to skilled nursing facility [SNF], inpatient rehabilitation facility [IRF], and Home with Home Health Care [HHC]), after accounting for patient characteristics. Compared to non-Hispanic Whites, Hispanics have a significantly lower odds ratio for discharge to HHC 0.62 (95%CI=0.53-0.73), IRF 0.44 (CI=0.39-0.51), and SNF 0.26 (CI=0.23-0.30). Improving care in patients with ADRD and reducing racial and ethnic disparities in quality of care and health outcomes will be discussed.

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