The Impact of Level of Physical Therapist Assistant Involvement on Patient Outcomes Following Stroke

2020 ◽  
Vol 100 (12) ◽  
pp. 2165-2173
Author(s):  
Jennifer Biggs
Keyword(s):  
Length Of Stay ◽  
Functional Outcome ◽  
Patient Outcomes ◽  
Physical Therapist ◽  
Inpatient Rehabilitation ◽  
Scoring Methods ◽  
Regression Analyses ◽  
Rehabilitation Facility ◽  
Physical Therapist Assistant ◽  
Discharge Location

Abstract Objective This study investigates if higher utilization of physical therapist assistants adversely affects patient outcomes in the acute rehabilitation setting for patients following a cerebrovascular accident (CVA). Methods Participants were admitted to 1 of 5 inpatient rehabilitation facilities following a CVA from 2008 to 2010. High physical therapist assistant use was defined as ≥20% of the physical therapist visits being provided by the physical therapist assistant for an episode of care. Multivariable regression techniques examined differences in functional outcome, discharge location, and length of stay between high and low physical therapist assistant use groups. Propensity scoring methods supplemented findings of the regression analyses. Results Of the 1561 participants, 496 (32%) had high physical therapist assistant involvement. Baseline participant characteristics such as age, sex, baseline motor function, and comorbidities did not differ between high and low physical therapist assistant use groups. After adjusting for patient characteristics, rehabilitation facility, and year, higher physical therapist assistant use did not adversely affect functional outcome or length of stay. Fewer conclusions can be drawn regarding discharge location, although there was no significant difference in discharge location between groups with high and low physical therapist assistant utilization. Propensity scoring methods supported the findings of the regression analyses. Conclusions Higher physical therapist assistant involvement in the rehabilitation of patients following CVA did not adversely affect functional outcome, increase length of stay, or reduce the likelihood of discharge to home from an inpatient rehabilitation facility. Impact The results demonstrate the value of the physical therapist assistant in the provision of physical therapy for patients with stroke in the inpatient rehabilitation setting. Higher involvement of the physical therapist assistant may provide cost savings while maintaining patient outcomes for this setting and population.

Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

PM&R ◽  
2013 ◽  
Vol 5 ◽  
pp. S235-S236
Author(s):  
Margaret A. DiVita ◽  
Michelle Camicia ◽  
Hua Wang ◽  
Jacqueline M. Mix ◽  
Paulette Niewczyk
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Stroke Patient ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

2016 ◽  
Vol 41 (2) ◽  
pp. 78-90 ◽  
Author(s):  
Michelle Camicia ◽  
Hua Wang ◽  
Margaret DiVita ◽  
Jacqueline Mix ◽  
Paulette Niewczyk
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Stroke Patient ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

Poster 53 Length of Stay at Inpatient Rehabilitation Facility and Stroke Patient Outcomes

2013 ◽  
Vol 94 (10) ◽  
pp. e30
Author(s):  
Michelle Camicia ◽  
Hua Wang ◽  
Margaret A. DiVita ◽  
Jacqueline Mix ◽  
Paulette Niewczyk
Keyword(s):  
Length Of Stay ◽  
Patient Outcomes ◽  
Stroke Patient ◽  
Inpatient Rehabilitation ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

scholarly journals CRITICAL ASPECTS OF MOBILITY FOR IMPROVING PATIENT OUTCOMES AFTER CARDIAC SURGERY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S472-S472
Author(s):  
Tiffany Tsay ◽  
Jennifer A Schrack ◽  
Allyse Depenbrock ◽  
Amal A Wanigatunga ◽  
Jacek Urbanek ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Functional Change ◽  
Post Surgery ◽  
Primary Mechanism ◽  
Discharge Location ◽  
Improve Patient ◽  
Post Cardiac Surgery ◽  
Critical Aspects

Abstract Physical activity after major cardiac surgery has been associated with length of stay, discharge location, risk of readmission, and functional change. However, in-hospital mobility is not currently assessed in a standardized way with nurse reports being the primary mechanism of tracking patient activity. Furthermore, it is unclear whether it is the total amount, frequency, or type of activity that is most important for improving patient outcomes post-surgery. To better understand the duration, frequency, and intensity of patient activity post-cardiac surgery, we conducted an observational study of 206 patients using a wrist-worn accelerometer and ankle-worn pedometer. Patients with lower levels of average daily pedometer-based ambulation in the first four days post-surgery, when compared to counterparts who ambulated more, had higher odds of a longer length of stay (OR=4.55, p<0.0001) or being discharged to rehab vs. home (OR=7.7 p=0.012), independent of age, race, bypass time, and EuroSCORE (cardiac surgery risk score). Engaging in an average of less than two bouts of accelerometer-derived activity lasting 5 minutes or more each day was associated with higher odds of having a longer length of stay (OR=2.69, p=0.008) or being discharged to rehab vs. home (OR=20.9, p=0.019). A slower speed of recovery during the first four postoperative days, characterized by a smaller increase in pedometer-based ambulation with each successive day, was also associated with higher odds of being discharged to rehab vs. home (OR=6.62, p=0.008). Further research is needed to develop appropriate frequency and activity thresholds for use as intervention tools to improve patient outcomes post-surgery.

scholarly journals Frequency of and Reasons for Unplanned Transfers From the Inpatient Rehabilitation Facility in a Tertiary Hospital

2020 ◽  
Vol 44 (2) ◽  
pp. 151-157
Author(s):  
Soobin Im ◽  
Da Young Lim ◽  
Min Kyun Sohn ◽  
Yeongwook Kim
Keyword(s):  
Infectious Disease ◽  
Length Of Stay ◽  
Acute Care ◽  
Inpatient Rehabilitation ◽  
Tertiary Hospital ◽  
Control Group ◽  
Surgical Department ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility ◽  
Transfer Group

Objective To characterize the patients in the inpatient rehabilitation facility who were transferred to acute care facilities and identify the frequency of and reasons for the unplanned transfer.Methods Medical records of patients admitted to the inpatient rehabilitation facility from October 2017 to December 2018 were reviewed. Patients were categorized according to their diagnoses. The included patients were divided into the unplanned transfer and control groups based on whether they required to transfer to another department for acute care before completing an uninterrupted rehabilitation course. The groups were compared in terms of sex, age, length of stay, admission sources, and disease groups. The reasons for unplanned transfers were classified based on medical or surgical conditions.Results Of the 1,378 patients were admitted to the inpatient rehabilitation facility, 1,301 satisfied inclusion criteria. Among them, 121 (9.3%) were unexpectedly transferred to the medical or surgical department. The unplanned transfer group had a higher age (69.54±12.53 vs. 64.39±15.32 years; p=0.001) and longer length of stay (85.69±66.08 vs. 37.81±31.13 days; p<0.001) than the control group. The top 3 reasons for unplanned transfers were infectious disease, cardiopulmonary disease, and orthopedic problem.Conclusion The unplanned transfer group had a significantly higher age and longer length of stay. The most common reason for the unplanned transfer was infectious disease. However, the proportions of those with orthopedic and neurological problems were relatively high. Therefore, further studies of these patient populations may help organize systematic strategies that are needed to reduce unplanned transfers to acute facilities for patients in rehabilitation facilities.

scholarly journals Shorter Length of Stay Is Associated With Worse Functional Outcomes for Medicare Beneficiaries With Stroke

2013 ◽  
Vol 93 (12) ◽  
pp. 1592-1602 ◽  
Author(s):  
Suzanne R. O'Brien ◽  
Ying Xue ◽  
Gail Ingersoll ◽  
Adam Kelly
Keyword(s):  
Length Of Stay ◽  
Confidence Interval ◽  
Inpatient Rehabilitation ◽  
Assessment Instrument ◽  
Medicare Beneficiaries ◽  
Patient Assessment ◽  
Rehabilitation Facility ◽  
Discharge Outcomes ◽  
Inpatient Rehabilitation Facility ◽  
Facility Level

BackgroundUnderstanding of the potential impact that length of stay (LOS) may have on Medicare beneficiaries' poststroke discharge function and discharge destination since implementation of a prospective payment system is lacking.ObjectiveThis study examined the trends and associations between LOS and discharge outcomes in Medicare beneficiaries with stroke treated in inpatient rehabilitation facilities (IRFs).DesignA serial, cross-sectional analysis of the Inpatient Rehabilitation Facility Patient Assessment Instrument dataset was conducted. The sample consisted of 371,211 patients with stroke who were over 65 years of age in all IRFs in the United States between January 1, 2002, and June 30, 2007.MethodsAnnual trends for means of LOS, admission and discharge Functional Independence Measure (FIM) scores, and percent community discharge were examined using generalized estimating equations (GEEs) with facility level control and post hoc testing. The association between discharge FIM scores and LOS was examined using a continuous, multivariate GEE model. The association between community discharge and LOS was examined using a logistic, multivariate GEE model.ResultsTime trends showed mean LOS decreased 1.8 days; admission and discharge FIM scores declined 4.4 points and 3.6 points, respectively; and mean community discharges declined 5.4%. Controlling for study year and covariates, each day was associated with an increase of 0.50 discharge FIM points (95% confidence interval=0.48, 0.52). Each day also was associated with a 0.3% decrease in odds of community discharge (95% confidence interval=0.994, 0.999).LimitationsReliability and validity of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) are lacking. Results may have been biased by a lack of control at the patient and facility levels.ConclusionsMedicare beneficiaries with stroke treated in IRFs experienced shorter LOS, had worsening admission and discharge function, and had fewer community discharges. Worsening admission function and shorter LOS may contribute to worsening discharge outcomes, which may indicate a lack of readiness for IRF treatment and that facility-level factors may be playing a role in shorter LOS.

Use of Damage Control and the Open Abdomen in Combat

2013 ◽  
Vol 79 (8) ◽  
pp. 747-753 ◽  
Author(s):  
Benjamin Bograd ◽  
Carlos Rodriguez ◽  
Richard Amdur ◽  
Fred Gage ◽  
Eric Elster ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Multivariate Regression ◽  
Injury Severity ◽  
Open Abdomen ◽  
Damage Control ◽  
Unit Length ◽  
Significant Risk ◽  
Hospital Length Of Stay ◽  
Study Cohort ◽  
Regression Analyses

Despite the well-documented use of damage control laparotomy (DCL) in civilian trauma, its use has not been well described in the combat setting. Therefore, we sought to document the use of DCL and to investigate its effect on patient outcome. Prospective data were collected on 1603 combat casualties injured between April 2003 and January 2009. One hundred seventy patients (11%) underwent an exploratory laparotomy (ex lap) in theater and comprised the study cohort. DCL was defined as an abbreviated ex lap resulting in an open abdomen. Patients were stratified by age, Injury Severity Score (ISS), Glasgow Coma Score (GCS), mechanism of injury, and blood product administration. Multivariate regression analyses were used to determine risks factors for intensive care unit length of stay (ICU LOS), hospital length of stay (HLOS), and the need for DCL. Mean age of the cohort was 24 ± 5 years, ISS was 21 ± 11, and 94 per cent sustained penetrating injury. Patients with DCL comprised 50.6 per cent (n = 86) of the study cohort and had significant increases in ICU admission ( P < 0.001), ICU LOS ( P < 0.001), HLOS ( P < 0.05), ventilator days ( P < 0.001), abdominal complications ( P < 0.05), but not mortality ( P = 0.65) compared with patients without DCL. When compared with the non-DCL group, patients undergoing DCL required significantly more blood products (packed red blood cells, fresh-frozen plasma, platelets, and cryoprecipitate; P < 0.001). Multivariate regression analyses revealed blood transfusion and GCS as significant risk factors for DCL ( P < 0.05). Patients undergoing DCL had increased complications and resource use but not mortality compared with patients not undergoing DCL. The need for combat DCL may be different compared with civilian use. Prospective studies to evaluate outcomes of DCL are warranted.

Sign in / Sign up

Export Citation Format

Share Document