Association of AM-PAC “6-Clicks” Basic Mobility and Daily Activity Scores With Discharge Destination

2021 ◽  
Author(s):  
Meghan Warren ◽  
Jeff Knecht ◽  
Joseph Verheijde ◽  
James Tompkins
Keyword(s):  
Daily Activity ◽  
Physical Therapist ◽  
Multinomial Logistic Regression ◽  
Care Home ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Occupational Therapist ◽  
Good Prediction ◽  
Discharge Destination ◽  
Cut Point

Abstract Objective Using AM-PAC “6-Clicks” scores at initial physical therapist and/or occupational therapist evaluation to assess: (1) predictive ability for community versus institution discharge and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). Methods In this retrospective cohort study, initial “6-Clicks” Basic Mobility (6CBM) and/or Daily Activity (6CDA) t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between 10/1/15–8/31/18. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive 6CBM and 6CDA scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for 6CBM (≤40.78 vs > 40.78) and 6CDA (≤40.22 vs > 40.22), accounting for patient and clinical characteristics. Results Area under the curve (AUC) for 6CBM was 0.80 (95% CI = 0.80–0.81) and 6CDA was 0.81 (95% CI = 0.80–0.82). The best cut-point for 6CBM was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for 6CDA was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). 6CBM and 6CDA were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The 6CBM scores ≤ 40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5–1.9]), SNF (OR = 7.8 [95% CI = 6.8–8.9]), and IRF (OR = 7.5 [95% CI = 6.3–9.1]) 6CDA scores ≤ 40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7–2.0]), SNF (OR = 8.9 [95% CI = 7.9–10.0]), and IRF (OR = 11.4 [95% CI = 9.7–13.5]). Conclusions “6-Clicks” at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. Impact Initial 6CBM and 6CDA scores are valuable clinical tools in the determination of discharge destination.

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.

scholarly journals Race, Bundled Payment Policy, and Discharge Destination After TKA: The Experience of an Urban Academic Hospital

2018 ◽  
Vol 9 ◽  
pp. 215145931880322 ◽  
Author(s):  
Michele Fang ◽  
Eric Hume ◽  
Said Ibrahim
Keyword(s):  
African American ◽  
Elective Surgery ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Adverse Outcomes ◽  
Discharge Destination ◽  
Bundled Payment ◽  
Bundled Payments ◽  
Care Improvement ◽  
White Patients

Background: Total knee arthroplasty (TKA) provides good clinical outcomes for the treatment of end-stage osteoarthritis; however, discharge destination after TKA has major implications on postoperative adverse outcomes and readmissions. With the initiation of Bundled Payments for Care Improvement (BPCI), it is unclear how racial disparities in discharge destination after TKA will be affected by the new bundled payment for TKA. Methods: Bundled Payments for Care Improvement was implemented in July 01, 2014, at the University of Pennsylvania. We compared differences during early implementation (July 1, 2014, to, March 30, 2016) and during late policy implementation (April 1, 2016, to February 28, 2017) in patient characteristics (including race: African American [AA], white, and other race), discharge destination (skilled nursing facility [SNF], inpatient rehabilitation facility, home, home with home health, or other), and outcomes. Results: We identified 2276 patients who underwent TKA (43.8% AA, 48.2% white, and 8.0% other race). African American patients were more likely to be discharged to SNF as opposed to home than white patients both during the early BPCI (AA: 53.0%, n = 320; white: 32.4%, n = 210, P < .05) and late BPCI implementation (AA: 44.4%, n = 169, white: 26.9%, n = 120, P < .05), though all races showed trends to decreasing SNF use during the late BPCI implementation. Discussion: There were no significant differences in readmissions, length of stay, mortality, or intensive care unit days during early and late implementation of BPCI or when AA patients were compared to white patients. Conclusion: We found no significant changes in racial variations in discharge destination and outcomes after elective TKA. Bundled Payments for Care Improvement has encouraged better preoperative preparation of patients and discharge planning; however, payment reforms alone might not be sufficient to address variation in post-op management following elective surgery.

Comparative analysis of Medicare discharges following an acute inpatient hospitalization under MS-DRG 207

2014 ◽  
Vol 8 (4) ◽  
pp. 430-444
Author(s):  
Jared Frank ◽  
Muhiuddin Haider
Keyword(s):  
Comparative Analysis ◽  
Multinomial Logistic Regression ◽  
Skilled Nursing Facility ◽  
Secondary Data ◽  
Patient Discharge ◽  
Inpatient Rehabilitation ◽  
Fiscal Year ◽  
Provider Type ◽  
Inpatient Hospitalization ◽  
Content Type

Purpose – The purpose of this study is to conduct a comparative analysis of the Medicare patients discharged to a long-term (acute) care hospitals (LTCH), skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) following an acute inpatient hospitalization under Medicare-severity diagnosis-related group (MS-DRG) 207. The likelihood of discharge by provider type was also examined to determine criteria informing patient discharge to a LTCH, SNF or IRF for treatment. Design/methodology/approach – Retrospective cohort study, based on secondary data analysis, utilizing Medicare Provider Analysis and Review (MedPAR) File data collected by Centers for Medicare & Medicaid Services for fiscal year 2011, October 1, 2010, through September 30, 2011. Findings – Numerous analyses were conducted upon those patients discharged to a LTCH, SNF or IRF following an acute inpatient hospitalization under MS-DRG 207. Concerning those patients discharged to LTCHs, patients were not significantly older, did not have the highest length of stay and had comparable diagnoses and diagnosis counts to those discharged to SNFs or IRFs. However, costs were significantly higher among discharges to LTCHs. Multinomial logistic regression analyses also indicated numerous associations between certain variables and discharge location. Originality/value – With the aging of the US population and increasing costs of rendering services, both the Medicare population and Medicare expenditures, already at their highest levels in the history of the program, are projected to rise going forward (The Boards of Trustees, 2012). As such, recent research has focused on Part A hospitals/facilities and the variations in costs submitted and payments received for treatment/services provided. This study aims to address whether patients discharged to LTCHs, which receive higher payment(s) as a result of serving a higher proportion of medically complex beneficiaries, are more medically complex than those discharged to SNFs/IRFs.

scholarly journals Descriptive Data Analysis Examining How Standardized Assessments Are Used to Guide Post–Acute Discharge Recommendations for Rehabilitation Services After Stroke

2015 ◽  
Vol 95 (5) ◽  
pp. 710-719 ◽  
Author(s):  
Marghuretta D. Bland ◽  
Michelle Whitson ◽  
Hilary Harris ◽  
Jeff Edmiaston ◽  
Lisa Tabor Connor ◽  
...  
Keyword(s):  
Acute Care ◽  
Clustering Algorithm ◽  
Physical Therapist ◽  
Inpatient Rehabilitation ◽  
Occupational Therapist ◽  
Standardized Assessments ◽  
Rehabilitation Services ◽  
Care Hospital ◽  
Assessment Scores ◽  
Cluster A

BackgroundUse of standardized assessments in acute rehabilitation is continuing to grow, a key objective being to assist clinicians in determining services needed postdischarge.ObjectiveThe purpose of this study was to examine how standardized assessment scores from initial acute care physical therapist and occupational therapist evaluations contribute to discharge recommendations for poststroke rehabilitation services.Design&gt;A descriptive analysis was conducted.MethodsA total of 2,738 records of patients admitted to an acute care hospital with a diagnosis of stroke or transient ischemic attack were identified. Participants received an initial physical therapist and occupational therapist evaluation with standardized assessments and a discharge recommendation of home with no services, home with services, inpatient rehabilitation facility (IRF), or skilled nursing facility (SNF). A K-means clustering algorithm determined if it was feasible to categorize participants into the 4 groups based on their assessment scores. These results were compared with the physical therapist and occupational therapist discharge recommendations to determine if assessment scores guided postacute care recommendations.ResultsParticipants could be separated into 4 clusters (A, B, C, and D) based on assessment scores. Cluster A was the least impaired, followed by clusters B, C, and D. In cluster A, 50% of the participants were recommended for discharge to home without services, whereas 1% were recommended for discharge to an SNF. Clusters B, C, and D each had a large proportion of individuals recommended for discharge to an IRF (74%–80%). There was a difference in percentage of recommendations across the clusters that was largely driven by the differences between cluster A and clusters B, C, and D.LimitationsAdditional unknown factors may have influenced the discharge recommendations.ConclusionsParticipants poststroke can be classified into meaningful groups based on assessment scores from their initial physical therapist and occupational therapist evaluations. These assessment scores, in part, guide poststroke acute care discharge recommendations.

Robotic-assisted total hip arthroplasty: an economic analysis

2021 ◽  
Author(s):  
James Pierce ◽  
Keith Needham ◽  
Chris Adams ◽  
Andrea Coppolecchia ◽  
Carlos Lavernia
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Skilled Nursing Facility ◽  
Health Agency ◽  
Inpatient Rehabilitation ◽  
Cost Index ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Robotic Assisted ◽  
Total Hip

Aim: To evaluate 90-day episode-of-care (EOC) resource consumption in robotic-assisted total hip arthroplasty (RATHA) versus manual total hip arthroplasty (mTHA). Methods: THA procedures were identified in Medicare 100% data. After propensity score matching 1:5, 938 RATHA and 4,670 mTHA cases were included. 90-day EOC cost, index costs, length of stay and post-index rehabilitation utilization were assessed. Results: RATHA patients were significantly less likely to have post-index inpatient rehabilitation or skilled nursing facility admissions and used fewer home health agency visits, compared with mTHA patients. Total 90-day EOC costs for RATHA patients were found to be US$785 less than those of mTHA patients (p = 0.0095). Conclusion: RATHA was associated with an overall lower 90-day EOC cost when compared with mTHA. The savings associated with RATHA were driven by reduced utilization and cost of post-index rehabilitation services.

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