Abstract WP188: Clinical Characteristics and Therapy Content of Stroke Patients admitted to Inpatient Rehabilitation Facility versus Skilled Nursing Facility

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
David J Lin ◽  
Chunyang Feng ◽  
Lesli E Skolarus ◽  
James F Burke
Keyword(s):  
Clinical Characteristics ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility

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.

Abstract P35: Mild or Improving Stroke is the Most Frequently Documented Reason for Not Giving rt-PA in Time-Eligible Acute Ischemic Stroke Patients: Findings From Get With the Guidelines-Stroke

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Eric E Smith ◽  
Gregg C Fonarow ◽  
Mathew J Reeves ◽  
Margueritte Cox ◽  
DaiWai Olson ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
National Study ◽  
Stroke Patients ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Poor Outcomes ◽  
Get With The Guidelines

Introduction: Previous studies suggest that mild or improving stroke is a frequently cited reason for not giving IV rt-PA and that some of these patients have poor outcomes. Methods: We examined the frequency of rt-PA use and contraindications among acute ischemic stroke patients arriving ≤2 hrs in the Get With The Guidelines-Stroke Program. Results: Between 4/1/2003-9/29/2009 there were 98,708 patients who arrived directly to the hospital within 2 hours. Among these patients 26.4% received IV rt-PA, 30.9% did not receive rt-PA solely because of mild/improving stroke, 28.6% had other contraindications, and 14.1% had no documented contraindications. From 2003-2009 rtPA use increased, the proportions not given rtPA despite no documented contraindications decreased, and the proportions with mild/improving stroke or other contraindications were similar (Figure). The initial NIH Stroke Scale (NIHSS) was recorded in 62.1% with mild/improving stroke and 82.3% given rt-PA; 75% of mild/improving stroke patients had NIHSS <5 while 90% of IV rt-PA-treated patients had NIHSS ≥5. Short-term outcomes in patients with mild/improving stroke were not always good: 1.1% died, 0.7% were discharged to hospice, 10.3% to a skilled nursing facility and 15.1% to an inpatient rehabilitation facility. Conclusion: In this large national study, mild/improving stroke is the most common reason for not giving rt-PA to early arriving patients. More patients are excluded because of mild/improving stroke than are treated with rt-PA. When deciding whether to withhold thrombolysis in patients with mild/improving stroke, clinicians should consider the risk of poor outcomes in this population.

Abstract TMP47: Impact of Medicare Reform on Inpatient Rehabilitation Facility Access for Hemorrhagic Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nneka L Ifejika ◽  
Farhaan Vahidy ◽  
Mathew Reeves ◽  
Xian Ying ◽  
Roland Matsouaka ◽  
...  
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Prospective Payment System ◽  
Sensitivity Analyses ◽  
Teaching Hospitals ◽  
Admission Criteria ◽  
Stroke Patients ◽  
Rehabilitation Facility ◽  
Inpatient Rehabilitation Facility ◽  
The Impact

Introduction: There is growing evidence that ICH patients make larger & faster recovery gains compared to ischemic stroke patients. Inpatient rehabilitation facility (IRF) care can significantly facilitate improvement. In 2010, changes to IRF admission criteria potentially restricted access. We hypothesize the Centers for Medicare and Medicaid Services (CMS) 2010 IRF Prospective Payment System Rule decreased IRF access & increased skilled nursing facility (SNF) utilization in ICH patients. Methods: The proportion of ICH survivors discharged to IRF, SNF or home was estimated using GWTG-Stroke data between 1/1/2008 & 12/31/2015 (n=265,444). Two binary hierarchical models determined the association between the 1/1/2010 CMS admission criteria change for IRFs and discharge setting, adjusting for patient & hospital characteristics. Subgroup analyses evaluated the effects of age, region & hospital type. Sensitivity analyses used complete NIHSS data (≈49%). Results: The prevalence of the 3 discharge destinations changed significantly over time (CMH row-mean-score P<0.0001; Figure 1). IRF rehab odds decreased and SNF rehab odds increased for ICH patients compared to home after the CMS 2010 IRF PPS Rule (Figure 2a & 2b). Decreased IRF rehab odds were found in patients age<65, Western US location or at non-teaching hospitals (Figure 2a). Increased SNF rehab odds were found in patients age≥65, Midwest location or at teaching hospitals (Figure 2b). Conclusions: IRF Rehab odds decreased and SNF rehab odds increased during the time period after CMS 2010 IRF PPS Rule implementation in ICH patients. The impact of such legislative changes on patient outcomes warrants further study.

scholarly journals The Clinical Utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) at a Long-Term Acute Care Hospital: A Prospective Cohort Study

2012 ◽  
Vol 92 (12) ◽  
pp. 1536-1545 ◽  
Author(s):  
Aaron Thrush ◽  
Melanie Rozek ◽  
Jennifer L. Dekerlegand
Keyword(s):  
Functional Status ◽  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Short Stay ◽  
Nursing Facility ◽  
Term Care ◽  
Skilled Nursing ◽  
Inpatient Rehabilitation Facility ◽  
Stay Hospital

Background and Purpose Long-term acute care hospitals (LTACHs) have emerged for patients requiring medical care beyond a short stay. Minimal data have been reported on functional outcomes in this setting. The purposes of this study were: (1) to measure the clinical utility of the Functional Status Score for the Intensive Care Unit (FSS-ICU) in an LTACH setting and (2) to explore the association between FSS-ICU score and discharge setting. Participants Data were obtained from 101 patients (median age=70 years, interquartile range [IQR]=61–78; 39% female, 61% male) who were admitted to an LTACH. Participants were categorized into 1 of 5 groups by discharge setting: (1) home (n=14), (2) inpatient rehabilitation facility (n=26), (3) skilled nursing facility (n=23), (4) long-term care/hospice/expired (n=13), or (5) transferred to a short-stay hospital (n=25). Methods Data were prospectively collected from a 38-bed LTACH in the United States over 8 months beginning in September 2010. Functional status was scored using the FSS-ICU within 4 days of admission and every 2 weeks until discharge. The FSS-ICU consists of 5 categories: rolling, supine-to-sit transfers, unsupported sitting, sit-to-stand transfers, and ambulation. Each category was rated from 0 to 7, with a maximum cumulative FSS-ICU score of 35. Results Cumulative FSS-ICU scores significantly improved from a median (IQR) of 9 (3–17) to 14 (5–24) at discharge. Median (IQR) cumulative discharge FSS-ICU scores were significantly different among the discharge categories: home=28 (22–32), inpatient rehabilitation facility=21 (15–24), skilled nursing facility=14 (8–21), long-term care/hospice/expired=5 (0–11), and transfer to a short-stay hospital=4 (0–7). Discussion and Conclusions Patients receiving therapy at an LTACH demonstrate significant improvements from admission to discharge using the FSS-ICU. This outcome tool discriminates among discharge settings and successfully documents functional improvements of patients in an LTACH setting.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document