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Mention de date : 2018
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Dépouillements
Ajouter le résultat dans votre panierEvolving Models of Rehabilitation-Related Patient Safety and Quality: PIECES / Bruce M. Gans in Archives of Physical Medicine and Rehabilitation, Vol. 99, n° 6 (2018)
Titre : Evolving Models of Rehabilitation-Related Patient Safety and Quality: PIECES Type de document : Article Auteurs : Bruce M. Gans Article en page(s) : p. 1033-1034 Langues : Anglais (eng) Descripteurs : HE Vinci
Qualité des soins de santé ; Rééducation et réadaptation ; Securité ; Soins de suiteMots-clés : Subacute Care Quality of Health Care Safety Résumé : A conceptual framework for measuring and reporting safety and quality in medical rehabilitation is described in this special communication. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1033-1034[article] Evolving Models of Rehabilitation-Related Patient Safety and Quality: PIECES [Article] / Bruce M. Gans . - p. 1033-1034.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1033-1034
Descripteurs : HE Vinci
Qualité des soins de santé ; Rééducation et réadaptation ; Securité ; Soins de suiteMots-clés : Subacute Care Quality of Health Care Safety Résumé : A conceptual framework for measuring and reporting safety and quality in medical rehabilitation is described in this special communication. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure Type de document : Article Auteurs : Poonam K. Pardasaney ; Anne Deutsch ; Jeniffer Iriondo-Perez Article en page(s) : p. 1035-1041 Langues : Anglais (eng) Descripteurs : HE Vinci
Autosoins ; Évaluation de résultat (soins) ; Patients hospitalisés ; Qualité des soins de santé ; Rééducation et réadaptationMots-clés : Inpatients Outcome Assessment (Health Care) Quality of health care Self care Résumé : Objective
To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016.
Design
Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF–Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability.
Setting
IRFs.
Participants
Medicare FFS patients aged ≥21 years (N=4769).
Interventions
Not applicable.
Main Outcome Measures
Facility-level discharge self-care quality measure performance score.
Results
A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged Conclusions
The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1035-1041[article] Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure [Article] / Poonam K. Pardasaney ; Anne Deutsch ; Jeniffer Iriondo-Perez . - p. 1035-1041.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1035-1041
Descripteurs : HE Vinci
Autosoins ; Évaluation de résultat (soins) ; Patients hospitalisés ; Qualité des soins de santé ; Rééducation et réadaptationMots-clés : Inpatients Outcome Assessment (Health Care) Quality of health care Self care Résumé : Objective
To describe the calculation and psychometric properties of the discharge self-care functional status quality measure implemented in the Centers for Medicare & Medicaid Services' (CMS) Inpatient Rehabilitation Facility (IRF) Quality Reporting Program on October 1, 2016.
Design
Medicare fee-for-service (FFS) patients from 38 IRFs that participated in the CMS Post-Acute Care Payment Reform Demonstration were included in this cohort study. Data came from the Continuity Assessment Record and Evaluation Item Set, IRF–Patient Assessment Instrument, and Medicare claims. For each patient, we calculated an expected discharge self-care score, risk-adjusted for demographic and baseline clinical characteristics. The performance score of each IRF equaled the percentage of patient stays where the observed discharge self-care score met or exceeded the expected score. We assessed the measure's discriminatory ability across IRFs and reliability.
Setting
IRFs.
Participants
Medicare FFS patients aged ≥21 years (N=4769).
Interventions
Not applicable.
Main Outcome Measures
Facility-level discharge self-care quality measure performance score.
Results
A total of 4769 patient stays were included; 57% of stays were in women, and 12.1% were in patients aged Conclusions
The discharge self-care quality measure showed strong discriminatory ability and reliability, representing an important initial step in evaluation of IRF self-care outcomes. A wide range in performance scores suggested a gap in quality of care across IRFs. Future work should include testing the measure with nationwide data from all IRFs.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Effect of Rehabilitation Intensity on Mortality Risk After Stroke Type de document : Article Auteurs : Cheng-Yang Hsieh ; Hsiu-Chen Huang ; Darren Philbert Wu Article en page(s) : p. 1042-1048 Langues : Anglais (eng) Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Mortalité ; Rééducation et réadaptationMots-clés : Mortality Stroke Résumé : Objective
To determine the relation between rehabilitation intensity and poststroke mortality.
Design
Retrospective cohort study.
Setting
Nationwide claims data.
Participants
From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.
Interventions
The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions.
Main Outcome Measures
Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.
Results
Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63–.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84–1.06) compared with the low-intensity group. This association was not modified by stroke severity.
Conclusions
Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1042-1048[article] Effect of Rehabilitation Intensity on Mortality Risk After Stroke [Article] / Cheng-Yang Hsieh ; Hsiu-Chen Huang ; Darren Philbert Wu . - p. 1042-1048.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1042-1048
Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Mortalité ; Rééducation et réadaptationMots-clés : Mortality Stroke Résumé : Objective
To determine the relation between rehabilitation intensity and poststroke mortality.
Design
Retrospective cohort study.
Setting
Nationwide claims data.
Participants
From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled.
Interventions
The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions.
Main Outcome Measures
Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates.
Results
Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63–.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84–1.06) compared with the low-intensity group. This association was not modified by stroke severity.
Conclusions
Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation Type de document : Article Auteurs : Laura Coots Daras ; Melvin J. Ingber ; Jessica Carichner Article en page(s) : p. 1049-1059 Langues : Anglais (eng) Descripteurs : HE Vinci
Patients hospitalisés ; Réadmission du patient ; Soins de suiteMots-clés : Inpatients Medicare Patient Readmission Subacute Care Résumé : Objective
To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs).
Design
Observational design.
Setting
Inpatient rehabilitation facilities.
Participants
Medicare fee-for-service beneficiaries (N=567,850 patient-stays).
Interventions
Not applicable.
Main Outcome Measures
The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission.
Results
The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%+3.5%, and the mean risk-standardized readmission rate was 13.1%+0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0+8.6 days and varied by rehabilitation diagnosis.
Conclusions
Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1049-1059[article] Evaluating Hospital Readmission Rates After Discharge From Inpatient Rehabilitation [Article] / Laura Coots Daras ; Melvin J. Ingber ; Jessica Carichner . - p. 1049-1059.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1049-1059
Descripteurs : HE Vinci
Patients hospitalisés ; Réadmission du patient ; Soins de suiteMots-clés : Inpatients Medicare Patient Readmission Subacute Care Résumé : Objective
To examine facility-level rates of all-cause, unplanned hospital readmissions for 30 days after discharge from inpatient rehabilitation facilities (IRFs).
Design
Observational design.
Setting
Inpatient rehabilitation facilities.
Participants
Medicare fee-for-service beneficiaries (N=567,850 patient-stays).
Interventions
Not applicable.
Main Outcome Measures
The outcome is all-cause, unplanned hospital readmission rates for IRFs. We adapted previous risk-adjustment and statistical approaches used for acute care hospitals to develop a hierarchical logistic regression model that estimates a risk-standardized readmission rate for each IRF. The IRF risk-adjustment model takes into account patient demographic characteristics, hospital diagnoses and procedure codes, function at IRF admission, comorbidities, and prior hospital utilization. We presented national distributions of observed and risk-standardized readmission rates and estimated confidence intervals to make statistical comparisons relative to the national mean. We also analyzed the number of days from IRF discharge until hospital readmission.
Results
The national observed hospital readmission rate by 30 days postdischarge from IRFs was 13.1%. The mean unadjusted readmission rate for IRFs was 12.4%+3.5%, and the mean risk-standardized readmission rate was 13.1%+0.8%. The C-statistic for our risk-adjustment model was .70. Nearly three-quarters of IRFs (73.4%) had readmission rates that were significantly different from the mean. The mean number of days to readmission was 13.0+8.6 days and varied by rehabilitation diagnosis.
Conclusions
Our results demonstrate the ability to assess 30-day, all-cause hospital readmission rates postdischarge from IRFs and the ability to discriminate between IRFs with higher- and lower-than-average hospital readmission rates.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States Type de document : Article Auteurs : Laura Coots Daras ; Melvin J. Ingber ; Anne Deutsch Article en page(s) : p. 1060-1066 Langues : Anglais (eng) Descripteurs : HE Vinci
Réadmission du patient ; Rééducation et réadaptation ; Soins de suiteMots-clés : Medicare Patient readmission Subacute care Résumé : Objective
To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions.
Design
Observational study.
Setting
IRFs.
Participants
Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs).
Interventions
Not applicable.
Main Outcome Measures
We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state).
Results
IRFs’ mean risk-standardized hospital readmission rate was 13.00%+0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (P<.001 we also found geographic variation: irfs in the south atlantic and central census regions had highest hospital readmission rates than did new england that lowest rates.> Conclusions
Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1060-1066[article] Geographic Region and Profit Status Drive Variation in Hospital Readmission Outcomes Among Inpatient Rehabilitation Facilities in the United States [Article] / Laura Coots Daras ; Melvin J. Ingber ; Anne Deutsch . - p. 1060-1066.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1060-1066
Descripteurs : HE Vinci
Réadmission du patient ; Rééducation et réadaptation ; Soins de suiteMots-clés : Medicare Patient readmission Subacute care Résumé : Objective
To examine whether there are differences in inpatient rehabilitation facilities' (IRFs') all-cause 30-day postdischarge hospital readmission rates vary by organizational characteristics and geographic regions.
Design
Observational study.
Setting
IRFs.
Participants
Medicare fee-for-service beneficiaries discharged from all IRFs nationally in 2013 and 2014 (N = 1166 IRFs).
Interventions
Not applicable.
Main Outcome Measures
We applied specifications for an existing quality measure adopted by Centers for Medicare & Medicaid Services for public reporting that assesses all-cause unplanned hospital readmission measure for 30 days postdischarge from inpatient rehabilitation. We estimated facility-level observed and risk-standardized readmission rates and then examined variation by several organizational characteristics (facility type, profit status, teaching status, proportion of low-income patients, size) and geographic factors (rural/urban, census division, state).
Results
IRFs’ mean risk-standardized hospital readmission rate was 13.00%+0.77%. After controlling for organizational characteristics and practice patterns, we found substantial variation in IRFs' readmission rates: for-profit IRFs had significantly higher readmission rates than did not-for-profit IRFs (P<.001 we also found geographic variation: irfs in the south atlantic and central census regions had highest hospital readmission rates than did new england that lowest rates.> Conclusions
Our findings point to variation in quality of care as measured by risk-standardized hospital readmission rates after IRF discharge. Thus, monitoring of readmission outcomes is important to encourage quality improvement in discharge care planning, care transitions, and follow-up.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries Type de document : Article Auteurs : Addie Middleton ; James E. Graham ; Kenneth J. Ottenbacher Article en page(s) : p. 1067-1076 Langues : Anglais (eng) Descripteurs : HE Vinci
Autosoins ; Mobilité réduite ; Réadmission du patient ; Rééducation et réadaptationMots-clés : Mobility limitation Patient readmission Self care Résumé : Objectives
To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.
Design
Retrospective cohort study.
Setting
Inpatient rehabilitation facilities submitting claims to Medicare.
Participants
National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1+7.6 years. Most were women (59.7%) and white (84.5%).
Interventions
Not applicable.
Main Outcome Measures
(1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions.
Results
The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3–3.5) versus 6.9% (95% CI, 6.7–7.1), mobility: 3.3% (95% CI, 3.2–3.4) versus 7.2% (95% CI, 7.0–7.4), and cognition: 3.5% (95% CI, 3.4–3.6) versus 6.2% (95% CI, 6.0–6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67–.74), mobility: .64 (95% CI, .61–.68), and cognition: .84 (95% CI, .80–.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).
Conclusions
Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1067-1076[article] Functional Status Is Associated With 30-Day Potentially Preventable Hospital Readmissions After Inpatient Rehabilitation Among Aged Medicare Fee-for-Service Beneficiaries [Article] / Addie Middleton ; James E. Graham ; Kenneth J. Ottenbacher . - p. 1067-1076.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1067-1076
Descripteurs : HE Vinci
Autosoins ; Mobilité réduite ; Réadmission du patient ; Rééducation et réadaptationMots-clés : Mobility limitation Patient readmission Self care Résumé : Objectives
To determine the association between patients' functional status at discharge from inpatient rehabilitation and 30-day potentially preventable hospital readmissions. A secondary objective was to examine the conditions resulting in these potentially preventable readmissions.
Design
Retrospective cohort study.
Setting
Inpatient rehabilitation facilities submitting claims to Medicare.
Participants
National cohort (N=371,846) of inpatient rehabilitation discharges among aged Medicare fee-for-service beneficiaries in 2013 to 2014. The average age was 79.1+7.6 years. Most were women (59.7%) and white (84.5%).
Interventions
Not applicable.
Main Outcome Measures
(1) Observed rates and adjusted odds of 30-day potentially preventable hospital readmissions after inpatient rehabilitation and (2) primary diagnoses for readmissions.
Results
The overall rate of any 30-day hospital readmission after inpatient rehabilitation was 12.4% (n=46,265), and the overall rate of potentially preventable readmissions was 5.0% (n=18,477). Functional independence was associated with lower observed rates and adjusted odds ratios for potentially preventable readmissions. Observed rates for the highest versus lowest quartiles within each functional domain were as follows: self-care: 3.4% (95% confidence interval [CI], 3.3–3.5) versus 6.9% (95% CI, 6.7–7.1), mobility: 3.3% (95% CI, 3.2–3.4) versus 7.2% (95% CI, 7.0–7.4), and cognition: 3.5% (95% CI, 3.4–3.6) versus 6.2% (95% CI, 6.0–6.4), respectively. Similarly, adjusted odds ratios were as follows: self-care: .70 (95% CI, .67–.74), mobility: .64 (95% CI, .61–.68), and cognition: .84 (95% CI, .80–.89). Infection-related conditions (44.1%) were the most common readmission diagnoses followed by inadequate management of chronic conditions (31.2%) and inadequate management of other unplanned events (24.7%).
Conclusions
Functional status at discharge from inpatient rehabilitation was associated with 30-day potentially preventable readmissions in our sample of aged Medicare beneficiaries. This information may help identify at-risk patients. Future research is needed to determine whether follow-up programs focused on improving functional independence will reduce readmission rates.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care Type de document : Article Auteurs : Janet K. Freburger ; Dongmei Li ; Anna M. Johnson Article en page(s) : p. 1077-1089 Langues : Anglais (eng) Descripteurs : HE Vinci
Continuité des soins ; Rééducation et réadaptationMots-clés : Continuity of patient care Occupational therapists Ergothérapeutes Physical therapists Kinésithérapeutes Résumé : Objective
To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.
Design
Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data.
Setting
Acute care hospital and community.
Participants
Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.
Interventions
Not applicable.
Main Outcome Measures
Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.
Results
Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.
Conclusions
Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1077-1089[article] Physical and Occupational Therapy From the Acute to Community Setting After Stroke: Predictors of Use, Continuity of Care, and Timeliness of Care [Article] / Janet K. Freburger ; Dongmei Li ; Anna M. Johnson . - p. 1077-1089.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1077-1089
Descripteurs : HE Vinci
Continuité des soins ; Rééducation et réadaptationMots-clés : Continuity of patient care Occupational therapists Ergothérapeutes Physical therapists Kinésithérapeutes Résumé : Objective
To identify predictors of therapist use (any use, continuity of care, timing of care) in the acute care hospital and community (home or outpatient) for patients discharged home after stroke.
Design
Retrospective cohort analysis of Medicare claims (2010–2013) linked to hospital-level and county-level data.
Setting
Acute care hospital and community.
Participants
Patients (N=23,413) who survived the first 30 days at home after being discharged from an acute care hospital after stroke.
Interventions
Not applicable.
Main Outcome Measures
Physical and occupational therapist use in acute care and community settings; continuity of care across the inpatient and home or the inpatient and outpatient settings; and early therapist use in the home or outpatient setting. Multivariate logistic and multinomial logistic regression analyses were conducted to identify hospital-level, county-level, and sociodemographic characteristics associated with therapist use, continuity, and timing, controlling for clinical characteristics.
Results
Seventy-eight percent of patients received therapy in the acute care hospital, but only 40.8% received care in the first 30 days after discharge. Hospital nurse staffing was positively associated with inpatient and outpatient therapist use and continuity of care across settings. Primary care provider supply was associated with inpatient and outpatient therapist use, continuity of care, and early therapist care in the home and outpatient setting. Therapist supply was associated with continuity of care and early therapist use in the community. There was consistent evidence of sociodemographic disparities in therapist use.
Conclusions
Therapist use after stroke varies in the community and for specific sociodemographic subgroups and may be underused. Inpatient nurse staffing levels and primary care provider supply were the most consistent predictors of therapist use, continuity of care, and early therapist use.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions Type de document : Article Auteurs : Tracy M. Mroz ; Ann Meadow ; Elizabeth Colantuoni Article en page(s) : p. 1090-1098 Langues : Anglais (eng) Descripteurs : HE Vinci
Qualité des soins de santé ; Recherche sur les services de santé ; Rééducation et réadaptation ; Services de soins à domicileMots-clés : Health services research Home care services Medicare Quality of Health Care Résumé : Objective
To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.
Design
Retrospective analysis.
Setting
Home health agencies.
Participants
Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.
Interventions
Not applicable.
Main Outcome Measures
Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.
Results
Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).
Conclusions
As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1090-1098[article] Home Health Agency Characteristics and Quality Outcomes for Medicare Beneficiaries With Rehabilitation-Sensitive Conditions [Article] / Tracy M. Mroz ; Ann Meadow ; Elizabeth Colantuoni . - p. 1090-1098.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1090-1098
Descripteurs : HE Vinci
Qualité des soins de santé ; Recherche sur les services de santé ; Rééducation et réadaptation ; Services de soins à domicileMots-clés : Health services research Home care services Medicare Quality of Health Care Résumé : Objective
To examine associations between organizational characteristics of home health agencies (eg, profit status, rehabilitation therapy staffing model, size, and rurality) and quality outcomes in Medicare beneficiaries with rehabilitation-sensitive conditions, conditions for which occupational, physical, and/or speech therapy have the potential to improve functioning, prevent or slow substantial decline in functioning, or increase ability to remain at home safely.
Design
Retrospective analysis.
Setting
Home health agencies.
Participants
Fee-for-service beneficiaries (N=1,006,562) admitted to 9250 Medicare-certified home health agencies in 2009.
Interventions
Not applicable.
Main Outcome Measures
Institutional admission during home health care, community discharge, and institutional admission within 30 days of discharge.
Results
Nonprofit (vs for-profit) home health agencies were more likely to discharge beneficiaries to the community (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.13–1.33) and less likely to have beneficiaries incur institutional admissions within 30 days of discharge (OR, .93; 95% CI, .88–.97). Agencies in rural (vs urban) counties were less likely to discharge patients to the community (OR, .83; 95% CI, .77–.90) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.24; 95% CI, 1.18–1.30) and within 30 days of discharge (OR, 1.15; 95% CI, 1.10–1.22). Agencies with contract (vs in-house) therapy staff were less likely to discharge beneficiaries to the community (OR, .79, 95% CI, .70–.91) and more likely to have beneficiaries incur institutional admissions during home health (OR, 1.09; 95% CI, 1.03–1.15) and within 30 days of discharge (OR, 1.17; 95% CI, 1.07–1.28).
Conclusions
As payers continue to test and implement reimbursement mechanisms that seek to reward value over volume of services, greater attention should be paid to organizational factors that facilitate better coordinated, higher quality home health care for beneficiaries who may benefit from rehabilitation.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder Type de document : Article Auteurs : Maya N. Hatch ; Jason Raad ; Katie Suda Article en page(s) : p. 1099-1107 Langues : Anglais (eng) Descripteurs : HE Vinci
Anciens combattants ; Rééducation et réadaptation ; Traumatismes de la moelle épinièreMots-clés : Dual use research Recherche à double usage Medicare Spinal cord injuries Veterans Résumé : Objective
To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D).
Design
Retrospective, cross-sectional, observational study.
Setting
Outpatient clinics and pharmacies.
Participants
Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits.
Interventions
Not applicable.
Main Outcome Measures
Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes.
Results
A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics.
Conclusions
Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1099-1107[article] Evaluating the Use of Medicare Part D in the Veteran Population With Spinal Cord Injury/Disorder [Article] / Maya N. Hatch ; Jason Raad ; Katie Suda . - p. 1099-1107.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1099-1107
Descripteurs : HE Vinci
Anciens combattants ; Rééducation et réadaptation ; Traumatismes de la moelle épinièreMots-clés : Dual use research Recherche à double usage Medicare Spinal cord injuries Veterans Résumé : Objective
To examine the different sources of medications, the most common drug classes filled, and the characteristics associated with Medicare Part D pharmacy use in veterans with spinal cord injury/disorder (SCI/D).
Design
Retrospective, cross-sectional, observational study.
Setting
Outpatient clinics and pharmacies.
Participants
Veterans (N=13,442) with SCI/D using Medicare or Veteran Affairs pharmacy benefits.
Interventions
Not applicable.
Main Outcome Measures
Characteristics and top 10 most common drug classes were examined in veterans who (1) used VA pharmacies only; (2) used both VA and Medicare Part D pharmacies; or (3) used Part D pharmacies only. Chi-square tests and multinomial logistic regression analyses were used to determine associations between various patient variables and source of medications. Patient level frequencies were used to determine the most common drug classes.
Results
A total of 13,442 veterans with SCI/D were analyzed in this study: 11,788 (87.7%) used VA pharmacies only, 1281 (9.5%) used both VA and Part D pharmacies, and 373 (2.8%) used Part D pharmacies only. Veterans older than 50 years were more likely to use Part D pharmacies, whereas those with traumatic injury, or secondary conditions, were less associated with the use of Part D pharmacies. Opioids were the most frequently filled drug class across all groups. Other frequently used drug classes included skeletal muscle relaxants, gastric medications, antidepressants (other category), anticonvulsants, and antilipemics.
Conclusions
Approximately 12% of veterans with SCI/D are receiving medication outside the VA system. Polypharmacy in this population of veterans is relatively high, emphasizing the importance of health information exchange between systems for improved care for this medically complex population.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults Type de document : Article Auteurs : Mohammad Auais ; Suzanne N. Morin ; Lois Finch Article en page(s) : p. 1108-1115 Langues : Anglais (eng) Descripteurs : HE Vinci
Qualité de vie ; Rééducation et réadaptationMots-clés : Cohort studies Études de cohortes Quality of Life Hip Fractures Fractures de la hanche Recovery of function Récupération fonctionnelle Résumé : Objectives
To examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using 2 different definitions of recovery.
Design
Inception cohort with 8 assessments over 1 year.
Setting
Participants were recruited from a tertiary-care hospital and followed up in the community.
Participants
Community-dwelling hip fracture patients (N=47, 75% of all eligible; aged ≥65y).
Interventions
Not applicable.
Main Outcome Measures
Prefracture functional level was used to identify subgroups of participants with similar trajectories of mobility over time. Recovery in functional mobility was defined in 2 ways: the “traditional” definition (return to prefracture level of functional mobility) and a “targeted recovery” definition (ability to climb 10 steps). Both were measured using the Lower Extremity Functional Scale. HRQL was measured using the RAND 36-Item Short-Form Health Survey.
Results
Participants were categorized into 3 subgroups with: low, medium, and high prefracture functional abilities. Agreement between the 2 definitions of recovery (quantified using κ coefficient) was strong for the medium group (.81; 95% confidence interval, .56–1.00), weak for the high group (.46; 95% confidence interval, 0.0–.99), and minimal for the low group (.12; 95% confidence interval, 0.0–.328). Contrary to the traditional definition, patients who achieved targeted recovery had statistically and clinically better HRQL than the rest of the cohort throughout the study (estimated average difference of 10.8 points on RAND 36-Item Short-Form Health Survey; 95% confidence interval, 6.67–15.07).
Conclusions
The agreement between the 2 definitions of recovery ranged from minimal to strong according to patient group. Using a functional target to define recovery predicted HRQL better. It is vital to consider the definition of recovery carefully for research or clinical practice because it can influence subsequent decisions (eg, endorsing a specific intervention or discharging patients).Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1108-1115[article] Toward a Meaningful Definition of Recovery After Hip Fracture: Comparing Two Definitions for Community-Dwelling Older Adults [Article] / Mohammad Auais ; Suzanne N. Morin ; Lois Finch . - p. 1108-1115.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1108-1115
Descripteurs : HE Vinci
Qualité de vie ; Rééducation et réadaptationMots-clés : Cohort studies Études de cohortes Quality of Life Hip Fractures Fractures de la hanche Recovery of function Récupération fonctionnelle Résumé : Objectives
To examine the course of recovery and resulting health-related quality of life (HRQL) after low-trauma hip fracture using 2 different definitions of recovery.
Design
Inception cohort with 8 assessments over 1 year.
Setting
Participants were recruited from a tertiary-care hospital and followed up in the community.
Participants
Community-dwelling hip fracture patients (N=47, 75% of all eligible; aged ≥65y).
Interventions
Not applicable.
Main Outcome Measures
Prefracture functional level was used to identify subgroups of participants with similar trajectories of mobility over time. Recovery in functional mobility was defined in 2 ways: the “traditional” definition (return to prefracture level of functional mobility) and a “targeted recovery” definition (ability to climb 10 steps). Both were measured using the Lower Extremity Functional Scale. HRQL was measured using the RAND 36-Item Short-Form Health Survey.
Results
Participants were categorized into 3 subgroups with: low, medium, and high prefracture functional abilities. Agreement between the 2 definitions of recovery (quantified using κ coefficient) was strong for the medium group (.81; 95% confidence interval, .56–1.00), weak for the high group (.46; 95% confidence interval, 0.0–.99), and minimal for the low group (.12; 95% confidence interval, 0.0–.328). Contrary to the traditional definition, patients who achieved targeted recovery had statistically and clinically better HRQL than the rest of the cohort throughout the study (estimated average difference of 10.8 points on RAND 36-Item Short-Form Health Survey; 95% confidence interval, 6.67–15.07).
Conclusions
The agreement between the 2 definitions of recovery ranged from minimal to strong according to patient group. Using a functional target to define recovery predicted HRQL better. It is vital to consider the definition of recovery carefully for research or clinical practice because it can influence subsequent decisions (eg, endorsing a specific intervention or discharging patients).Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Assessment of Rehabilitation Infrastructure in Peru Type de document : Article Auteurs : Amy K. Fuhs ; Lacey N. LaGrone ; Miguel G. Moscoso Porras Article en page(s) : p. 1116-1123 Langues : Anglais (eng) Descripteurs : HE Vinci
Ergotherapie ; Médecine physique et de réadaptation ; Organisation mondiale de la sante ; Pérou ; Personnel de santé ; Rééducation et réadaptation ; Services de santéMots-clés : Health information systems Systèmes d'information sur la santé Health personnel Health services Interdisciplinary communication Communication interdisciplinaire Occupational therapy Peru Physical and rehabilitation medicine Physical therapists Kinésithérapeutes Rehabilitation nursing Soins infirmiers en rééducation-réadaptation Speech-language pathology Pathologie de la parole et du langage (spécialité) World Health Organization Résumé : Objective
To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks.
Design
Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input.
Setting
Large public hospitals and referral centers and an online survey platform.
Participants
Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies.
Interventions
Not applicable.
Main Outcome Measures
Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems.
Results
Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent.
Conclusions
Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1116-1123[article] Assessment of Rehabilitation Infrastructure in Peru [Article] / Amy K. Fuhs ; Lacey N. LaGrone ; Miguel G. Moscoso Porras . - p. 1116-1123.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1116-1123
Descripteurs : HE Vinci
Ergotherapie ; Médecine physique et de réadaptation ; Organisation mondiale de la sante ; Pérou ; Personnel de santé ; Rééducation et réadaptation ; Services de santéMots-clés : Health information systems Systèmes d'information sur la santé Health personnel Health services Interdisciplinary communication Communication interdisciplinaire Occupational therapy Peru Physical and rehabilitation medicine Physical therapists Kinésithérapeutes Rehabilitation nursing Soins infirmiers en rééducation-réadaptation Speech-language pathology Pathologie de la parole et du langage (spécialité) World Health Organization Résumé : Objective
To assess rehabilitation infrastructure in Peru in terms of the World Health Organization (WHO) health systems building blocks.
Design
Anonymous quantitative survey; questions were based on the WHO's Guidelines for Essential Trauma Care and rehabilitation professionals' input.
Setting
Large public hospitals and referral centers and an online survey platform.
Participants
Convenience sample of hospital personnel working in rehabilitation and neurology (N=239), recruited through existing contacts and professional societies.
Interventions
Not applicable.
Main Outcome Measures
Outcome measures were for 4 WHO domains: health workforce, health service delivery, essential medical products and technologies, and health information systems.
Results
Regarding the domain of health workforce, 47% of physical therapists, 50% of occupational therapists, and 22% of physiatrists never see inpatients. Few reported rehabilitative nurses (15%) or prosthetist/orthotists (14%) at their hospitals. Even at the largest hospitals, most reported ≤3 occupational therapists (54%) and speech-language pathologists (70%). At hospitals without speech-language pathologists, physical therapists (49%) or nobody (34%) perform speech-language pathology roles. At hospitals without occupational therapists, physical therapists most commonly (59%) perform occupational therapy tasks. Alternate prosthetist/orthotist task performers are occupational therapists (26%), physical therapists (19%), and physicians (16%). Forty-four percent reported interdisciplinary collaboration. Regarding the domain of health services, the most frequent inpatient and outpatient rehabilitation barriers were referral delays (50%) and distance/transportation (39%), respectively. Regarding the domain of health information systems, 28% reported rehabilitation service data collection. Regarding the domain of essential medical products and technologies, electrophysical agents (88%), gyms (81%), and electromyography (76%) were most common; thickened liquids (19%), swallow studies (24%), and cognitive training tools (28%) were least frequent.
Conclusions
Rehabilitation emphasis is on outpatient services, and there are comparatively adequate numbers of physical therapists and physiatrists relative to rehabilitation personnel. Financial barriers seem low for accessing existing services. There appear to be shortages of inpatient rehabilitation, specialized services, and interdisciplinary collaboration. These may be addressed by redistributing personnel and investing in education and equipment for specialized services. Further examination of task sharing's role in Peru's rehabilitation services is necessary to evaluate its potential to address deficiencies.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Postacute Care Setting, Facility Characteristics, and Poststroke Outcomes: A Systematic Review Type de document : Article Auteurs : Matthew Alcusky ; Christine M. Ulbricht ; Kate L. Lapane Article en page(s) : p. 1124-1140 Langues : Anglais (eng) Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Évaluation de résultat (soins) ; Rééducation et réadaptation ; Soins de suiteMots-clés : Outcome Assessment (Health Care) Skilled nursing facilities Établissements de soins qualifiés Stroke Subacute care Résumé : Objectives
To synthesize research comparing poststroke health outcomes between patients rehabilitated in skilled nursing facilities (SNFs) and those in inpatient rehabilitation facilities (IRFs) as well as to evaluate relations between facility characteristics and outcomes.
Data Sources
PubMed and CINAHL searches spanned January 1, 1998, to October 6, 2016, and encompassed MeSH and free-text keywords for stroke, IRF/SNF, and study outcomes. Searches were restricted to peer-reviewed research in humans published in English.
Study Selection
Observational and experimental studies examining outcomes of adult patients with stroke rehabilitated in an IRF or SNF were eligible. Studies had to provide site of care comparisons and/or analyses incorporating facility-level characteristics and had to report ≥1 primary outcome (discharge setting, functional status, readmission, quality of life, all-cause mortality). Unpublished, single-center, descriptive, and non-US studies were excluded. Articles were reviewed by 1 author, and when uncertain, discussion with study coauthors achieved consensus. Fourteen titles (0.3%) were included.
Data Extraction
The types of data, time period, size, design, and primary outcomes were extracted. We also extracted 2 secondary outcomes (length of IRF/SNF stay, cost) when reported by included studies. Effect measures, modeling approaches, methods for confounding adjustment, and potential confounders were extracted. Data were abstracted by 1 author, and the accuracy was verified by a second reviewer.
Data Synthesis
Two studies evaluating community discharge, 1 study evaluating the predicted probability of readmission, and 3 studies evaluating all-cause mortality favored IRFs over SNFs. Functional status comparisons were inconsistent. No studies evaluated quality of life. Two studies confirmed increased costs in the IRF versus SNF setting. Although substantial facility variation was described, few studies characterized sources of variation.
Conclusions
The few studies comparing poststroke outcomes indicated better outcomes (with higher costs) for patients in IRFs versus those in SNFs. Contemporary research on the role of the postacute care setting and its attributes in determining health outcomes should be prioritized to inform reimbursement system reform.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1124-1140[article] Postacute Care Setting, Facility Characteristics, and Poststroke Outcomes: A Systematic Review [Article] / Matthew Alcusky ; Christine M. Ulbricht ; Kate L. Lapane . - p. 1124-1140.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1124-1140
Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Évaluation de résultat (soins) ; Rééducation et réadaptation ; Soins de suiteMots-clés : Outcome Assessment (Health Care) Skilled nursing facilities Établissements de soins qualifiés Stroke Subacute care Résumé : Objectives
To synthesize research comparing poststroke health outcomes between patients rehabilitated in skilled nursing facilities (SNFs) and those in inpatient rehabilitation facilities (IRFs) as well as to evaluate relations between facility characteristics and outcomes.
Data Sources
PubMed and CINAHL searches spanned January 1, 1998, to October 6, 2016, and encompassed MeSH and free-text keywords for stroke, IRF/SNF, and study outcomes. Searches were restricted to peer-reviewed research in humans published in English.
Study Selection
Observational and experimental studies examining outcomes of adult patients with stroke rehabilitated in an IRF or SNF were eligible. Studies had to provide site of care comparisons and/or analyses incorporating facility-level characteristics and had to report ≥1 primary outcome (discharge setting, functional status, readmission, quality of life, all-cause mortality). Unpublished, single-center, descriptive, and non-US studies were excluded. Articles were reviewed by 1 author, and when uncertain, discussion with study coauthors achieved consensus. Fourteen titles (0.3%) were included.
Data Extraction
The types of data, time period, size, design, and primary outcomes were extracted. We also extracted 2 secondary outcomes (length of IRF/SNF stay, cost) when reported by included studies. Effect measures, modeling approaches, methods for confounding adjustment, and potential confounders were extracted. Data were abstracted by 1 author, and the accuracy was verified by a second reviewer.
Data Synthesis
Two studies evaluating community discharge, 1 study evaluating the predicted probability of readmission, and 3 studies evaluating all-cause mortality favored IRFs over SNFs. Functional status comparisons were inconsistent. No studies evaluated quality of life. Two studies confirmed increased costs in the IRF versus SNF setting. Although substantial facility variation was described, few studies characterized sources of variation.
Conclusions
The few studies comparing poststroke outcomes indicated better outcomes (with higher costs) for patients in IRFs versus those in SNFs. Contemporary research on the role of the postacute care setting and its attributes in determining health outcomes should be prioritized to inform reimbursement system reform.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016 Type de document : Article Auteurs : Tiago S. Jesus ; Christina Papadimitriou ; Cátia S. Pinho Article en page(s) : p. 1141-1148 Langues : Anglais (eng) Descripteurs : HE Vinci
Amélioration de la qualité ; Rééducation et réadaptation ; Revue de la littératureMots-clés : Quality improvement Review Safety management Gestion de la sécurité Résumé : Objective
To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.
Data Sources
Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.
Study Selection
Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.
Data Extraction
Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.
Data Synthesis
Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.
Conclusions
The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1141-1148[article] Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016 [Article] / Tiago S. Jesus ; Christina Papadimitriou ; Cátia S. Pinho . - p. 1141-1148.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1141-1148
Descripteurs : HE Vinci
Amélioration de la qualité ; Rééducation et réadaptation ; Revue de la littératureMots-clés : Quality improvement Review Safety management Gestion de la sécurité Résumé : Objective
To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.
Data Sources
Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.
Study Selection
Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.
Data Extraction
Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.
Data Synthesis
Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.
Conclusions
The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis Type de document : Article Auteurs : Marsh Königs ; Eva A. Beurskens ; Lian Snoep Article en page(s) : p. 1149-1159 Langues : Anglais (eng) Descripteurs : HE Vinci
Méta-analyse ; Rééducation et réadaptationMots-clés : Brain injuries Lésions encéphaliques Meta-analysis Résumé : Objective
To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.
Data Sources
PubMed, Embase, PsycINFO, and Cochrane Database.
Study Selection
Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by 2 independent authors. Eleven articles were included for systematic review and meta-analysis.
Data Extraction
Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration tool. Discrepancies between authors were resolved by consensus.
Data Synthesis
Systematic review of a total of 6 randomized controlled trials, 1 quasi-randomized trial, and 4 controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome compared with usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d=1.02; P<.001 confidence interval and a medium-sized positive effect for intensive neurorehabilitation programs p ci .38 compared with usual care. these effects were replicated based solely on studies low overall risk of bias.> Conclusions
The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI compared with usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1149-1159[article] Effects of Timing and Intensity of Neurorehabilitation on Functional Outcome After Traumatic Brain Injury: A Systematic Review and Meta-Analysis [Article] / Marsh Königs ; Eva A. Beurskens ; Lian Snoep . - p. 1149-1159.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1149-1159
Descripteurs : HE Vinci
Méta-analyse ; Rééducation et réadaptationMots-clés : Brain injuries Lésions encéphaliques Meta-analysis Résumé : Objective
To systematically review evidence on the effects of timing and intensity of neurorehabilitation on the functional recovery of patients with moderate to severe traumatic brain injury (TBI) and aggregate the available evidence using meta-analytic methods.
Data Sources
PubMed, Embase, PsycINFO, and Cochrane Database.
Study Selection
Electronic databases were searched for prospective controlled clinical trials assessing the effect of timing or intensity of multidisciplinary neurorehabilitation programs on functional outcome of patients with moderate or severe TBI. A total of 5961 unique records were screened for relevance, of which 58 full-text articles were assessed for eligibility by 2 independent authors. Eleven articles were included for systematic review and meta-analysis.
Data Extraction
Two independent authors performed data extraction and risk of bias analysis using the Cochrane Collaboration tool. Discrepancies between authors were resolved by consensus.
Data Synthesis
Systematic review of a total of 6 randomized controlled trials, 1 quasi-randomized trial, and 4 controlled trials revealed consistent evidence for a beneficial effect of early onset neurorehabilitation in the trauma center and intensive neurorehabilitation in the rehabilitation facility on functional outcome compared with usual care. Meta-analytic quantification revealed a large-sized positive effect for early onset rehabilitation programs (d=1.02; P<.001 confidence interval and a medium-sized positive effect for intensive neurorehabilitation programs p ci .38 compared with usual care. these effects were replicated based solely on studies low overall risk of bias.> Conclusions
The available evidence indicates that early onset neurorehabilitation in the trauma center and more intensive neurorehabilitation in the rehabilitation facility promote functional recovery of patients with moderate to severe TBI compared with usual care. These findings support the integration of early onset and more intensive neurorehabilitation in the chain of care for patients with TBI.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Early Botulinum Toxin Injections in Infants With Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness Type de document : Article Auteurs : Jean-Sébastien Bourseul ; Anais Molina ; Mael Lintanf Article en page(s) : p. 1160-1176 Langues : Anglais (eng) Descripteurs : HE Vinci
Nourrisson ; Rééducation et réadaptation ; SecuritéMots-clés : Botulinum toxins Toxines botuliniques Infant Safety Résumé : Objective
To report current evidence regarding the safety of intramuscular botulinum toxin injection (BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders >2 years of age.
Data Sources
PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science.
Study Selection
Two reviewers independently selected studies based on predetermined inclusion criteria.
Data Extraction
Data relating to the aim were extracted. Methodologic quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale.
Data Synthesis
Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5% to 25%. Results regarding efficacy were preliminary, dependent on the pathology, and limited by the small number of studies and their low levels of evidence.
Conclusions
BTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. Regarding effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1160-1176[article] Early Botulinum Toxin Injections in Infants With Musculoskeletal Disorders: A Systematic Review of Safety and Effectiveness [Article] / Jean-Sébastien Bourseul ; Anais Molina ; Mael Lintanf . - p. 1160-1176.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1160-1176
Descripteurs : HE Vinci
Nourrisson ; Rééducation et réadaptation ; SecuritéMots-clés : Botulinum toxins Toxines botuliniques Infant Safety Résumé : Objective
To report current evidence regarding the safety of intramuscular botulinum toxin injection (BTI) in children with orthopedic- and neurologic-related musculoskeletal disorders >2 years of age.
Data Sources
PubMed, Cochrane Library, and ScienceDirect, Google Scholar, and Web of Science.
Study Selection
Two reviewers independently selected studies based on predetermined inclusion criteria.
Data Extraction
Data relating to the aim were extracted. Methodologic quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale.
Data Synthesis
Data of 473 infants were analyzed. Fifty-five infants had cerebral palsy, 112 had obstetric brachial plexus palsy, 257 had clubfoot, and 44 had congenital torticollis. No studies reported any severe adverse event that could be attributed to the BTI. The rate of mild to moderate adverse events reported varied from 5% to 25%. Results regarding efficacy were preliminary, dependent on the pathology, and limited by the small number of studies and their low levels of evidence.
Conclusions
BTI is already widely used as an early treatment for this age group. The safety profile of BTI in infants appears similar to that of older children and risks appear more related to the severity of the pathology and the location of the injections than to the toxin itself. Regarding effectiveness, other studies with higher levels of evidence should be carried out for each specific pathology.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature Type de document : Article Auteurs : Robbert M. Wouters ; Jonathan Tsehaie ; Steven E.R. Hovius Article en page(s) : p. 1177-1212 Langues : Anglais (eng) Descripteurs : HE Vinci
Arthroplastie ; Arthrose ; Pouce ; Rééducation et réadaptationMots-clés : Arthroplasty Carpometacarpal joints Articulations carpométacarpiennes Osteoarthritis Thumb Résumé : Objective
To provide an overview of rehabilitation for patients who underwent first carpometacarpal joint (CMC-1) arthroplasty, with emphasis on early active mobilization.
Data Sources
PubMed/MEDLINE, Embase, CINAHL, and Cochrane were searched.
Study Selection
Articles written in English that described the postoperative regimen (including immobilization period/method and/or description of exercises/physical therapy, follow-up 6wk) on CMC-1 arthroplasty were included.
Data Extraction
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as guidance in this review, and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale.
Data Synthesis
Twenty-seven studies were included consisting of 1015 participants, in whom 1118 surgical procedures were performed. A summary of the components of postoperative rehabilitation used in the included studies of CMC-1 osteoarthritis is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of range of motion and strength exercises) provides positive outcomes for pain, limitations in activities of daily living, and grip and pinch strength, but comparative studies are lacking. Furthermore, 3 postoperative exercises/therapy phases were identified in the literature—the acute phase, the unloaded phase, and the functional phase—but again comparative studies are lacking.
Conclusions
Early active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation for CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high-quality comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1177-1212[article] Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature [Article] / Robbert M. Wouters ; Jonathan Tsehaie ; Steven E.R. Hovius . - p. 1177-1212.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1177-1212
Descripteurs : HE Vinci
Arthroplastie ; Arthrose ; Pouce ; Rééducation et réadaptationMots-clés : Arthroplasty Carpometacarpal joints Articulations carpométacarpiennes Osteoarthritis Thumb Résumé : Objective
To provide an overview of rehabilitation for patients who underwent first carpometacarpal joint (CMC-1) arthroplasty, with emphasis on early active mobilization.
Data Sources
PubMed/MEDLINE, Embase, CINAHL, and Cochrane were searched.
Study Selection
Articles written in English that described the postoperative regimen (including immobilization period/method and/or description of exercises/physical therapy, follow-up 6wk) on CMC-1 arthroplasty were included.
Data Extraction
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used as guidance in this review, and methodological quality was assessed using the Effective Public Health Practice Project quality assessment tool. Randomized studies were additionally scored using the Physiotherapy Evidence Database scale.
Data Synthesis
Twenty-seven studies were included consisting of 1015 participants, in whom 1118 surgical procedures were performed. A summary of the components of postoperative rehabilitation used in the included studies of CMC-1 osteoarthritis is presented for different surgical interventions. We found that early active recovery (including short immobilization, early initiation of range of motion and strength exercises) provides positive outcomes for pain, limitations in activities of daily living, and grip and pinch strength, but comparative studies are lacking. Furthermore, 3 postoperative exercises/therapy phases were identified in the literature—the acute phase, the unloaded phase, and the functional phase—but again comparative studies are lacking.
Conclusions
Early active recovery is used more often in the literature and does not lead to worse outcomes or more complications. This systematic review provides guidance for clinicians in the content of postoperative rehabilitation for CMC-1 arthroplasty. The review also clearly identifies the almost complete lack of high-quality comparative studies on postoperative rehabilitation after CMC-1 arthroplasty.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014 Type de document : Article Auteurs : Michael P. Jr. Cary ; Victoria Goode ; Nancy Crego Article en page(s) : p. 1213-1216 Langues : Anglais (eng) Descripteurs : HE Vinci
Amélioration de la qualité ; Qualité des soins de santé ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Hospitals Hôpitaux Medicare Patient safety Quality improvement Quality of Health Care Résumé : Objective
To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients.
Design
Retrospective cross-sectional descriptive design.
Setting
Community-based acute care hospitals.
Participants
Total sample size (N=142,022) included THR patients (identified as ICD-9-CM procedure code 81.51) in 2009 (n=31,232) and (n=32,863) in 2014.
Interventions
Not applicable.
Main Outcome Measures
30-Day hospital readmission.
Results
The overall readmission rate decreased by 1.3% from 2009 to 2014. The decrease in readmission rates varied by groups, with lesser improvements seen in THR patients who were younger, with private insurance, and residing in lower-income and rural communities. Device complications were the leading cause of readmission in THR patients, increasing from 19.8% in 2009 to 23.9% in 2014.
Conclusions
There has been little decrease in hospital 30-day readmission rates for US community hospitals between 2009 and 2014. Findings from this brief report indicate patient groups at greater risk for 30-day hospital readmission as well as leading causes for readmission in THR patients which can inform the development of tailored interventions for reduction.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1213-1216[article] Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014 [Article] / Michael P. Jr. Cary ; Victoria Goode ; Nancy Crego . - p. 1213-1216.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1213-1216
Descripteurs : HE Vinci
Amélioration de la qualité ; Qualité des soins de santé ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Hospitals Hôpitaux Medicare Patient safety Quality improvement Quality of Health Care Résumé : Objective
To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients.
Design
Retrospective cross-sectional descriptive design.
Setting
Community-based acute care hospitals.
Participants
Total sample size (N=142,022) included THR patients (identified as ICD-9-CM procedure code 81.51) in 2009 (n=31,232) and (n=32,863) in 2014.
Interventions
Not applicable.
Main Outcome Measures
30-Day hospital readmission.
Results
The overall readmission rate decreased by 1.3% from 2009 to 2014. The decrease in readmission rates varied by groups, with lesser improvements seen in THR patients who were younger, with private insurance, and residing in lower-income and rural communities. Device complications were the leading cause of readmission in THR patients, increasing from 19.8% in 2009 to 23.9% in 2014.
Conclusions
There has been little decrease in hospital 30-day readmission rates for US community hospitals between 2009 and 2014. Findings from this brief report indicate patient groups at greater risk for 30-day hospital readmission as well as leading causes for readmission in THR patients which can inform the development of tailored interventions for reduction.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Medical Safety Huddles in Rehabilitation: A Novel Patient Safety Strategy Type de document : Article Auteurs : Meiqi Guo ; Gaetan Tardif ; Mark Bayley Article en page(s) : p. 1217-1219 Langues : Anglais (eng) Descripteurs : HE Vinci
Equipe soignante ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Patient care team Patient safety Physician's role Rôle médical Résumé : Objective
To describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety.
Design
Single-center observational study.
Setting
Brain and spinal cord injury rehabilitation program at an urban, academic adult rehabilitation hospital.
Participants
Physicians associated with the program (N=18).
Interventions
Weekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues.
Main Outcome Measures
Main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken, and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures.
Results
Over a 7-month period, average physician attendance at medical huddles was 76.0%. There were 1.0+0.8 patient safety incidents and 3.2+2.1 anticipated patient safety issues identified in each weekly huddle. Most patient safety incidents identified were clinical administrative and clinical process related, which differed from information gathered from the organization's preexisting patient safety monitoring strategies. A total of 79 actions, or 3.3+1.8 actions per huddle, were taken in response to improve patient safety for the program. Adverse events decreased from 31.2 (95% confidence interval [CI], 27.0–35.3) to 22.9 per month (95% CI, 19.3–26.5) after implementation.
Conclusions
Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1217-1219[article] Medical Safety Huddles in Rehabilitation: A Novel Patient Safety Strategy [Article] / Meiqi Guo ; Gaetan Tardif ; Mark Bayley . - p. 1217-1219.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1217-1219
Descripteurs : HE Vinci
Equipe soignante ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Patient care team Patient safety Physician's role Rôle médical Résumé : Objective
To describe the implementation process, outcomes, and lessons learned in the implementation of medical safety huddles, a novel patient safety monitoring strategy that promotes physician engagement with patient safety.
Design
Single-center observational study.
Setting
Brain and spinal cord injury rehabilitation program at an urban, academic adult rehabilitation hospital.
Participants
Physicians associated with the program (N=18).
Interventions
Weekly physicians' safety huddles were implemented to review, anticipate, and address patient safety issues.
Main Outcome Measures
Main outcome measures were the number and nature of identified and anticipated patient safety incidents, actions taken, and physician attendance during huddles. The number of adverse events in the program before and after huddle implementation were secondary measures.
Results
Over a 7-month period, average physician attendance at medical huddles was 76.0%. There were 1.0+0.8 patient safety incidents and 3.2+2.1 anticipated patient safety issues identified in each weekly huddle. Most patient safety incidents identified were clinical administrative and clinical process related, which differed from information gathered from the organization's preexisting patient safety monitoring strategies. A total of 79 actions, or 3.3+1.8 actions per huddle, were taken in response to improve patient safety for the program. Adverse events decreased from 31.2 (95% confidence interval [CI], 27.0–35.3) to 22.9 per month (95% CI, 19.3–26.5) after implementation.
Conclusions
Medical safety huddles are a novel strategy to engage physicians in patient safety and organizational quality improvement. They have the potential to enhance organizational anticipation of safety risks by supplementing existing methods. Other rehabilitation settings may wish to consider implementing and evaluating similar huddles into their existing patient safety and quality improvement frameworks.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage Type de document : Article Auteurs : Mona N. Bahouth ; Melinda C. Power ; Elizabeth K. Zink Article en page(s) : p. 1220-1225 Langues : Anglais (eng) Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Early ambulation Lever précoce Stroke Patient safety Résumé : Objective
To measure the impact of a progressive mobility program on patients admitted to a neurocritical critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge owing to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the intensive care unit have been excluded from randomized trials of early mobilization after stroke.
Design
An interdisciplinary working group developed a formalized NCCU Mobility Algorithm that allocates patients to incremental passive or active mobilization pathways on the basis of level of consciousness and motor function. In a quasi-experimental consecutive group comparison, patients with ICH admitted to the NCCU were analyzed in two 6-month epochs, before and after rollout of the algorithm. Mobilization and safety endpoints were compared between epochs.
Setting
NCCU in an urban, academic hospital.
Participants
Adult patients admitted to the NCCU with primary intracerebral hemorrhage.
Intervention
Progressive mobilization after stroke using a formalized mobility algorithm.
Main Outcome Measures
Time to first mobilization.
Results
The 2 groups of patients with ICH (pre-algorithm rolllout, n=28; post-algorithm rollout, n=29) were similar on baseline characteristics. Patients in the postintervention group were significantly more likely to undergo mobilization within the first 7 days after admission (odds ratio 8.7, 95% confidence interval 2.1, 36.6; P=.003). No neurologic deterioration, hypotension, falls, or line dislodgments were reported in association with mobilization. A nonsignificant difference in mortality was noted before and after rollout of the algorithm (4% vs 24%, respectively, P=.12).
Conclusions
The implementation of a progressive mobility algorithm was safe and associated with a higher likelihood of mobilization in the first week after spontaneous ICH. Research is needed to investigate methods and the timing for the first mobilization in critically ill stroke patients.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1220-1225[article] Safety and Feasibility of a Neuroscience Critical Care Program to Mobilize Patients With Primary Intracerebral Hemorrhage [Article] / Mona N. Bahouth ; Melinda C. Power ; Elizabeth K. Zink . - p. 1220-1225.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1220-1225
Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Rééducation et réadaptation ; Sécurité des patientsMots-clés : Early ambulation Lever précoce Stroke Patient safety Résumé : Objective
To measure the impact of a progressive mobility program on patients admitted to a neurocritical critical care unit (NCCU) with intracerebral hemorrhage (ICH). The early mobilization of critically ill patients with spontaneous ICH is a challenge owing to the potential for neurologic deterioration and hemodynamic lability in the acute phase of injury. Patients admitted to the intensive care unit have been excluded from randomized trials of early mobilization after stroke.
Design
An interdisciplinary working group developed a formalized NCCU Mobility Algorithm that allocates patients to incremental passive or active mobilization pathways on the basis of level of consciousness and motor function. In a quasi-experimental consecutive group comparison, patients with ICH admitted to the NCCU were analyzed in two 6-month epochs, before and after rollout of the algorithm. Mobilization and safety endpoints were compared between epochs.
Setting
NCCU in an urban, academic hospital.
Participants
Adult patients admitted to the NCCU with primary intracerebral hemorrhage.
Intervention
Progressive mobilization after stroke using a formalized mobility algorithm.
Main Outcome Measures
Time to first mobilization.
Results
The 2 groups of patients with ICH (pre-algorithm rolllout, n=28; post-algorithm rollout, n=29) were similar on baseline characteristics. Patients in the postintervention group were significantly more likely to undergo mobilization within the first 7 days after admission (odds ratio 8.7, 95% confidence interval 2.1, 36.6; P=.003). No neurologic deterioration, hypotension, falls, or line dislodgments were reported in association with mobilization. A nonsignificant difference in mortality was noted before and after rollout of the algorithm (4% vs 24%, respectively, P=.12).
Conclusions
The implementation of a progressive mobility algorithm was safe and associated with a higher likelihood of mobilization in the first week after spontaneous ICH. Research is needed to investigate methods and the timing for the first mobilization in critically ill stroke patients.Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Turning Data Into Information: Opportunities to Advance Rehabilitation Quality, Research, and Policy Type de document : Article Auteurs : Janet Prvu Bettger ; Vu Q.C. Nguyen ; George J. Thomas Article en page(s) : p. 1226-1231 Langues : Anglais (eng) Descripteurs : HE Vinci
Politique de santé ; Qualité des soins de santé ; Recherche sur les services de santé ; Rééducation et réadaptationMots-clés : Electronic health records Dossiers médicaux électroniques Health policy Health services research Quality of health care Résumé : Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1226-1231[article] Turning Data Into Information: Opportunities to Advance Rehabilitation Quality, Research, and Policy [Article] / Janet Prvu Bettger ; Vu Q.C. Nguyen ; George J. Thomas . - p. 1226-1231.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1226-1231
Descripteurs : HE Vinci
Politique de santé ; Qualité des soins de santé ; Recherche sur les services de santé ; Rééducation et réadaptationMots-clés : Electronic health records Dossiers médicaux électroniques Health policy Health services research Quality of health care Résumé : Attention to health care quality and safety has increased dramatically. The internal focus of an organization is not without influence from external policy and research findings. Compared with other specialties, efforts to align and advance rehabilitation research, practice, and policy using electronic health record data are in the early stages. This special communication defines quality, applies the dimensions of quality to rehabilitation, and illustrates the feasibility and utility of electronic health record data for research on rehabilitation care quality and outcomes. Using data generated at the point of care provides the greatest opportunity for improving the quality of health care, producing generalizable evidence to inform policy and practice, and ultimately benefiting the health of the populations served. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda Type de document : Article Auteurs : Michelle L. Nelson ; Kaileah A. McKellar ; Sarah Munce Article en page(s) : p. 1232-1241 Langues : Anglais (eng) Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Comorbidité ; Psychologie ; Rééducation et réadaptation ; Santé holistiqueMots-clés : Cerebrovascular Disorders Angiopathies intracrâniennes Comorbidity Holistic Health Psychology Research design Plan de recherche Stroke Résumé : Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1232-1241[article] Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda [Article] / Michelle L. Nelson ; Kaileah A. McKellar ; Sarah Munce . - p. 1232-1241.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1232-1241
Descripteurs : HE Vinci
Accident vasculaire cérébral (AVC) ; Comorbidité ; Psychologie ; Rééducation et réadaptation ; Santé holistiqueMots-clés : Cerebrovascular Disorders Angiopathies intracrâniennes Comorbidity Holistic Health Psychology Research design Plan de recherche Stroke Résumé : Evidence suggests that a stroke occurs in isolation (no comorbid conditions) in less than 6% of patients. Multimorbidity, compounded by psychosocial issues, makes treatment and recovery for stroke increasingly complex. Recent research and health policy documents called for a better understanding of the needs of this patient population, and for the development and testing of models of care that meet their needs. A research agenda specific to complexity is required. The primary objective of the think tank was to identify and prioritize research questions that meet the information needs of stakeholders, and to develop a research agenda specific to stroke rehabilitation and patient complexity. A modified Delphi and World Café approach underpinned the think tank meeting, approaches well recognized to foster interaction, dialogue, and collaboration between stakeholders. Forty-three researchers, clinicians, and policymakers attended a 2-day meeting. Initial question-generating activities resulted in 120 potential research questions. Sixteen high-priority research questions were identified, focusing on predetermined complexity characteristics—multimorbidity, social determinants, patient characteristics, social supports, and system factors. The final questions are presented as a prioritized research framework. An emergent result of this activity is the development of a complexity and stroke rehabilitation research network. The research agenda reflects topics of importance to stakeholders working with stroke patients with increasingly complex care needs. This robust process resulted in a preliminary research agenda that could provide policymakers with the evidence needed to make improvements toward better-organized services, better coordination between settings, improved patient outcomes, and lower system costs. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
Titre : Knowledge Translation: The Bridging Function of Cochrane Rehabilitation Type de document : Article Auteurs : Stefano Negrini ; Francesca Gimigliano ; Chiara Arienti Article en page(s) : p. 1242-1245 Langues : Anglais (eng) Descripteurs : HE Vinci
Médecine physique et de réadaptation ; Pratique factuelleMots-clés : Physical and rehabilitation medicine Cochrane Résumé : Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation. The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap. In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation. In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1242-1245[article] Knowledge Translation: The Bridging Function of Cochrane Rehabilitation [Article] / Stefano Negrini ; Francesca Gimigliano ; Chiara Arienti . - p. 1242-1245.
Langues : Anglais (eng)
in Archives of Physical Medicine and Rehabilitation > Vol. 99, n° 6 (2018) . - p. 1242-1245
Descripteurs : HE Vinci
Médecine physique et de réadaptation ; Pratique factuelleMots-clés : Physical and rehabilitation medicine Cochrane Résumé : Cochrane Rehabilitation is aimed to ensure that all rehabilitation professionals can apply Evidence Based Clinical Practice and take decisions according to the best and most appropriate evidence in this specific field, combining the best available evidence as gathered by high-quality Cochrane systematic reviews, with their own clinical expertise and the values of patients. This mission can be pursued through knowledge translation. The aim of this article is to shortly present what knowledge translation is, how and why Cochrane (previously known as Cochrane Collaboration) is trying to reorganize itself in light of knowledge translation, and the relevance that this process has for Cochrane Rehabilitation and in the end for the whole world of rehabilitation. It is well known how it is difficult to effectively apply in everyday life what we would like to do and to apply the scientific knowledge in the clinical field: this is called the know-do gap. In the field of evidence-based medicine, where Cochrane belongs, it has been proven that high-quality evidence is not consistently applied in practice. A solution to these problems is the so-called knowledge translation. In this context, Cochrane Rehabilitation is organized to provide the best possible knowledge translation in both directions (bridging function), obviously toward the world of rehabilitation (spreading reviews), but also to the Cochrane community (production of reviews significant for rehabilitation). Cochrane is now strongly pushing to improve its knowledge translation activities, and this creates a strong base for Cochrane Rehabilitation work, focused not only on spreading the evidence but also on improving its production to make it more meaningful for the world of rehabilitation. Disponible en ligne : Oui En ligne : https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/journal/a [...]
