Commission On Accreditation Of Rehabilitation Facilities Research Articles

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

Special Report: Measurement-Based Care—Using Data to Augment Psychotherapy

A National Perspective on Exploring Correlates of Accreditation in Children's Mental Health Care.

This study is the first to explore national accreditation rates and the relationship between accreditation status and organizational characteristics and quality indicators in children's mental health. Data from the Substance Abuse and Mental Health Services Administration's (SAMHSA's) National Survey of Mental Health Treatment Facilities (NSMHTF) were used from 8,247 facilities that serve children and/or adolescents. Nearly 60% (n=4,925) of the facilities were accredited by the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), or The Joint Commission (TJC). Chi-square analyses were conducted to explore relationships. Compared to non-accredited facilities, more accredited facilities reported greater number of admissions, acceptance of government funding and client funds, and implementation of several quality indicators. Policies with incentives for accreditation could influence accreditation rates, and accreditation could influence quality indicators. These results set the foundation for future research about the drivers of the accreditation phenomenon and its impact on children's mental health outcomes.

Optimal Colostomy Placement in Spinal Cord Injury Patients

Barring unusual circumstances, sigmoid colostomy is the optimal technique for management of defecation in spinal cord injury (SCI) patients. We sought to provide evidence that a sigmoid colostomy is not difficult to perform in SCI patients and has better long-term results. The St. Louis Department of Veterans Affairs has a Commission on Accreditation of Rehabilitation Facilities (CARF)-approved SCI Unit. We reviewed the operative notes on all SCI patients who received a colostomy for fecal management by three ASCRS-certified colorectal surgeons at the St. Louis Department of Veterans Affairs from January 1, 2007 to November 26, 2012. There were 27 operations for which the recorded indication for surgery suggested that the primary disorder was SCI. Fourteen had traumatic SCI of the thoracic and/or lumbar spine and were evaluable. Of these 14 patients, 12 had laparoscopic sigmoid colostomy and two had open sigmoid colostomy. We encountered one evaluable patient with a remarkably large amount of retroperitoneal bony debris who successfully underwent laparoscopic sigmoid colostomy. In conclusion, sigmoid colostomy is the consensus optimal procedure for fecal management in SCI patients. Laparoscopic procedures are preferred. Care providers should specify sigmoid colostomy when contacting a surgeon.

Implementing the New CARF Wellness Standards

Our objectives in this article are to provide background and practical applications of the implementation of the new wellness standards developed by the Commission on Accreditation of Rehabilitation Facilities (CARF). The focus of rehabilitation in the stroke population ideally extends beyond maximizing functioning and prevention of further debilitation, by addressing wellness and the opportunity to create a healthy lifestyle. This concept has been recognized by CARF, which has included new wellness standards for stroke rehabilitation. This article provides a framework for implementing these standards and trends related to prevalence, incidence, and prevention of stroke. The Transtheoretical Model of Change, as described by James Prochaska, is discussed in relation to facilitating lifestyle changes in stroke patients in the rehabilitation setting. Additionally, the Six Dimensions of Wellness Model by Dr Bill Hettler is presented as a framework for developing a wellness tool. Finally, we discuss the development, barriers, and implementation of a wellness tool used at Madonna Rehabilitation Hospital to exemplify a tangible strategy to meet the new CARF standards.

Impact of Voluntary Accreditation on Short-Stay Rehabilitative Measures in U.S. Nursing Homes

To examine accreditation from nursing homes accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and whether this is associated with improved rehabilitation care. Cross-sectional association of CARF accreditation and quality. Comparison of the short-stay quality measures (influenza and pneumococcal vaccination; pain; delirium; pressures sores; five-star quality and health inspection scores) between the sample of 246 CARF-accredited homes compared with the 15,393 nursing homes in the 2010 On-Line Survey Certification of Automated Records (OSCAR). CARF-accredited nursing homes demonstrate better quality with regard to the short-stay quality measures. Approaches beyond traditional regulation and governmental inspections are necessary to improve the quality of care in nursing homes. During a patient's rehabilitation stay, minimizing iatrogenic complications is paramount. Given the findings of this study, it is unfortunate that very few nursing homes are CARF accredited.

Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation

This is a single-group, retrospective study. The objective of this study was to understand the factors contributing to satisfaction with life (SWL) among veterans with a spinal cord injury (SCI) completing rehabilitation. This study was conducted at Veterans Administration Medical Center, San Diego.MethodsBetween 1998 and 2010, N=118 Veterans participated in a Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited rehabilitation program after a new SCI. Pre-rehabilitation measures of impairment at the organ/body level, activity limitation at the person level and participation restriction at the societal level were used to predict Satisfaction with Life Scale (SWLS) scores upon discharge. Although overall mean SWLS admission and discharge scores were not significantly different (P>0.10), individual change in SWLS scores during rehabilitation was notable, ranging from a 17-point improvement to a 22-point decline across veterans (mean Δ=+1.18, s.d.=6.04). Veterans who exhibited less activity limitation (higher cognitive functioning, r=0.31, P<0.01) and less participation restriction (greater social integration, r=0.21, P<0.05; a trend toward greater economic sufficiency, r=0.16, P<0.10) at baseline had higher SWLS scores after rehabilitation. When these factors were entered together into a single regression model, only cognitive functioning remained statistically significant (P<0.05). Findings highlight potential targets for interventions, aiming to improve SWL post SCI among US veterans. In addition to directly targeting SWL with psychosocial interventions, results suggest that rehabilitation settings should continue and/or expand upon programs targeting cognitive functioning (activity limitation) and social integration (participation restriction). Nevertheless, additional research is warranted to identify the biopsychosocial factors most reliably associated with SWL and/or other aspects of quality of life.

Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature

BACKGROUND AND OBJECTIVE:Accreditation is usually a voluntary program in which trained external peer reviewers evaluate a healthcare organization's compliance and compare it with pre-established performance standards. The aim of this study was to evaluate the impact of accreditation programs on the quality of healthcare servicesMETHODS:We did a systematic review of the literature to evaluate the impact of accreditation programs on the quality of healthcare services. Several databases were systematically searched, including Medline, Embase, Healthstar, and Cinhal.RESULTS:Twenty-six studies evaluating the impact of accreditation were identified. The majority of the studies showed general accreditation for acute myocardial infarction (AMI), trauma, ambulatory surgical care, infection control and pain management; and subspecialty accreditation programs to significantly improve the process of care provided by healthcare services by improving the structure and organization of healthcare facilities. Several studies showed that general accreditation programs significantly improve clinical outcomes and the quality of care of these clinical conditions and showed a significant positive impact of subspecialty accreditation programs in improving clinical outcomes in different subspecialties, including sleep medicine, chest pain management and trauma management.CONCLUSIONS:There is consistent evidence that shows that accreditation programs improve the process of care provided by healthcare services. There is considerable evidence to show that accreditation programs improve clinical outcomes of a wide spectrum of clinical conditions. Accreditation programs should be supported as a tool to improve the quality of healthcare services.

Listening to consumers ... CARF Canada opens

The Commission on Accreditation of Rehabilitation Facilities (CARF) has experienced considerable market growth in recent years. Growth has occurred in the health care industry with exceptional growth occurring in the fields of persons with disabilities and children’s services. Expansion of their services beyond the American boarders has resulted in CARF accrediting organizations in Canada, Ireland and Sweden with active work occurring in Denmark, Finland, France, Scotland, Italy, England and Australia. In Canada, policy makers at all levels of government began demanding greater community involvement in consumer service delivery. Policy makers and consumers made it clear that a system of accountability needed to be incorporated to ensure quality of service. In order to address the resulting growth in Canada and listen to the needs of consumers it became apparent that a separate office was required to meet the unique needs of Canadians. CARF Canada was established to meet the needs.

Govt. Names Organizations That Can Accredit Methadone Programs

Back to table of contents Previous article Next article Professional NewsFull AccessGovt. Names Organizations That Can Accredit Methadone ProgramsJim RosackJim RosackSearch for more papers by this authorPublished Online:1 Feb 2002https://doi.org/10.1176/pn.37.3.0005bFour organizations were chosen last month by the Substance Abuse and Mental Health Services Administration (SAMHSA) to accredit programs that use methadone to treat individuals with opiate abuse and dependency.Along with the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Council on Accreditation for Children and Family Services (COA), and the State of Washington Department of Social and Health Services Division of Alcohol and Substance Abuse will accredit methadone treatment programs for SAMHSA’s Center for Substance Abuse Treatment (CSAT).CSAT hopes that the move to accreditation, announced last year (Psychiatric News, March 2, 2001), will lead to improvements in the quality and oversight of opioid treatment programs that use either methadone or levo-alpha-acetyl-methadol (LAAM) to prevent relapse in addiction to heroin and other opiates.“As a benchmark of quality,” CSAT Director H. Westley Clark, M.D., J.D., M.P.H., said in a prepared statement released by the center, “accreditation indicates that an organization meets certain critical performance standards. This should enhance community confidence in opioid treatment and enhance the ability of treatment programs to access managed care contracts.”SAMHSA Administrator Charles G. Curie added that “accreditation of methadone treatment programs is a fundamental shift in the way we approach drug abuse treatment in our nation. Accreditation can help to reduce stigma and discrimination by moving drug abuse treatment into the mainstream of medicine. Just like treatment for other diseases, physicians and other health care professionals will make decisions based on standards that emphasize best-care practices for patients.”The final approval of the four accrediting agencies follows recommendations made in 1997 by a National Institutes of Health consensus panel, which concluded that the existing federal and state regulations limited the ability of physicians to provide methadone treatment to patients and recommended the move away from regulatory oversight to accreditation in an effort to improve the quality of care. The change is also consistent with a report by the Institute of Medicine in 1995, which stressed the need to readjust the balance among regulations, clinical practice guidelines, and quality assurance systems.Under the regulations authorizing the new accreditation process, treatment programs must apply for certification to one of the four approved accrediting agencies no later than March 4, so that accreditation is achieved no later than May 19, 2003.CSAT, Clark said, is providing technical assistance to help treatment programs meet the new federal regulations and the accreditation standards. Each of the four accrediting agencies will provide technical assistance to programs seeking certification through their agency.Questions regarding technical assistance with meeting the new accreditation standards can be directed to a toll-free CSAT helpline at (800) 839-6120. Other information about the new federal regulations is available toll free from CSAT at (866) 463-6687. ▪ ISSUES NewArchived

Gold award: A community-based program providing a successful alternative to acute psychiatric hospitalization.

Gold award: A community-based program providing a successful alternative to acute psychiatric hospitalization.

Accreditation and the use of outcomes-oriented information systems

Rehabilitation programs of all types and sizes must be able to use information technology to respond to both internal and external forces. One can anticipate that consumer-driven care will mean a desire for and access to more public information about health plans, specialty components of health care (eg, rehabilitation), and the quality of plans and providers. Providers need information with which to plan and manage their outcomes and resource allocation, to monitor and improve the quality of services, and to communicate with external stakeholders. The Commission on Accreditation of Rehabilitation Facilities (CARF) has for more than two decades required accredited organizations to have active outcome-oriented program evaluation systems. Yet, accreditation requirements have historically been process-oriented. This process orientation is now evolving toward an outcome orientation, both in the accreditation environment at large, and at CARF. This article describes these outcome-oriented initiatives, including CARF SCoRs SM, a standards conformance rating system under development at CARF, and a project to identify a limited, uniform set of performance indicators for rehabilitation programs. In addition, the article reflects on the significance of a potential National Information System for brain injury to the accreditation and outcomes arena.

The current nursing procedure for intermittent urinary catheterization in rehabilitation facilities.

The purpose of the research study described in this article was to identify the range of catheterization techniques currently practiced in inpatient care settings and to determine current methods of patient-caregiver education about catheterization in a home setting. A questionnaire was mailed to a random sample of 175 rehabilitation facilities accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF); the return rate was 81%. Data were analyzed on the basis of region of the country, type of practice setting, and number of rehabilitation beds. There were few statistically significant correlations, based on this analysis. These results provide a baseline for current practice and suggest the need for development of a standard for practice based on research. A multicenter study that compares clean with sterile methods needs to be conducted to determine which technique is preferable for inpatient practice and which for patient-caregiver education.

A survey of accredited and other rehabilitation facilities: education, training and cognitive rehabilitation in brain-injury programmes.

Although it is routinely acknowledged that cognitive rehabilitation therapy comprises a major part of the services provided to survivors of brain injury, there continues to be no general consensus regarding the methods and training of those who provide cognitive rehabilitation services. This survey of 398 head-injury rehabilitation facilities includes information on which disciplines are providing and supervising cognitive rehabilitation therapy, which therapy formats are used, and a first attempt to define the costs and providers for cognitive therapy staff training in Commission on Accreditation of Rehabilitation Facilities (CARF) approved and other (non-CARF) facilities. The education and training of junior and senior staff members is compared, and respondents suggest changes in the education and training of those who provide cognitive rehabilitation therapy. The results of this survey suggest no significant differences in the organization and delivery of cognitive rehabilitation therapy in CARF and non-CARF programmes. They indicate that cognitive rehabilitation therapy and the education and training of providers deserve further study and definition, given the widespread provision of cognitive rehabilitative services.

Revitalizing a Documentation System

The nursing department of a 154-bed acute rehabilitation facility, cognizant of the changing trends in health care and responding to feedback from staff, developed and implemented a comprehensive documentation system. The previous system had been fragmented, inconsistent, and inefficient. The development of the new system focused on the complex needs of the rehabilitation client and the equally complex standards required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and insurance carriers. The final product, which was based on the nursing process and functional health patterns, encompassed the following areas from admission to discharge: providing feedback on clients' functional abilities and progress toward goals, satisfying requirements of the 1990 JCAHO standards, and, finally, using a flow sheet that saves nursing time and increases objectivity. This article describes the system from conceptualization to successful implementation.

Integrating program evaluation, quality assurance, and marketing for inpatient rehabilitation.

A competitive market, stricter accreditation requirements, and cost containment concerns have made the need for effective program evaluation, quality assurance, and marketing greater than ever. The Lutheran General Health Care System has addressed this need by developing and organizing a single, integrated reporting system for inpatient rehabilitation: the LORS American Data System (LADS). Using a database of over 10,000 patients, regression equations for 21 impairment groups were developed to predict expected ranges for length of stay, total charges, and functional status at discharge. Combining demographic data and regression analyses, the LADS produces reports useful for Commission on Accreditation of Rehabilitation Facilities (CARF) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accreditation because they assess internal strengths and weaknesses and demonstrate quality and efficiency for marketing purposes.