Inpatient Facilities Research Articles

Abstract 4131228: Where Adults with Advanced Heart Failure Die: Insights from the CDC-WONDER Database

Background: Adults with heart failure (HF) are becoming more and more prevalent. The location of death and related disparities in these patients are poorly understood. Aim: The purpose of the study was to look at the locations of adult deaths from HF and identify any age, race, or ethnicity-related variations over a 25-year period. Methods: The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database provided death certificate data and the National Center for Health Statistics provided individual-level mortality data for the trend-level analysis of adults aged (20-64 and 65+ years) conducted from 1999-2023. Hospital, home, hospice and nursing home/long-term care were the categories for the places of death. Results: Between 1999 and 2023, a total of 7,644,759 adult deaths from HF were recorded (87.9% White, 53.4% female). HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. Conclusion: Prioritize end-of-life planning for HF patients with poor prognosis, regardless of age, to improve quality of life and death.

Institutional Betrayal in Inpatient Psychiatry: Effects on Trust and Engagement With Care.

Patients' experiences of inpatient psychiatry have received limited empirical scrutiny. The authors examined patients' likelihood of experiencing institutional betrayal (harmful actions or inactions toward patients) at facilities with for-profit, nonprofit, or government ownership; patient-level characteristics associated with experiencing institutional betrayal; associations between betrayal and patients' trust in mental health providers; and associations between betrayal and patients' willingness to engage in care postdischarge. Former psychiatric inpatients (N=814 adults) responded to an online survey. Data were collected on patients' demographic characteristics; experiences of institutional betrayal; and the impact of psychiatric hospitalization on patients' trust in providers, willingness to engage in care, and attendance at 30-day follow-up visits. Participants' responses were linked to secondary data on facility ownership type. Experiencing institutional betrayal was associated with less trust in mental health providers (25-percentage-point increase in reporting less trust, 95% CI=17-32), reduced willingness (by 45 percentage points, 95% CI=39-52) voluntarily undergo hospitalization, reduced willingness (by 30 percentage points, 95% CI=23-37) to report distressing thoughts to mental health providers, and lower probability of reporting attendance at a 30-day follow-up visit (11-percentage-point decrease, 95% CI=5-18). Participants treated at a for-profit facility were significantly more likely (by 14 percentage points) to report experiencing institutional betrayal than were those treated at a nonprofit facility (p=0.01). Institutional betrayal is one mechanism through which inpatient psychiatric facilities may cause iatrogenic harm, and the potential for betrayal was larger at for-profit facilities. Further research is needed to identify the determinants of institutional betrayal and strategies to support improvement in care quality.

Abstract 4138715: Disparities in Aortic Dissection and Aortic Aneurysm-Related Mortality in The United States From 1999-2020

Background: Aortic dissection (AD) and aneurysm (AA) have a low incidence but are severe health risks associated with high mortality rates, and based on location, can have a mortality rate of over 80%. We aim to highlight disparities in mortality based on gender, race, age and demographic background. Methods: This retrospective study analyzed death certificate data for AD and AA (ICD-10 code I71) from 1999 to 2020 using the CDC WONDER database. Age-adjusted mortality rates (AAMR) per 100,000 were assessed for adults aged 25 and older by gender, race, year, state, and place of death, while crude mortality rates (CMR) per 100,000 were used for age groups. Joinpoint regression calculated the annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals. Results: From 1999 to 2020, AD and AA resulted in 400,748 deaths in the US. During this period, AAMR for men (12.19) was approximately double that for women (5.77). Overall, the AAMR decreased from 12.40 to 6.71 (AAPC: -2.93; 95% CI: -3.06 to -2.79; p-value<0.000001). NH whites had the highest AAMR at 8.93, while Hispanic and Latino populations had the lowest at 4.20. Approximately 52.3% of the deaths occurred in inpatient medical facilities, whereas 18.4% occurred at home. Vermont, West Virginia, and Wyoming had the highest AAMRs, at 11.60, 11.47, and 11.30, respectively. Among racial groups, both males and females experienced a decrease in AAMR except for NH black men. For this group, there was an increase in AAMR from 9.42 in 2012 to 10.43 in 2020 (APC:1.03; 95% CI: 0.15 to 2.22; p-value:0.028). The CMR for young adults rose significantly from 0.62 in 2014 to 0.73 in 2020 (APC:2.55; 95% CI 1.11 to 6.74; p-value:0.02), and for middle-aged adults from 3.09 in 2010 to 3.61 in 2020 (APC: 1.57; 95% CI 1.04 to 2.25; p-value<0.000001). Conversely, a steep decline in CMR was observed for older adults from 27.93 in 2014 to 25.4 in 2020 (APC:-1.34; 95% CI -1.9 to -0.69; p-value:0.0004). Conclusion: Although AD and AA mortality rates have declined over time, significant disparities persist for NH Black men and young/middle-aged adults. This highlights the need for early screening programs and equitable healthcare provision for all populations.

Therapeutic climbing in inpatient rehabilitation

Abstract: Background: Therapeutic climbing (TC) has been increasingly implemented in the context of mental health care, with promising effects. While most evaluation studies focus on symptom reduction, the specific elements and mechanisms that make climbing effective compared to other therapeutic sports remain unclear. This study explores the subjective experiences of participants of a climbing therapy program in order to explore the underlying processes and the subjectively perceived effects. Method: The study took place at an inpatient rehabilitation facility in southern Germany, where a weekly group TC program was part of the treatment for individuals with mental disorders. Data from 265 participants with ICD-10 mental disorders collected between 2010 and 2022 was analyzed via questionnaires quantitatively assessing physical, psychological, and social improvements with rating items. Additionally open answers on subjectively relevant psychological experiences were analyzed using a qualitative content analysis. Results: Climbing therapy was generally perceived as relevant to their rehabilitation and rated as influential in terms of improving physical and psychological condition as well as sociability. The qualitative analysis identified five main categories being “Successful coping and positive mood”, “Challenge and coping strategies”, “Self-reflection and self-perception”, “Social experiences and belaying” and “Letting go of worries and being in the moment”. Conclusion: The results support previous findings on the benefits of TC and highlight its relevance as a therapeutic tool. Participants with mental disorders reported various positive experiences, emphasizing the unique demands, motivational aspects and social context of climbing. Further high-quality research is needed to compare climbing’s potential with other therapeutic sports across different target groups.

Cost-effectiveness of using granulocyte colony-stimulating factor in the treatment of uterine body leiomyosarcomas. A retrospective analysis

Background. The main approach in the treatment of patients with uterine leiomyosarcoma is surgery followed by chemotherapy, which is the basis of treatment. Febrile neutropenia (FN) is a life-threatening condition, so the use of granulocyte colony-stimulating factor (G-CSF) after each cycle of chemotherapy in this category of patients remains an integral part. Aim. To evaluate the pharmacoeconomic efficacy of the use of short and long-acting G-CSF forms in a round-the-clock inpatient facility (RIF). Materials and methods. A retrospective analysis of economic expenditures was performed at the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine in the RIF setting for the period from January 2018 to December 2023 for the treatment of 62 patients with high-grade uterine leiomyosarcomas of stage IB–IVA according to the classification of the International Federation of Gynecology and Obstetrics (2009). All patients underwent surgical treatment, complete hysterectomy with appendages, followed by antitumor drug therapy with a high risk of FN. In the economic cost analysis, the treatment regimens gemcitabine 900 mg/m2 on day 1 and day 8 + docetaxel 100 mg/m2 + empegfilgrastim (regimen code sh1207.1) and gemcitabine 900 mg/m2 on day 1 and day 8 + docetaxel 100 mg/m2 + filgrastim (regimen code sh1070) were compared. The costs of clinical blood tests and staying in RIF were also considered. Results. The stay in the RIF was 9 bed days with a long-acting G-CSF regimen and 15 days with a short-acting G-CSF regimen. When using a treatment regimen with filgrastim in 6 patients, the number of bed days increased to 18 due to persistent neutropenia. No FN events were reported. The calculations consisted of the cost of a bed day in the RIF (1,660 rubles) and purchasing of short- and long-acting G-CSF, without the cost of the main therapy. The costs of treating patients with short-acting G-CSF were comparable to those with long-acting G-CSF. Conclusion. The regimen with long-acting G-CSF is effective, easy to use, and cost-effective in RIF settings.

Reduction in Restraint and Critical Incidents in a Norwegian Residential Treatment Facility for Children Aged 7–13 Following the Implementation of the Neurosequential Model of Therapeutics

In child and adolescent inpatient, residential and day-treatment facilities, the use of physical restraints and the occurrence of critical incidents are a significant problem. Restraints may sometimes be necessary if a child exhibits dangerous aggressive behavior, but may also be misused or overused, and have been shown to be preventable in many cases. This study aims to investigate if the implementation of the Neurosequential Model of Therapeutics (NMT) has an effect on the annual number of physical restraint incidents in a residential treatment facility for children with complex mental health disorders. Data before and after NMT implementation were collected from the agency’s restraint records. The results showed that post-NMT implementation, there was a substantial and sustained reduction in restraint incidents, with a Cohen’s d value of 2.03, indicating a very large effect. Limiting restraint use in treating children with complex mental health disorders can foster a safer and more therapeutic environment, with potential improvements in treatment outcomes. This study demonstrated a substantial drop in restraint incidents following the implementation of the Neurosequential Model in a residential facility for children aged 7–13. This reduction is presumably pivotal for children with complex mental health disorders, making treatment less coercive and offering promise for settings in which restraint incidents are a concern.

A retrospective analysis of a clinician-initiated high-intensity locomotor training implementation project in an inpatient rehabilitation facility.

The Academy of Neurologic Physical Therapy's Intensity Matters campaign recommends the implementation of high-intensity locomotor training for all patients with neurologic dysfunction with goals to improve walking. Retrospectively determine the effectiveness of a clinician-initiated implementation project on the adoption, reach, and fidelity of high-intensity locomotor training for patients with stroke during inpatient rehabilitation and, determine whether the project led to changes in patient outcomes. Retrospective analysis of electronic medical records from 1 year before and after the project. Patients admitted with a stroke diagnosis were included. Demographic information, the number of high-intensity sessions, the percentage of time spent in the target heart rate zone, standardized assessment scores for motor function, functional mobility, balance, gait speed and endurance, and discharge destination were extracted for descriptive and linear mixed model analysis. Clinician reach was 75%, and adoption of high-intensity training varied between clinicians from 47.1% and 83.3%. Of eligible patients, 55% received the target intervention at least once, reflecting the patient reach. Implementation fidelity was 18.84%. Linear mixed effects modeling revealed a statistically significant effect of time (p < .001) but not group allocation or group × time interaction. Although statistically significant differences in patient outcomes compared to pre-implementation were not found, results highlight the limitations associated with adopting high-intensity locomotor training for patients post-stroke in this setting .It remains unclear whether the implementation fidelity achieved was sufficient to impact patient outcomes. Further research is needed to establish fidelity targets and identify barriers to successful implementation projects by clinicians.

Bimanual Arm Trainer Versus Traditional Occupational Therapy Services in Upper Extremity Function.

Upper extremity (UE) dysfunction resulting from stroke significantly affects a person's ability to complete self-care activities, consequently diminishing functional independence. Effective interventions that improve UE function in persons with stroke are needed. To explore the effectiveness of the Bimanual Arm Trainer (BAT) compared with traditional occupational therapy treatment sessions (i.e., a control group) on improving UE function after acute ischemic stroke. Clinical trial, two-group, nonrandomized repeated-measures design. Inpatient rehabilitation facility. Twenty-seven persons with ischemic stroke and an Action Research Arm Test (ARAT) score ≤17. Minimum of three 10-min sessions on the BAT. ARAT, Upper Extremity Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). Both the intervention and control groups showed significant improvement on the ARAT from evaluation to discharge (main effect of time: p = .02). There was no statistically significant main effect of group and no significant Time × Group interaction (p = .63). FMA-UE scores also improved significantly in the intervention group from evaluation to discharge (p < .001). FMA-UE scores were not available for the control group. Both the intervention and control groups demonstrated significant improvements in UE function from evaluation to discharge. There were no statistically significant differences between groups, indicating that the BAT results in similar improvements in UE function, as would be expected in traditional occupational therapy. Further research is warranted to examine additional BAT programs, use different outcome measures, and assess participants over a longer time span. Plain-Language Summary: The Bimanual Arm Trainer (BAT) is a novel device that can be used in occupational therapy to improve arm function among stroke patients. There is limited research on BAT's effectiveness in improving arm function among stroke patients. In an acute inpatient rehabilitation setting, we compared outcome scores of patients who received traditional occupational therapy services with those who also used the BAT. Both groups achieved significant improvements in arm function from evaluation to discharge. We found that the addition of the BAT interventions did not significantly affect the outcome measure scores for either group. We conclude that more research is needed to examine additional BAT programs, use different outcome measures, and assess participants over a longer period of time.

Communication-oriented group therapy for non-progressive dysarthria: A randomised controlled trial in an inpatient setting

Purpose To examine the effectiveness of communication-oriented group therapy for non-progressive dysarthria regarding functional speech and communicative participation. Method Prospective two-arm randomised controlled trial, targeting communication-oriented dysarthria group therapy (DGT). A non-specific social group program served as the control condition/group (CG). Participants’ speech was assessed immediately before and after completing the respective three week program, using a standardised diagnostic test (objective outcome measure). Participants rated the extent of their communication participation immediately before and after group therapy, as well as three months after program completion (subjective outcome measure). Result Fifty-six persons aged 40–88 years with mild to severe dysarthria (median duration 29 days) from an inpatient facility participated. Prior to the intervention, self-rated communication participation correlated with severity of dysarthria. Immediately after the intervention, DGT participants achieved significantly higher scores than the CG on both outcome measures. After three months, the difference between groups in the subjective outcome measure was no longer significant. Conclusion Participation in DGT resulted in improved speech and better communication participation. Results suggest that three weeks may be too short to ensure maintenance of treatment gains. Also, reduced opportunity for social interaction due to COVID-19 restrictions may have influenced the results.

Efficacy of continuous passive motion compared to physiotherapy in rehabilitation after total knee replacement: a prospective randomized controlled non-inferiority trial.

Successful total knee replacement (TKR) heavily depends on postoperative rehabilitation. This study aims to investigate the efficacy of continuous passive motion (CPM) partially replacing group physiotherapy in an inpatient rehabilitation setting in order to contribute to the lack of physiotherapists in patients' care. Adult patients after TKR were included. A prospective randomized controlled two-center trial was conducted across inpatient rehabilitation facilities in Germany. Participants were randomly assigned to CPM or group physiotherapy. In addition, all participants received the same standard rehabilitation program. Primary outcome was the Staffelstein Score, and secondary outcome measures included Oxford Knee Score, range of motion (ROM), pain, and return to work. Non-inferiority margin for Staffelstein Score was set at ±5% of maximum scores based on previous collected data. Results indicate no significant differences between CPM and physiotherapy groups in the Staffelstein Score (CPM: 94 ± 10 points; group physiotherapy: 92 ± 10 points; P > 0.05), ROM, or pain management at discharge from rehabilitation facility. This study underscores the potential of CPM as a valuable component of TKR rehabilitation, providing comparable outcomes to traditional physiotherapy. However, individualized physiotherapy remains integral to optimizing long-term success. Future research should explore extended follow-up periods and diverse patient populations to further elucidate CPM's role in TKR rehabilitation.

Examining the Receptivity to Tobacco Treatment Information for Individuals Living With Mental Illnesses: A Mixed Method Study.

People living with mental illnesses (MI) have a specific need that requires tailored tobacco treatment (TT) information to be delivered in a desirable, appropriate, and acceptable manner to increase their receptivity. In this mixed-method study, we aimed to develop tailored TT pamphlets for people with MI. In Phase I, we explored perspectives on tailored TT information from mental health providers (MHPs) and individuals with MI. In Phase II, we assessed the desirability, applicability, and acceptability of the developed tailored TT pamphlets. Semistructured interviews were used to obtain qualitative and quantitative data from 16 MHPs and 13 individuals with MIs recruited from an inpatient psychiatric facility. Thematic analysis and descriptive statistics were used to synthesize the data. The study guides the development of effective approaches, presentations, and content to enhance TT engagement for people with MI. The proposed tailored TT pamphlets proved desirable, applicable, and acceptable for individuals with MI. We recommend developing tailored TT information for people with MI in collaboration with MHPs and the target audience. Clear, concise communication is crucial, ensuring desirability, applicability, and acceptability. Further research should identify effective approaches and evaluate tailored TT materials to enhance program effectiveness.

Crafting the Future of Community-Based Medical Rehabilitation: Exploring Optimal Models for Non-Inpatient Rehabilitation Services through a Narrative Review.

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations.

Rehabilitation Transition Program to Improve Community Participation Among Stroke Survivors

Interventions are needed to support the long-term needs of stroke survivors when they transition from inpatient rehabilitation to home, where they face new home and community environmental barriers. To compare the efficacy of a novel, enhanced rehabilitation transition program with attentional control to improve community participation and activity of daily living (ADL) performance and to reduce environmental barriers in the home and community after stroke. This phase 2b, parallel randomized clinical trial assessed patients 50 years or older who had experienced an acute ischemic stroke or intracerebral hemorrhage, were independent in ADLs before stroke, and planned to be discharged home. Patients were assessed at an inpatient rehabilitation facility in St Louis, Missouri, and their homes from January 9, 2018, to December 20, 2023. Community Participation Transition after Stroke (COMPASS), including home modifications and strategy training. The primary outcome was community participation (Reintegration to Normal Living Index). Secondary outcomes were daily activity performance (Stroke Impact Scale ADL domain and the In-Home Occupational Performance Evaluation [I-HOPE] activity, performance, and satisfaction scores) and environmental barriers in the home (I-HOPE environmental barriers score). A total of 185 participants (mean [SD] age, 66.3 [9.0] years; 105 [56.8%] male) were randomized (85 to the COMPASS group and 100 to the control group). The COMPASS and control participants experienced similar improvements in community participation by 12 months, with no significant group (mean difference, 0.3; 95% CI, -4.6 to 5.2; P = .91) or group × time interaction (between-group differences in changes over time, 1.3; 95% CI, -7.1 to 9.6; P = .76) effects. Improvements in I-HOPE performance and satisfaction scores were greater for COMPASS participants than control participants at 12 months (between-group differences in changes for performance: 0.39; 95% CI, 0.01-0.77; P = .046; satisfaction: 0.52; 95% CI, 0.08-0.96; P = .02). The COMPASS participants had greater improvements for I-HOPE environmental barriers than the control participants (P = .003 for interaction), with the largest differences at 6 months (between-group differences in changes: -15.3; 95% CI -24.4 to -6.2). In this randomized clinical trial of stroke survivors, participants in both groups experienced improvements in community participation. COMPASS participants had greater improvements in self-rated performance and satisfaction with performing daily activities as well as a greater reduction in environmental barriers than control participants. COMPASS reduced environmental barriers and improved performance of daily activities for stroke survivors as they transitioned from inpatient rehabilitation to home. ClinicalTrials.gov Identifier: NCT03485820.

Are Suicide-Specific Interventions Required to Reduce Suicidal Ideation? An Empirical Examination in a Clinical Sample of Eating-Disorder Participants

In this research, we examined whether non-suicide-specific treatments effectively reduced suicidal ideation (SI) among a clinical sample of eating-disorder (ED) patients ( N = 3,447, of whom 50.9% presented with SI). All participants met criteria for a current ED diagnoses based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders and were administered a combination of evidence-based treatments in inpatient, residential, partial hospitalization, and intensive outpatient ED treatment facilities. Mediation analyses tested whether SI at discharge decreased specifically through standardized residual change scores in ED symptoms. Both SI and ED symptoms decreased over the course of treatment without clinically meaningful differences by ED diagnosis. ED symptom improvement partially mediated the relationship between SI at admission and discharge, suggesting that treating ED symptoms with evidence-based treatments can be an effective way to reduce SI, at least partially, for many patients. These findings demonstrate the importance of facilitating evidence-based-treatment referrals for specific disorders as a component of broad-based suicide outreach and prevention strategies.

Factors associated with colon cancer fragmentation in the Keystone state.

120 Background: Fragmentation of cancer care delivery across multiple providers can impact care quality and patient outcomes. Management of non-metastatic colon cancer often involves adjuvant chemotherapy, which increases the risk of potentially deleterious care dispersion. This study assesses the extent of care fragmentation across different inpatient facilities and examines patient characteristics associated with inpatient care fragmentation. Methods: We adapt the modified Herfindahl-Hirschman market concentration index to construct a Fragmentation Index (FI) capturing the distribution of a patient’s care across inpatient facilities. For patients who underwent oncologic surgery for colon cancer from 2010-2016, we calculate FI for the 15 months post-diagnosis if at least 2 admissions occur during the study period. We use Pennsylvania Cancer Registry data linked to all-payer statewide facility discharge records to estimate the relationship between FI and patient demographics, rurality, area deprivation index (ADI), and payer status using adjusted multivariable linear regression models. Results: For the operative cohort (28.6% Stage I, 34.7% Stage II, 36.7% Stage III, n = 7803), 86% of patients lived in urban areas, 9.5% in large towns and 5% in rural areas. 60% had Medicare, 6.1% Medicaid and 7.1% were uninsured or had unknown payer status. 52% of patients were female and 87% were non-Hispanic White. The overall mean FI was 0.192; 60% (n = 4693) had an FI of 0, indicating all admissions were at the same hospital, and among those with FI&gt; 0 (n = 3110), mean FI was 0.483. The mean FI for patients potentially eligible for adjuvant chemotherapy (Stage II, III) was 0.188: 61% of patients had an FI of 0 and among those with FI &gt; 0 (n = 2173), mean FI was 0.482. Stratification by stage reveals similar proportions of FI &gt; 0.5 (stage I: 24.6%, stage II: 22.3%, stage III: 21.3%). Increased care dispersion was observed in patients from large towns (ΔFI 0.04, CI 0.03—0.06) or rural areas (ΔFI 0.04, CI 0.02—0.08) relative to urban areas, as well as for patients with relatively higher number of hospitalizations (ΔFI 0.04, CI 0.03—0.04). Less care dispersion was seen in patients with stage III disease (relative to stage I ΔFI -0.02, CI -0.03 — -0.01), uninsured status (relative to private insurance ΔFI -0.03, CI -0.05 – -0.01) or residence in the most disadvantaged ADI quartile (relative to Q1 ADI ΔFI -0.02, CI -0.04 — 0.00). Conclusions: Among patients with operatively managed colon cancer, slightly more than half did not experience inpatient care fragmentation. As expected, a higher number of total admissions and non-urban residence were associated with increased inpatient care dispersion. However, our findings of more concentrated care among patients with stage III disease, higher levels of relative economic disadvantage, and uninsured status suggest potentially complex and divergent forces driving hospital selection, to be explored in future work.

Predictive Value of Diaphragm Muscle Ultrasound for Ventilator Weaning Outcomes After Cervical Spinal Cord Injury: A Retrospective Case Series.

Neuromuscular respiratory failure after cervical spinal cord injury (cSCI) can lead to dependence on an invasive mechanical ventilator. Ventilator-free breathing after cSCI is associated with improved morbidity, mortality, and quality of life. We investigated the use of diaphragm muscle ultrasound to predict ventilator weaning outcomes after cSCI. This is a retrospective case series conducted at a university-affiliated freestanding inpatient rehabilitation facility. We identified patients with cSCI who had a tracheostomy and were dependent on an invasive mechanical ventilator at the time of admission to inpatient rehabilitation. A diaphragm muscle ultrasound was performed, which included measurements of the thickness of the diaphragm and a calculation of the thickening ratio (TR), which reflects diaphragm muscle contraction. The primary outcome measure was the need for mechanical ventilation at time of discharge from the inpatient rehabilitation facility. Successful ventilator weaning was defined as either daytime or full 24-hour ventilator-free breathing. Of the 21 patients enrolled, 11 (52%) were able to wean successfully (partially or fully) from the ventilator. Of the ultrasound measurements that were taken, the TR was the optimal predictor for ventilator weaning outcomes. A threshold of TR ≥ 1.2 as the maximum hemidiaphragm measurement had a sensitivity of 1.0 and specificity of 0.90 for predicting ventilator weaning. Normal diaphragm contractility (TR ≥ 1.2) as determined by diaphragm muscle ultrasound is a strong positive predictor for successful ventilator weaning in patients with cSCI. Utilizing diaphragm ultrasound, rehabilitation physicians can set precision rehabilitation goals regarding ventilator weaning for inpatients with respiratory failure after cSCI, potentially improving both outcomes and quality of life.

Impact of functional recovery on patients having heart surgery.

To describe the results of a program developed to manage institutional postacute care (IPAC) (postacute skilled nursing, inpatient rehabilitation facility, and long-term acute care) in a CMS Bundled Payments for Care Improvement (BPCI) project for coronary artery bypass graft (CABG) surgery. We compared pre- and postutilization patterns during a 3-year period by evaluating risk-adjusted national, state, and other BPCI participant comparisons using a difference-in-differences (DID) analysis in a large urban community tertiary center with a CABG surgery program. Included in the analysis were all Medicare patients receiving CABG surgery at the institution (n = 504), across the nation (n = 213,423), and at other BPCI institutions (n = 4939). The intervention included (1) use of a standardized tool for evaluation and prognostication of patient placement, (2) programmatic changes to manage patient functional recovery, and (3) patient and family engagement in postacute placement and functional recoveryplan. Physical therapist/occupational therapist time with patients who had undergone CABG surgery increased by more than 179% between the pre- and postintervention periods. This was associated with a 41.2% and 51.6% decline in IPAC use at the institution on an observed basis and adjusted basis, respectively. DID comparison demonstrated a 14.40% (95% CI, -19.30% to -9.60%) greater reduction at the target hospital than at other participating BPCI hospitals. A strong association exists between a focused patient functional recovery program and IPAC use reduction after CABG surgery. Using a structured approach to clinical analytics and hypothesis testing of redesign efforts when managing postacute care populations removes waste from care delivery.

Oncology care model cost data for breast, lung, and multiple myeloma: Influence of outpatient rehabilitation therapy services.

14 Background: High value cancer care is defined by access to coordinated, appropriate healthcare services that achieve optimal outcomes at a reasonable cost. Evidence supports outpatient cancer rehabilitation (physical, occupational or speech therapy) as a mechanism to improve outcomes such as health-related quality of life, suggesting that integration of these services is beneficial for cancer survivors. However, the impact of outpatient rehabilitation services on healthcare costs is unknown. We aimed to compare cost segments between those who attended community-based outpatient rehabilitation therapy services (Rehab) versus those who did not (Non-rehab). We hypothesized that healthcare costs would be lower for the Rehab group in the following cost segments: emergency department (ED), part D drugs, home health services, skilled nursing facility services (SNF), inpatient rehabilitation facilities (IRF), and hospice. Methods: This is a retrospective cohort study of Medicare beneficiaries who received chemotherapy at a large community oncology practice that participated in the oncology care model (OCM) program from 2018 to 2021. Two data sources were linked, OCM cost data and the rehabilitation medical record. This yielded sufficient sample sizes for analysis of breast, lung, or multiple myeloma (MM) cancer types. Rehab cases were then matched to Non-rehab cases 3:1 based on cancer type, stage, and sex. Cost variables included total cost of care (TCOC) and cost segments using OCM methodology. Mann-Whitney-Wilcoxon statistic (p&lt;.05) was used for analysis. Results: Cases (N=3,033) primarily had early-stage cancer (0 to 2, 74.8%) and were 70.4±7.3 (Rehab) or 71.6±8.5 years old at diagnosis (Non-rehab). Most had breast cancer (81.2%), followed by lung cancer (11.7%) and MM (7.2%). TCOC was $32,387 and $26,257 for the Rehab and Non-rehab groups, respectively. Costs were significantly lower for the Rehab group in five of the six segments analyzed; IRF costs were lower, but not statistically significant (Table). Conclusions: To our knowledge, this is the first study to explore the influence of real-world, outpatient cancer rehabilitation therapy services on the cost of cancer care. Community-based therapy services were associated with significantly lower costs in ED, part D drugs, home health, SNF, and hospice segments. Future studies examining rehabilitation services as a relatively low-cost supportive care option to meet patient needs and enhance high-value care are warranted. Healthcare segment costs for rehab vs. non-rehab cases. Rehab Non-rehab Between-group Difference Mean, (SD) Mean (SD) p-value ED $85 (260) $104 (372) .019 Part D drugs $4,813 (18,221) $5,675 (18,797) &lt;.001 Home health $433 (1,600) $705 (2,118) &lt;.001 SNF $160 (1,988) $386 (3,943) .046 Hospice $75 (770) $198 (1,529) &lt;.001 IRF $245 (2,275) $384 (3,277) .434

International comparison of hospitalizations and emergency department visits related to mental health conditions across high-income countries before and during the COVID-19 pandemic.

To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high-income countries before and during the COVID-19 pandemic. Administrative patient-level data between 2017 and 2020 of eight high-income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US). Multi-country retrospective observational study using a federated data approach that evaluated age-sex standardized rates of hospitalizations and ED visits for mental health conditions. There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre-COVID-19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID-19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France. The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID-19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID-19 preparedness, and community-based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high-income countries, with substantial differences in access to effective care. The COVID-19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high-income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross-country differences in acute care management of mental health conditions coinciding with the onset of the COVID-19 pandemic.

Potentially Inappropriate Medications and De-prescribing: An Audit of STOPP/START on an Inpatient Rehabilitation Ward

Abstract Background Polypharmacy is well recognized in older adults with many adverse outcomes. Practical tools, such as the ‘STOPP/START’ criteria, aid clinicians in de-prescribing to tackle medication related morbidity. Current research suggests these tools are insufficiently implemented in clinical practice (1). Many older adults require rehabilitation after acute hospital admissions which can provide an ideal setting for medication review and de-prescribing. Methods A retrospective audit was carried out of 35 older adults in a gerontological inpatient rehabilitation facility between 8th February and 8th April 2024. Demographic and clinical data was collected using electronic and handwritten patient records. Each patients’ medication prescription was reviewed from date of admission to rehabilitation facility. Number of medications prescribed was recorded. Using the ‘STOPP/START’ criteria, potentially inappropriate medications (PIMs were identified, and de- prescribing was noted for the PIM where taken. Results 35 patients were included in the study. No patient was excluded. Mean age was 86.14 years and mean number of prescribed medications per patient was 11. The most common presenting complaint was a fall in 57.14% of patients, in which 95% had acute fracture. Other presenting complaints for acute admission included delirium and infection. Mean clinical frailty score was 5.71. 38 PIMswere identified, totalling 10% of all medication prescriptions. Of these, 12 de-prescribing opportunities were taken, one of which was a dose reduction. The most common PIMswere prescribing of PPI at full therapeutic dose (n=12), inappropriate opioid prescribing (n=4) and hypnotics (n=7) in high-risk groups. Conclusion Polypharmacy and PIMsare common in older adults and are related to adverse outcomes, especially in frail adults at risk of falls, fracture, and delirium. The rehabilitation setting is an ideal location for use of de-prescribing tools however their implementation varies. This may be improved by education and structured medication review in collaboration with trained pharmacists.