Inpatient Facilities Research Articles

Overview of Post-acute and Long-term Care Providers and Services Users in the United States, 2020.

This report presents national results from the National Post-acute and Long-term Care Study to describe providers and services users in seven major settings of paid, regulated post-acute and long-term care services in the United States. Data are from the 2020 National Post-acute and Long-term Care Study, which includes surveys of adult day services centers and residential care communities and administrative data from the Centers for Medicare and Medicaid Services on home health agencies, hospices, inpatient rehabilitation facilities, long-term care hospitals, and nursing homes. The findings show variation in characteristics of the seven post-acute and long-term care settings. About 68,150 providers served roughly 7.3 million people in the United States; about one-half of these providers were residential care communities, and about one-quarter were nursing homes. The Northeast had a higher percentage of adult day services centers than other settings, the Midwest had a higher percentage of nursing homes, the South had a higher percentage of long-term care hospitals, and the West had a higher percentage of residential care communities. Among the settings, more registered nurses were employed in inpatient rehabilitation facilities and long-term care hospitals, and more licensed practical nurses in home health agencies and long-term care hospitals. The most common services were skilled nursing and therapeutic services. Adult day services centers had the highest percentage of users younger than age 65, while nearly one-half of hospice and nursing home users were age 85 and older. Adult day services centers had the highest percentage of other non-Hispanic and Hispanic users among the settings. The percentage of users with selected diagnoses and activities of daily living difficulties varied by setting. The providers described in this report comprise a large share of the U.S. post-acute and long-term care industry. This report provides the most recent nationally representative information on these providers and services users and updates findings from previous National Center for Health Statistics reports.

Physical and Cognitive Function Trends in Post-acute Care after Total Joint Arthroplasty in Medicare Beneficiaries: 2013-2018

ObjectivesPhysical and cognitive conditions of patients discharged to skilled nursing facilities (SNFs), inpatient rehabilitation facilities (IRFs), and home with home health agencies (HHAs) following total joint arthroplasty (TJA) have not been evaluated. The purpose of this study is to examine the physical and cognitive function trends of Medicare beneficiaries discharged to SNFs, HHAs, and IRFs following TJA from 2013 to 2018. DesignObservational study using Medicare enrollment, claims, and assessment data from 2013–2018. Setting and Participants1,278,939 Medicare beneficiaries discharged to SNFs, HHAs, or IRFs for post-acute care following TJA from 2013 to 2018. MethodsMedicare data were used to examine the association between the endpoints of interest [discharge destination (SNF, HHA, or IRF) and the physical (measured using activities of daily living) and cognitive (measured using a range of setting-specific metrics) status of patients in each setting] and the year of TJA (2013–2018) by estimating multivariable models that controlled for patient- and hospital-level covariates. ResultsMultivariable analysis of 1,278,939 TJAs revealed that SNF discharge decreased [44.15% (2013)–21.57% (2018), P < .001], HHA increased (46.72%–72.47%, P < .001), and IRF decreased (9.13%–5.69%, P < .001). For SNF, the mean physical function scores [14.61 (2013)–14.23 (2018), P < .001] and cognitive impairment (13.25%–12.33%, P = .01) decreased, indicating less dependence. Physical function scores (3.09–3.94, P < .001) and cognitive impairment (13.95%–16.52%, P < .001) increased for HHA patients, indicating greater dependence. For IRF, motor functional independence measure decreased (38.81–37.78, P < .001) and cognitive dependence increased (39.08%–46.36%, P < .001), indicating greater dependence. Conclusions and ImplicationsFrom 2013 to 2018, patients were increasingly discharged to HHA. Although SNF patients were less dependent over time, HHA and IRF patients were physically and cognitively more dependent. Each setting is likely to benefit from policy and fiscal supports that help them manage changes in the volume and clinical intensity of patients requiring their services.

Clinical cut-off scores for the Borderline Personality Features Scale for Children to differentiate among adolescents with Borderline Personality Disorder, other psychopathology, and no psychopathology: a replication study

BackgroundDespite being one of the most popular measures of borderline pathology in adolescents, only one study has evaluated clinical cut-off scores for the Borderline Personality Features Scale for Children (BPFS-C) using a small sample without a healthy comparison group (Chang B, Sharp C, Ha C. The Criterion Validity of the Borderline Personality Features Scale for Children in an Adolescent Inpatient Setting. J Personal Disord. 2011;25(4):492–503. https://doi.org/10.1521/pedi.2011.25.4.492.). The purpose of the current study was to replicate and improve on the limitations of the prior study conducted by Chang et al. to more definitively establish clinical cut-off scores for the self- and parent-report versions of the BPFS-C to detect clinical and sub-clinical borderline personality disorder (BPD) in a large sample of adolescents with BPD, other psychopathology, and no psychopathology.MethodsA total of 900 adolescents ranging from ages 12–17 participated in this study. The clinical sample consisted of 622 adolescents recruited from an inpatient psychiatric facility, and the healthy control sample consisted of 278 adolescents recruited from the community. All participants completed the BPFS-C and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD).ResultsUsing three-way ROC analyses, cut-off scores on the self- and parent-report versions of the BPFS-C distinguishing adolescents with BPD from those with subclinical BPD, and those with subclinical BPD from healthy adolescents were established.ConclusionsThese findings support the use of both versions of the BPFS-C to detect adolescents with BPD and sub-clinical BPD.

Implementing workplace health promotion in nursing – A process evaluation in different care settings

ObjectiveWorkplace health promotion (WHP) in Germany is receiving increasing support from health insurance funds. Nevertheless, there is hardly any knowledge on the process of how health outcomes are achieved, especially in nursing. The aim of the study was to find out how and what can be implemented in different care settings and to examine the reactions and interactions of the participants under routine conditions.MethodsGuided by a logic model, a holistic WHP approach was implemented in four acute care hospitals, seven inpatient care facilities and four outpatient care services from April 2021 to October 2022. Data on realized WHP interventions, participant assessment and topics of work design was collected and analyzed descriptively.ResultsThe realized WHP interventions were adapted depending on the content and context. Mainly short relaxation interventions were delivered or those with an event character were received by participants. The highest participation rate of planned participants was achieved in team building training. Participants predominantly assessed WHP interventions as useful, the quality as (very) good and were generally (very) satisfied with the intervention components. For work design topics, intentions for the design of work organization were mainly documented in action plans.ConclusionCooperation with practitioners in research should be continued as a contribution to quality development. This could provide suggestions as to which content adjustments lead to greater acceptance by the target group in a specific context.Trial registrationThe project was registered in the German Clinical Trial Register (DRKS00024961, 2021/04/09).

Agreement of activity monitors for assessment of patients with sub-acute stroke in an inpatient rehabilitation facility

Purpose Determine the level of agreement of three activity monitors compared with the gold standard (video review) on the activity level of patients with stroke. Methods A prospective, observational, agreement study was performed on 47 individuals with sub-acute stroke in an inpatient rehabilitation facility. Data was collected during one physical therapy session. Individuals wore three device types; Actigraph (AG), Activpal (AP), and stepwatch activity monitor (SAM). Variables assessed were step counts for each limb (hemiparetic and non-hemiparetic) and percent time standing and other. Analysis Results from the activity monitors were compared to the video review and assessed for agreement using the intraclass correlation coefficient (ICC) and accuracy of mean difference from video observation. Results The step counts with the SAM on the non-hemiparetic limb had the highest ICC for step counts (ICC = 0.98, p < 0.001) and were overestimated with 21% accuracy. The SAM on the hemiparetic limb had 9.7% accuracy (ICC = 0.92, p < 0.001). For percent standing time all devices overestimated with poor reliability. For percent other activity time, the AP had the best accuracy and underestimated for both the hemiparetic limb (9.9% accuracy; ICC = 0.90, p < 0.001) and non-hemiparetic limb (8.3% accuracy; ICC = 0.84, p < 0.001). Conclusions The use of multiple devices may be warranted to capture an accurate understanding of activity levels in this population of individuals with sub-acute stroke. There are concerns with all monitors and clinicians and researchers should be aware of what measures they are wanting to understand about their population.

Psychologists engaging with people with psychosis in institutions: an interpretive phenomenological study

ABSTRACT Background The number of psychologists working in state hospitals has declined while the needs of patients with psychosis have increased. Prior research has focused on institutional and patient experiences but has rarely explored the experiences of providers in this level of care. Methods This study analyzed and described the experiences of eight licensed psychologists in the United States at inpatient psychiatric facilities engaging with people with psychosis. Interpretative Phenomenological Analysis was used to address the research question: How do licensed clinical psychologists describe and understand their experiences working with patients with psychosis at inpatient psychiatric facilities? Results The research identified four group experiential themes: (i) exposure to inpatient settings and patients with psychosis changed career trajectories; (ii) identification with and differentiation from patients; (iii) early experiences of extreme states in participants and others; (iv) a fundamental spiritual component orienting participants’ work. Discussion Institutional barriers to professional and clinical success persist via the lack of doctoral training and effective supervision with SMI. Therefore, this study recommends doctoral programs, the American Psychological Association, and licensure boards substantially improve their engagement with and support for students and psychologists in inpatient settings working with patients with psychosis.

Convalescent Plasma and Other Antibody Therapies for Infectious Diseases-Lessons Learned from COVID-19 and Future Prospects.

Antiviral passive antibody therapy includes convalescent plasma, hyperimmune globulin, and monoclonal antibodies. Passive antibodies have proven effective in reducing morbidity and mortality for SARS-CoV-2 and other infectious diseases when given early in the disease course with sufficiently high specific total and neutralizing antibody levels. Convalescent plasma can be delivered to patients before vaccination implementation or novel drug production. Carefully designed and executed randomized controlled trials near the pandemic outset are important for regulatory bodies, healthcare workers, guideline committees, the public, and the government. Unfortunately, many otherwise well-designed antibody-based clinical trials in COVID-19 were futile, either because they intervened too late in the disease or provided plasma with insufficient antibodies. The need for early treatment mandates outpatient clinical trials in parallel with inpatient trials. Early outpatient COVID-19 convalescent plasma transfusion with high antibody content within 9days of symptom onset has proven effective in blunting disease progression and reducing hospitalization, thus reducing hospital overcrowding in a pandemic. Convalescent plasma offers the opportunity for hope by enabling community participation in outpatient curative therapy while monoclonal therapies, vaccines, and drugs are being developed. Maintaining the appropriate infrastructure for antibody infusion in both outpatient and inpatient facilities is critical for future pandemic readiness.

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BackgroundKerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.MethodsWe conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.ResultsA total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.ConclusionThe ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

Hospitals' strategies to reduce costs and improve quality: survey of hospital leaders.

Hospitals in the US operate under various value-based payment programs, but little is known regarding the strategies they use in this context to improve quality and reduce costs, overall or in voluntary programs including Bundled Payments for Care Improvement Advanced (BPCI-A). A survey was administered to hospital leaders at 588 randomly selected acute care hospitals, with oversampling of BPCI-A participants, from November 2020 to June 2021. Twenty strategies and 20 barriers were queried in 4 domains: inpatient, postacute, outpatient, and community resources for vulnerable patients. Summary statistics were tabulated, andresponses were adjusted for sampling strategy andnonresponse. There were 203 respondents (35%), of which 159 (78%) were BPCI-A participants and 44 (22%) were nonparticipants. On average, respondents reported implementing 89% of queried strategies in the inpatient domain, such as care pathways or predictive analytics; 65% of postacute strategies, such as forming partnerships with skilled nursing facilities; 84% of outpatient strategies, such as scheduling close follow-up to prevent emergency department visits/hospitalizations; and 82% of strategies aimed at high-risk populations, such as building connections with community resources. There were no differences between BPCI-A and non-BPCI-A hospitals in 19 of 20care redesign strategies queried. However, 78.3% of BPCI-A-participating hospitals reported programs aimed at reducing utilization of skilled nursing and inpatient rehabilitation facilities compared with 37.6% of non-BPCI-A hospitals(P < .0001). Hospitals pursue a broad range of efforts to improve quality. BPCI-A hospitals have attempted to reduce use of postacute care, but otherwise the strategies they pursue are similar to other hospitals.

2159 Feasibility study: the use of the Edmonton frail scale in a psychiatric inpatient facility

Abstract Introduction Frailty is an important consideration in the health and wellbeing of older adults, particularly as it is associated with a risk of falls, and mental health difficulties such as depression. There has been no validation of frailty assessment tools among older adults with Psychiatric disorders. This was a feasibility study exploring the use of the Edmonton frail scale (EFS) among patients with highly complex mental health needs within a Psychiatric Inpatient Setting with a view to develop a service integration process leading to further research. Methods 45 participants were recruited from 8 older adult wards across Neuropsychiatry and Medium Secure divisions. EFS assessments were completed every six months by trained members of Multidisciplinary Teams over a 12-month period. Results: About 118 assessments were administered to approximately 45 patients, regardless of a patient’s length of stay at the hospital during the 12-month period. There was a 55% assessment completion rate. This was largely the result of difficulties in administering the cognitive domain of the EFS (Clock Drwing test) to patients with highly complex mental health needs, as the completion rate was 32%. It was also quite challenging for patients to understand and comply with the assessment instructions in the Functional Performance Domain (Timed Get Up and Go Test). As a result, many assessments in this domain were conducted through covert observation of patients’ movement during the course of the day. 29 of the 45 patients were found to have at least moderate level of frailty. Conclusion Older adults with psychiatric disorders may benefit from having an adapted assessment of the cognitive domain to promote complete administration of assessments. Prevalence of frailty is high in this setting. Continuous support towards staff engagement and education would be beneficial in promoting EFS use in determining frailty and integrating it into care planning.

Perceptions Toward Telemedicine of Health Care Staff in Nursing Homes in Northern Germany: Cross-Sectional Study.

Digitalization in the German health care system is progressing slowly, even though it offers opportunities for improvement of care. In nursing homes, most of the staff's work is paper based. Following the pandemic, there has been a decrease in the use of telemedicine applications. To ensure long-term implementation, the views of users, in this case nurses, are of interest. This cross-sectional study was conducted to describe which digital applications are already being used at inpatient care facilities, the attitude of nurses toward telemedicine, and for which areas the use of telemedicine in the facilities is considered appropriate by the participants. All inpatient care facility staff in Schleswig-Holstein were invited to participate in the survey from August 1 to October 31, 2022. The questionnaire consists of 17 determinants that ask about the attitude, use, and possible applications of telemedicine. In addition to a descriptive analysis, the influence of the general attitude toward telemedicine on various determinants was examined using the Fisher exact test for nominal variables and Spearman correlation coefficient for metric variables. A total of 425 caregivers participated in the survey. Of these respondents, 10.7% (n=41) currently used video consultations, and 76.1% (n=321) of the respondents were in favor of video consultations being practiced in training. Furthermore, 74.8% (n=312) of the respondents would attend a training on telephone medical consultation. Respondents indicated that video consultations have a small added value compared to asynchronous telemedicine (eg, sending photos). However, video consultations were perceived as somewhat less time-consuming than other communication channels. Video consultations are perceived as most useful for clarifying urgent problems. The respondents estimated that one in five paramedic calls at their facilities could be reduced through telemedicine approaches. It was important to the participants that telemedicine is as simple as possible and that there is a high level of data security. Although many caregivers have a positive attitude toward telemedicine and perceive its advantages, communication channels such as video consultation are still used infrequently in care facilities. To promote the use of telemedicine applications, it is important to emphasize their benefits. The presumed saving of paramedic calls thus represents a benefit, and it is crucial to train caregivers in the use of telemedicine to avoid uncertainties in dealing with the newer technologies. It is important to give them enough time and repetitions of the training.

Nonresponse Bias on Inpatient Rehabilitation Hospitals’ Experience of Care Quality Measure Scores

ObjectiveTo describe the magnitude of nonresponse bias on inpatient rehabilitation facility (IRF) experience of care survey data in patients with neurologic disorders. DesignCohort study of patients at 2 IRFs. Patients reported experience of care via an IRF-administered survey as part of routine operations approximately 2 weeks after discharge. A partially overlapping sample of research participants completed a similar survey approximately 2 weeks and 30 days after discharge. SettingTwo inpatient rehabilitation facilities. ParticipantsPatients aged ≥18 years with neurologic disorders who were discharged from 2 IRFs. InterventionsNone. Main Outcome MeasuresExperience of care data collected via an IRF Survey (self-report or proxy responses) and a Research Survey (self-report only). ResultsOf the 1055 patients admitted during the study period who met the age and diagnosis criteria, 490 (46.4%) completed one or both of the surveys. Of the 325 IRF Survey respondents, 202 were self-report, 99 were proxy respondents, and 24 were unknown respondents. Only patients completed the Research Survey (N=285). One hundred twenty patients completed both surveys, of which 7 were proxy IRF Survey respondents. IRF Survey respondents had higher cognitive function than nonrespondents; patients with spinal cord injuries were more likely to complete the IRF Survey than other patients. There were no differences in the proportions of patients answering favorably on the IRF Survey (all respondents) compared with the Research Survey, except for physician communication and discharge information. Mutual information analysis revealed agreement between the scores produced by the 2 data sources. ConclusionsThere were subtle, potentially important differences in quality measure results across surveys, reflecting the extent to which patients are encouraged to complete experience of care surveys. There was higher agreement on questions about global hospital perceptions than specific aspects of patients’ experience.

Methods for Estimating Costs for Stays at Inpatient Rehabilitation Facilities and Long-Term Care Hospitals

ObjectiveTo describe and compare 3 methods for estimating stay-level Medicare facility (Part A) costs using claims and cost report data for inpatient rehabilitation facilities (IRFs) and long-term care hospitals (LTCHs), the 2 hospital-based postacute care providers. DesignWe calculated stay-level facility costs using different methods. Method 1 used routine costs per day and ancillary cost-to-charge ratios. Method 2 used routine and ancillary cost-to-charge ratios (freestanding IRFs and LTCHs only). Method 3 used facility-specific operating cost-to-charge ratios from the Provider Specific File. For each method, we compared the costs with payments and charges at the claim and facility levels and examined facility margins. SettingData are from 1619 providers, including 266 freestanding IRFs, 909 IRF units, and 444 LTCHs. ParticipantsThe analyses included 239,284 claims from 2014, of which 86,118 claims were from freestanding IRFs, 92,799 claims were from IRF units, and 60,367 claims were from LTCHs. InterventionsNot applicable. Main Outcome MeasuresCosts and payments in 2014 United States Dollars. ResultsFor freestanding IRFs, the mean facility stay-level costs were calculated to be $13,610 (method 1), $13,575 (method 2), and $13,783 (method 3). For IRF units, the mean facility stay-level costs were $17,385 (method 1) and $19,093 (method 3). For LTCHs, the mean facility stay-level costs were $36,362 (method 1), $36,407 (method 2), and $37,056 (method 3). ConclusionsThe 3 methods resulted in small differences in facility mean stay-level costs. Using the facility-level cost-to-charge ratio (method 3) is the least resource-intensive method. Although more resource-intensive, using routine cost per day and ancillary cost-to-charge ratios (method 1) for cost calculations allows for differentiation in costs across patients based on differences in the mix of services used. As policymakers consider postacute care payment reforms, cost, rather than charge or payment data, needs to be calculated and the results of the methods compared.

A Role for Health Literacy in Protecting People With Limited English Proficiency Against Falling: A Retrospective, Cohort Study

ObjectiveTo identify risk factors related to falls within the scope of speech-language pathology (SLP) using assessments from the Inpatient Rehabilitation Facility-Patient Assessment Instrument over a 4-month period in 4 inpatient rehabilitation facilities (IRFs). DesignObservational retrospective cohort study. SettingFour IRFs as part of a larger learning health system. ParticipantsAdults aged ≥18 years admitted to the IRFs from October 1, 2022 to February 28, 2023 were included. InterventionN/A. Main Outcome MeasuresOccurrence of falls. ResultsAnalyses of 631 patient records revealed that the odds of falling were almost 3 times greater in people with limited English proficiency than in English speakers (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.09-6.85). People with limited English proficiency who reported poorer health literacy had 4 times higher odds of falling (OR, 3.90; 95% CI, 1.13-13.44) than English speakers who reported adequate health literacy. People with limited English proficiency who reported adequate health literacy had the same risk of falling as English speakers (OR, 0.98; 95% CI, 0.16-6.12), suggesting the protective role of health literacy for people with limited English proficiency. ConclusionsLanguage barriers have a significant effect on falls among patients in IRFs. SLPs improving health literacy and providing language support may play a crucial role in mitigating fall risk, thereby enhancing patient safety and outcomes.

Associations Between Rehabilitation Utilization and Out-of-Pocket Costs Among Older Adults With Breast Cancer in the United States

ObjectiveTo examine the association between rehabilitation utilization within 12 months of breast cancer diagnosis and out-of-pocket costs in the second year (12-24mo after diagnosis). DesignSecondary analysis of the 2009-2019 Surveillance, Epidemiology and End Results-Medicare linked database. Individuals who received rehabilitation services were propensity-score matched to individuals who did not receive services. Overall and health care service-specific models were examined using generalized linear models with a gamma distribution. SettingInpatient and outpatient medical facilities. ParticipantsA total of 35,212 individuals diagnosed with nonmetastatic breast cancer and were continuously enrolled in Medicare Fee-For Service (parts A, B, and D) in the 12 months before and 24 months postdiagnosis. InterventionNot applicable. Main Outcome MeasuresIndividual cost responsibility, a proxy for out-of-pocket costs, which was defined as deductibles, coinsurance, and copayments during the second year after diagnosis (12-24mo postdiagnosis). ResultsThe mean individual cost responsibility was higher in individuals who used rehabilitation than those who did not ($4013 vs $3783), although it was not a clinically meaningful difference (d=0.06). Individuals who received rehabilitative services had significantly higher costs attributed to individual provider care ($1634 vs $1476), institutional outpatient costs ($886 vs $812), and prescription drugs ($959 vs $906), and significantly lower costs attributed to institutional inpatient costs ($455 vs $504), and durable medical equipment ($81 vs $86). ConclusionsOlder adults with breast cancer who received rehabilitation services had higher cost responsibility during the second year after diagnosis than those who did not. Future work is needed to examine the relationship between rehabilitation and out-of-pocket costs across longer periods of time and in conjunction with perceived benefit.

Development of the comprehensive inpatient transfer tool: initial reliability and validity.

A new patient transfer assessment scale for use in inpatient rehabilitation facilities (IRFs) is warranted to assess level of assistance, adaptations needed for success, and movement strategies. This study presents initial psychometric analyses for the Comprehensive Inpatient Transfer Tool (CITT). CITT items were developed through interdisciplinary team discussions. Interrater reliability was assessed between blinded pairs of raters administering the CITT for each subject on the same day. Intrarater reliability was assessed with one rater administering the CITT for each subject twice within the same day. Thirty-six subjects in an IRF completed the CITT four times during their rehabilitation stay; three times at admission and once at discharge. Intraclass correlations (mixed models) were used in reliability and minimal detectable change (MDC) analyses. Spearman correlations of CITT and CITT change scores with their respective Functional Independence Measure (FIM) and Inpatient Rehabilitation Facility - Patient Assessment Instrument (IRF-PAI) transfer scores were performed for concurrent validity. Responsiveness was assessed using paired t-tests on change scores. Interrater and intrarater reliability ranged from 0.90 to 0.98. Correlations between the CITT and FIM/IRF-PAI ranged from 0.6 to 0.8. The MDC for CITT was 7.11 pts. Differences between admission and discharge CITT were significant (P < 0.001). The CITT, developed by an interdisciplinary team, addresses limitations of existing transfer measures utilized in IRFs. The CITT demonstrated excellent inter and intrarater reliability. Concurrent validity demonstrated modest agreement between existing transfer measures and the CITT. The CITT is a reliable, useful scale for evaluating transfer skills in patients admitted to an IRF.

Cyberbullying and Bullying Reports Among Youth in a Behavioral Health Inpatient Unit: Insights From Youth and Parent Intake Surveys.

BACKGROUND: Limited studies have examined the extent to which cyberbullying and offline bullying are factors related to youth admissions to behavioral health inpatient units. However, considering the rising use of technology and prevalence of youth bullying, intake procedures require adaptation to account for modern-day psychological pressures facing youth. AIMS: Our aims were to pilot and analyze results from a novel intake form, assessing offline bullying and cyberbullying, in a youth inpatient behavioral health facility. METHODS: Upon admission at an inpatient behavioral health facility in the Midwestern United States, 622 youth (ages 10 and older) and their parent/guardian completed intake forms including questions about their experience of bullying, cyberbullying, and feelings of safety in different environments, and feelings about whether bullying contributed to their inpatient admission. RESULTS: Overall, 21.50% (134/622) of youth self-reported being a cybervictim, 6.10% (38/622) reported being an offline bully victim, and 8.04% (50/622) reported mixed bullying. Bullied youth felt significantly less safe in all environments than non-bullied youth, and bullied youth who felt unsafe were more likely to attribute their hospitalization to bullying. Troublingly, only about one-third of parents were aware of cyberbullying. CONCLUSION: Using traditional standards of care that do not address offline bullying/cyberbullying, mental health care workers may be missing critical factors that contribute to youth inpatient hospitalization for mental health issues. Behavioral health units should consider adapting intake forms to include offline bullying/cyberbullying questions and developing programming for parents and adults to address issues of online and offline safety.

Functional priorities of individuals with spinal cord injury: a Saudi Arabian perspective.

People with spinal cord injury (SCI) are the deciding force behind the rehabilitation program to improve their quality of life (QoL) based on their personal preferences. Here we aimed to determine the preferences perceived most vital by Saudi SCI population to improve their QoL, and explore if these preferences are affected by gender, education, and duration, level, or extent of injury. Participants ranked seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." Inpatient rehabilitation facility. 120 participants (>18 years of age) of either sex with SCI without polytrauma, acquired brain injury, neurodegenerative disease, and dementia. Ranking scale of seven priorities of bodily functions as Rank I-VII with "I" being "Most important," and "VII" being "Least important." Of 101 individuals (mean age: 35.2 ± 14.8 years) finally included, 70.3% were males, 66.3% had onset of SCI since ≥ 3 years, 48.5% had a complete injury, and 75% had paraplegia. Most (26.7%) participants ranked walking as the first priority followed by hand/arm function (20.8%). Sexual function was the least important priority (39.6%). Hand/arm function was significantly more important for individuals with tetraplegia (p < 0.001). Trunk strength and balance was significantly less important for individuals with complete injury (p = 0.037). Participants with the onset of injury < 3 years and a complete injury reported bladder/bowel function as significantly more important (p = 0.011). Walking was significantly more important for people with incomplete injury and for people with injury duration ≥ 3 years (p = 0.022, p = 0.002 respectively). The top priority in our sample of Saudi people with SCI was walking followed by hand/arm function while the least desired function was regaining sexual function. Walking was a prioritized function for people with injury duration ≥ 3 years and people with a complete injury while hand/arm function was highly prioritized by people with tetraplegia.

Testing asymptomatic mental health patients for COVID-19 overburdens hospital resources

BackgroundInpatient mental health facilities required COVID-19 testing for all patients, including asymptomatic ones, due to perceived high susceptibility.AimThis study examined how the policy affected patient care and hospital resources.MethodA retrospective review was conducted on asymptomatic psychiatric patients admitted to the psychiatric emergency room between July and December 2020, analyzing COVID-19 test results, conversion rate, length of stay (LOS), and demographic variables.ResultsAmong asymptomatic patients (N = 2020), 2.5% (n = 51) tested positive, with 7.8% (n = 4) experiencing mild symptoms. The average hospital length of stay was 8 days, with 90.2% discharged home and 9.8% transferred to outside mental health inpatient facilities. Chi-square testing found no significant differences in age, gender, or housing status between positive and negative patients (p’s > 0.05), except for a significant difference in positivity rates among Hispanic patients (p < 0.05).ConclusionThe positivity rate among asymptomatic mental health patients was low. The policy of universal testing increased hospital spending and resource utilization, including unnecessary testing and hospital admissions, leading to longer stays. These findings underscore the need to assess the efficacy of COVID-19 testing policies and reconsider resource allocation based on evidence.

Oncology pharmacy staffing survey across practice settings in the United States.

This study was developed to provide a resource for staffing model metrics for oncology pharmacies at healthcare organizations. The Hematology/Oncology Pharmacy Association Practice Outcomes and Professional Benchmarking Committee (POPBC) Oncology Pharmacy Staffing Model Task Force designed and distributed a survey to collect baseline data and staffing metrics for oncology pharmacies. The survey was first tested by four POPBC volunteers. The Staffing Model Survey was distributed in multiple phases between September 2021 and January 2022. The task force focused on several different domains including facilities, general metrics, outpatient infusion services, inpatient and outpatient services, informatics/technology, and training and residency programs. Descriptive statistics were used to evaluate the data. A total of 67 responses were received from 68 surveys distributed (98.5%). Of the responders, the majority were from academic medical centers (AMCs) (n = 37, 55%) and community-based centers (CBCs) (n = 21, 31.3%). AMCs reported servicing more inpatient facilities than CBCs (2.1 vs 1.2). For all respondents, 20% tracked in-patient turn-around time compared with 39% of ambulatory sites. Patient education was tracked in all responding settings: 31% for inpatient and 27% for ambulatory. Most sites reported that pharmacy personnel were responsible for cleanroom cleaning (63%) or shared responsibility with an environmental service (37%). Of the 32 sites with ambulatory services, 19 sites were open on Saturday and 15 sites were open on Sundays. Sixty-eight percent of information technology respondents (n = 28) indicated that they use Epic/Beacon (EPIC Oncology Module) as their electronic health record. For the respondents, 89% used closed-system-transfer devices when compounding, 15% used gravimetric technology, and 11% used robotic technology. Oncology pharmacy operations and staffing models are unique to each pharmacy and practice setting. The results of the pharmacy staffing model survey provide an insight into operations across the country and highlight a need for staffing model benchmarking and metrics.