Nursing Facility Rehabilitation Research Articles

Higher Movement-Evoked Pain Is Associated With Slower Walking Speed In Older Adults Undergoing Skilled Nursing Facility Rehabilitation

Higher Movement-Evoked Pain Is Associated With Slower Walking Speed In Older Adults Undergoing Skilled Nursing Facility Rehabilitation

Association Between Cognitive Impairment and Repeat Fractures in Medicare Beneficiaries Recently Hospitalized for Hip Fracture.

Repeat fractures contribute substantially to fracture incidents in older adults. We examined the association between cognitive impairment and re-fractures during the first 90days after older adults with hip fractures were discharged home from a skilled nursing facility rehabilitation short stay. Multilevel binary logistic regression was used to analyze 100% of U.S.national postacute-care fee-for-service Medicare beneficiaries who had a hospital admission for hip fracture from January 1, 2018, to July 31, 2018; were admitted for a skilled nursing facility stay within 30days of hospital discharge; and were discharged to the community after a short stay. Our primary outcome was rehospitalization for any re-fractures within 90days of skilled nursing facility discharge. Cognitive status assessed at skilled nursing facility admission or before discharge was classified as either intact or having mild or moderate/severe impairment. In 29558 beneficiaries with hip fracture, odds of any re-fracture were higher in those with minor (odds ratio: 1.48; 95% confidence interval: 1.19-1.85; p < .01) and moderate/major cognitive impairment (odds ratio: 1.42; 95% confidence interval: 1.07-1.89; p=.0149) than in those classified as intact. Beneficiaries with cognitive impairment were more likely than their counterparts with no cognitive impairment to experience re-fractures. Community-dwelling older adults with minor cognitive impairment may experience a higher likelihood of experiencing a repeat fracture leading to rehospitalization.

Feasibility of Measuring Frailty and Patient-Reported Outcomes During and After Post-Acute Skilled Nursing Facility Rehabilitation.

Functional status and quality of life are not routinely assessed after skilled nursing facility (SNF) discharge. We determined feasibility of measuring frailty among adults ≥65 years admitted to SNF after hospitalization, and post-discharge outcomes. We calculated a frailty index (non-frail [≤0.25], mild frailty [0.26–0.35], moderate [0.36–0.45], and severe [>0.45]). After SNF discharge, we conducted serial telephone interviews measuring ability to perform functional activities and Patient Reported Outcome Measurement Information System (PROMIS) scores. Overall of 68 screened patients, 42 were eligible, and 24 (57.1%) eligible patients were enrolled. Of these, 5 (20.8%) were admitted after elective hospitalizations, 17 (70.8%) were female, and 11 (45.8%) had moderate-to-severe frailty. Frailty was measured in all participants in a mean 32.1 minutes. At 90 days, a total of three participants died, and two were lost to follow-up. Post-discharge functional status varied by frailty, with moderate-to-severe frailty having persistent impairment and lower PROMIS scores (worse quality of life) compared to those with no or mild frailty (38.2 [13.7] vs. 47.3 [8.1] p = .04). Measuring frailty and quality of life in older patients admitted to SNF is feasible. Furthermore, measuring frailty may help identify those at particularly high risk of poor recovery and lower quality of life after discharge.

Mixed-Methods Approach to Understanding Determinants of Practice Change in Skilled Nursing Facility Rehabilitation: Adapting to and Sustaining Value With Postacute Reform.

Postacute care reform is driving physical and occupational therapists in skilled nursing facilities (SNFs) to change how they deliver care to produce better outcomes in less time. However, gaps exist in understanding determinants of practice change, which limits translation of evidence into practice. This study explored what determinants impacted change in care delivery at 2 SNFs that implemented a high-intensity resistance training intervention. We used a mixed-methods, sequential explanatory design to explain quantitative findings using qualitative methods with a multiple-case study approach. Quantitative data were collected on therapists' attitudes toward evidence-based practice and aspects of intervention implementation. We conducted focus groups with therapists (N = 15) at 2 SNFs, classified as either high- (SNF-H) or low-performing (SNF-L) based on implementation fidelity and sustainability. Determinants of SNF rehabilitation practice change included the organizational system, team dynamics, patient and therapist self-efficacy, perceptions of intervention effectiveness, and ability to overcome preconceived notions. A patient-centered system, positive team dynamics, and ability to overcome preconceived notions fostered practice change at SNF-H. While self-efficacy and perception of effectiveness positively impacted change in practice at both SNFs, these determinants were not enough to overcome challenges at SNF-L. To adapt to changes and sustain rehabilitation value, further research must identify the combination of determinants that promote application of evidence-based practice. This study is the first step in understanding what drives change in SNF rehabilitation practice. As SNF rehabilitation continues to face changes in health care delivery and reimbursement, therapists will need to adapt, by changing practice patterns and adopting evidence-based approaches, to demonstrate value in postacute care.

Characterization of Facial Trauma Associated with Standing Electric Scooter Injuries

Abstract This case series describes 34 patients presenting with facial injuries after standing electric scooter use at two academic emergency departments, 6/2018-5/2019. The severity of injuries highlights this important emerging health risk and policy implications.

Factors Predicting Rehospitalization of Elderly Patients in a Postacute Skilled Nursing Facility Rehabilitation Program

Dombrowski W, Yoos JL, Neufeld R, Tarshish CY. Factors predicting rehospitalization of elderly patients in a postacute skilled nursing facility rehabilitation program. ObjectiveTo examine potential risk factors for rehospitalization of skilled nursing facility (SNF) rehabilitation patients. DesignRetrospective review of rehabilitation charts. SettingSNF rehabilitation beds (n=114) at a 514-bed urban, academic nursing home that receives patients from tertiary care hospitals. ParticipantsConsecutive rehabilitation patients (n=50) who were rehospitalized during days 4 to 30 of rehabilitation, compared with a matched group of rehabilitation patients (n=50) who were discharged without rehospitalization. InterventionsNot applicable. Main Outcome MeasureData on potential risk factors were collected: demographics, medical history, conditions associated with preceding hospitalization, and initial rehabilitation examination and laboratory values. The clinical conditions precipitating rehospitalizations were noted. ResultsSixty-two percent of rehospitalizations were related to complications or recurrence of the same medical condition that was treated during the preceding hospitalization. The rehospitalized group had significantly more comorbidities including anemia (P=.001) and malignant solid tumors (P<.001), index hospitalizations involving a gastrointestinal condition (P=.001), needed more assistance with eating (P=.001) and walking (P=.03), and had lower hemoglobin (P=.002) and albumin levels (P<.001). A logistic regression model found that the strongest predictors for rehospitalization are a history of a malignant solid tumor (odds ratio [OR]=10.10), a recent hospitalization involving gastrointestinal conditions (OR=4.62), and a low serum albumin level (with each unit decrease in albumin, the odds of rehospitalization are 4 times greater [OR=.24, P=.005]). ConclusionsComorbid conditions, reasons for index hospitalization, and laboratory values are associated with an increased risk for rehospitalization. Further studies are needed to identify high-risk elderly patients and target interventions to minimize rehospitalizations.

Usefulness of the Nursing Home Quality Measures and Quality Indicators for Assessing Skilled Nursing Facility Rehabilitation Outcomes

Silverstein B, Findley PA, Bode RK. Usefulness of the nursing home quality measures and quality indicators for assessing skilled nursing facility rehabilitation outcomes. Objective To examine the usefulness of the nursing home quality indicators and nursing home quality measures for differentiating among providers from a rehabilitation outcomes perspective. Design Retrospective. Setting Skilled nursing facilities (SNFs) across the United States. Participants A total of 211 SNFs. Interventions Not applicable. Main Outcome Measures All quality indicators, all quality measures except for CWLS01 (residents who lose too much weight), and a set of rehabilitation outcomes including residualized FIM motor gain, the percentage of patients discharged to community, and the percentage of patients reporting “quite a lot” or “completely” prepared to manage their care at discharge from SNF-based rehabilitation. Results No quality measures correlated with any rehabilitation outcomes. Residualized FIM motor gain did not correlate with any quality indicators or quality measures. Only 1 quality indicator—prevalence of daily use of restraints (QI 22)—correlated with the rehabilitation indicator community discharge percentage. The third rehabilitation indicator, prepared to manage care at discharge, correlated (negatively) only with QI 18 incidence of decrease in range of motion. Among the rehabilitation outcomes, residualized FIM motor gain correlated significantly with both community discharge percentage and prepared to manage care at discharge. Conclusions Patients and referrers choosing SNF-based medical rehabilitation need tools that differentiate among prospective providers from a rehabilitation outcomes perspective. Data in this study indicate that nursing home quality indicators and quality measures are inadequate for this purpose.

Skilled nursing facility rehabilitation and discharge to home after stroke

Wodchis WP, Teare GF, Naglie G, Bronskill SE, Gill SS, Hillmer MP, Anderson GM, Rochon PA, Fries BE. Skilled nursing facility rehabilitation and discharge to home after stroke. ObjectiveTo determine the relation between rehabilitation therapy (RT) intensity and time to discharge home for stroke patients in skilled nursing facilities (SNFs). DesignRetrospective cohort study. We used regression analyses, stratified by expected outcome, and propensity score adjustment. SettingAll SNFs in Ohio, Michigan, and Ontario, Canada. ParticipantsA cohort of residents, aged 65 and over, admitted from hospitals to SNFs with a diagnosis of stroke (N=23,824). InterventionsNot applicable. Main outcome measureTime to discharge home from an SNF. ResultsRT was given to more than 95% of residents for whom discharge was expected within 90 days and to more than 60% of residents for whom discharge was uncertain or not expected. RT increased the likelihood of discharge to the community for all groups except those expected to be discharged within 30 days. The dose-response relation was strongest for residents with either an uncertain discharge prognosis or no discharge expected. ConclusionsPostacute residents with an uncertain prognosis are an important target population for intensive RT.

Comparison of Home Based Older Patients Who Received Occupational Therapy with Patients Not Receiving Occupational Therapy

The relationship of occupational therapy (OT) services to improvement in functional status for frail elders has not been firmly established. The present study explored the relationship of receipt of community-based services to changes in activities of daily living and instrumental activities of daily living. Using a retrospective approach, two groups of older patients discharged from hospital, sub-acute and skilled nursing facility rehabilitation programs, or who were living in the community and qualified for home care services, were compared: one group received OT, the second group did not. The group that received OT demonstrated improved Activities of Daily Living (ADL) scores in three areas (dressing, toileting and walking) while the group that did not receive OT did not show improvement.

Preliminary observations on reduced utilization in skilled nursing facility rehabilitation.

Preliminary observations on reduced utilization in skilled nursing facility rehabilitation.

Differences in outcome: hospital rehabilitation vs skilled nursing facility rehabilitation

Differences in outcome: hospital rehabilitation vs skilled nursing facility rehabilitation

Differences in Outcome: Hospital Rehabilitation vs Skilled Nursing Facility Rehabilitation

To the Editor.— Analysis of data gathered on the hip fracture population at Spaulding Rehabilitation Hospital, Boston, Mass, contrasts with some of the findings illustrated in the study titled The Impact of Prospective Payment Systems on the Treatment of Hip Fractures in the Elderly by Palmer et al.1 Spaulding Rehabilitation Hospital data does suggest that despite Prospective Payment Systems and pressure to reduce lengths of stay, Spaulding was able to achieve outcome. Since the implementation of Prospective Payment Systems, Spaulding, like St Vincent's, has been able to achieve the same, and, in some cases, better results within a shorter hospitalization. By increasing the intensity of the treatment programs and encouraging staff and patients to achieve specific targeted goals, quality outcome can be achieved. However, the failure of treatments in two studies from Indianapolis by Palmer et al,1and Fitzgerald et al2is alarming and contrasts sharply