Post-acute Care Settings Research Articles

Home, but Homebound After Traumatic Brain Injury: Risk Factors and Associations With Nursing Home Entry and Death

ObjectiveTo examine risk factors associated with homeboundness 1-year after traumatic brain injury (TBI) and to explore associations between homebound status and risk of future mortality and nursing home entry. DesignSecondary analysis of a longitudinal prospective cohort study. SettingTBI Model Systems centers. ParticipantsCommunity-dwelling TBI Model Systems participants (n=6595) who sustained moderate-to-severe TBI between 2006 and 2016, and resided in a private residence 1-year postinjury. InterventionsNot applicable. Main Outcome MeasuresHomebound status (leaving home ≤1-2d per week), 5-year mortality, and 2- or 5-year nursing home entry. ResultsIn our sample, 14.2% of individuals were homebound 1-year postinjury, including 2% who never left home. Older age, having less than a bachelor's degree, Medicaid insurance, living in the Northeast or Midwest, dependence on others or special services for transportation, unemployment or retirement, and needing assistance for locomotion, bladder management, and social interactions at 1-year postinjury were associated with being homebound. After adjustment for potential confounders and an inverse probability weight for nonrandom attrition bias, being homebound was associated with a 1.69-times (95% confidence interval, 1.35-2.11) greater risk of 5-year mortality, and a nonsignificant but trending association with nursing home entry by 5 years postinjury (RR=1.90; 95% confidence interval, 0.94-3.87). Associations between homeboundness and mortality were consistent by age subgroup (±65y). ConclusionsThe negative long-term health outcomes among persons with TBI who rarely leave home warrants the need to re-evaluate home discharge as unequivocally positive. The identified risk factors for homebound status, and its associated negative long-term outcomes, should be considered when preparing patients and their families for discharge from acute and postacute rehabilitation care settings. Addressing modifiable risk factors for homeboundness, such as accessible public transportation options and home care to address mobility, could be targets for individual referrals and policy intervention.

A nurse practitioner-led deprescribing bundled intervention to reduce rates of polypharmacy in the post-acute care setting.

In post-acute care (PAC) settings, residents face elevated risks of adverse drug reactions and emergency department visits because of polypharmacy. With over 90% of PAC residents nationally taking five or more medications, targeted deprescribing of inappropriate or unnecessary medications emerges as a critical strategy. The project site faces high rates of polypharmacy with a root cause analysis revealing a deficiency in evidence-based practices (EBP) for deprescribing potentially inappropriate or unnecessary medications. To address this issue, a bundled deprescribing intervention was implemented as part of a quality improvement project aimed at reducing polypharmacy rates. This project, conducted at a PAC setting in the midwestern United States, used the RE-AIM Model. Data collection involved tracking prescribing rates before and after the intervention for residents admitted to the practice setting over a 5-month period. A bundled EBP intervention comprising a deprescribing framework, pharmacist collaboration, and the utilization of an EBP guideline, established a systematic process guiding deprescribing efforts for each resident on admission to the PAC setting. Fourty-nine patients received a deprescribing bundle, resulting in a 26.67% reduction in prescribed medications. On average, patients had 5.55 medications deprescribed, with reductions noted across 85 distinct therapeutic drug categories. Nurse practitioners play a pivotal role initiating successful deprescribing interventions within the PAC setting. Using a comprehensive approach, integrating pharmacist collaboration and EBP leads to reductions in prescribing rates among PAC residents. This model demonstrates potential for sustainable improvements in patient outcomes within the PAC environment.

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.

Crosswalk Algorithms for Cognitive and Functional Outcomes Among 2013–2018 Medicare Beneficiaries With Dementia

ObjectiveBefore 2019, the Minimum Data Set (MDS) and Outcome and Assessment Information Set (OASIS) had incongruent response categories for rating cognitive impairment and activities of daily living (ADLs), hindering direct comparisons between nursing facilities and home health. We devised rule-based algorithms to compare cognitive impairment and ADL limitations between these 2 care settings among people with Alzheimer's disease and Alzheimer's disease–related dementias (ADRD). DesignA retrospective cohort study. Setting and ParticipantsIncluded fee-for-service Medicare beneficiaries (2013–2018) transitioning from nursing facilities to home health, with 1-year of continuous enrollment, aged ≥65 years, diagnosed ADRD, and with complete MDS discharge and OASIS admission assessments (N = 398,496). MethodsWe identified target phenotypes using the Cognitive Function Scale (CFS) and ADL items from the MDS discharge assessment as reference standards. We compared 6 OASIS-based algorithms for cognitive impairment and 1 for each ADL limitation by estimating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). ResultsThe average age was 83.5 (SD = 7.5) years and 82.3% transitioned from nursing to home health within 3 days. In the MDS discharge assessment, 42.2% had moderate-to-severe cognitive impairment. ADL limitations ranged from 71.4% for feeding to 97.8% for bathing. Compared with the moderate-to-severe cognitive impairment (CFS ≥3) on the MDS, the OASIS cognitive assessment indicating “considerable assistance to total dependence in routine situations” had 24% sensitivity, 94% specificity, 75% PPV, and 63% NPV. The ADL limitation algorithms exhibited high sensitivities (>96%) and PPVs (>94%) except for feeding (Sensitivity: 82%; PPV: 74%). Despite the short time frame between the 2 assessments, the OASIS admission assessment showed a higher prevalence of ADL limitations than the MDS discharge assessment. Conclusions and ImplicationsWe highlighted differences in patient function between post-acute care settings. Our algorithms can help researchers, clinicians, and policymakers standardize patient-centered outcomes for comparative effectiveness research or quality initiatives.

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for > 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p < 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p < 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

Whole Genome Sequencing to Identify Multiple Clusters of Carbapenemase-Producing Enterobacterales Cases – Colorado, 2022-2023

Background: The Colorado Department of Public Health and Environment (CDPHE) detected an increase in Klebsiella pneumoniae carbapenemase-producing carbapenem-resistant Enterobacterales (KPC-CRE) infections in October 2022. We investigated patient epidemiological links and isolate relatedness to characterize interfacility transmission of KPC-CRE in the Denver metro area and inform regional prevention strategies. Methods: We defined a case as polymerase chain reaction detection of KPC from clinical or screening specimens collected during January 2022 – January 2023. Cases were identified through statewide CRE surveillance and carbapenemase testing at the CDPHE laboratory and counted once within a 30-day period. Medical records were reviewed to identify healthcare facility admissions and patient facility overlap in the 12 months prior to sample collection. Whole genome sequencing (WGS) was performed for 34 patients with available KPC-CRE isolates using short- and long-read sequencing techniques. We performed multi-locus sequence typing, generated genome phylogenetic trees, and compared plasmid contig sequences to identify relatedness between KPC-CRE isolates. Clusters were defined as ≥2 genetically related isolates of the same organism or carbapenemase plasmid, from different patients. Results: We identified 48 cases (34 clinical and 14 screening) among 39 patients (figure). Patients had a mean age of 52 years (range 16-86) and median of three healthcare facility admissions (range 1-14). Twenty-eight patients (72%) were male. We identified 16 (41%) patients with epidemiological links to one acute care hospital (ACH), 11 (28.2%) patients to one long-term acute care hospital (LTACH), and four (10.2%) patients to each of two ventilator-capable skilled nursing facilities (vSNF). Five distinct clusters of KPC-CRE were identified by WGS among 23 patients (E. hormaechei, two distinct E. cloacae clusters, K. pneumoniae, and K. oxytoca) with linkages to ten healthcare facilities, including two vSNFs, two LTACHs, and six ACHs. Three distinct KPC genes were identified among the clusters: KPC-2, KPC-3, and KPC-4. Genomes assembled from long reads identified identical or similar KPC-gene-containing plasmids across different species or sequence types, suggesting horizontal gene transfer of KPC. Conclusions: Multiple KPC-CRE strains co-circulated and were associated with patient movement between acute and post-acute care settings. WGS allowed us to identify multi-facility clusters. Time and location of carbapenemase acquisition were challenging to determine for genetically related isolates when epidemiologic links could not be determined from medical records. This could be due to undetected cases. We notified healthcare facilities of their shared transmission risk and advocated for improved attention to infection control, carbapenemase screening, and communication upon patient transfer.

SHEA position statement on pandemic preparedness for policymakers: building a strong and resilient healthcare workforce.

Throughout the COVID-19 pandemic, many areas in the United States experienced healthcare personnel (HCP) shortages tied to a variety of factors. Infection prevention programs, in particular, faced increasing workload demands with little opportunity to delegate tasks to others without specific infectious diseases or infection control expertise. Shortages of clinicians providing inpatient care to critically ill patients during the early phase of the pandemic were multifactorial, largely attributed to increasing demands on hospitals to provide care to patients hospitalized with COVID-19 and furloughs.1 HCP shortages and challenges during later surges, including the Omicron variant-associated surges, were largely attributed to HCP infections and associated work restrictions during isolation periods and the need to care for family members, particularly children, with COVID-19. Additionally, the detrimental physical and mental health impact of COVID-19 on HCP has led to attrition, which further exacerbates shortages.2 Demands increased in post-acute and long-term care (PALTC) settings, which already faced critical staffing challenges difficulty with recruitment, and high rates of turnover. Although individual healthcare organizations and state and federal governments have taken actions to mitigate recurring shortages, additional work and innovation are needed to develop longer-term solutions to improve healthcare workforce resiliency. The critical role of those with specialized training in infection prevention, including healthcare epidemiologists, was well-demonstrated in pandemic preparedness and response. The COVID-19 pandemic underscored the need to support growth in these fields.3 This commentary outlines the need to develop the US healthcare workforce in preparation for future pandemics.

Psychological Resilience in Post-acute Care: A Cross-Sectional Study of Health Care Workers in Singapore Community Hospitals

ObjectivesPsychological resilience is a crucial component of mental health and well-being for health care workers. It is positively linked to compassion satisfaction and inversely associated with burnout. The current literature on health care worker resilience has mainly focused on primary care and tertiary hospitals, but there is a lack of studies in post-acute and transitional care settings. Our study aims to address this knowledge gap and evaluate the factors associated with psychological resilience among health care professionals working in community hospitals. DesignCross-sectional study. Setting and ParticipantsPhysicians, nurses, rehabilitation therapists (consisting of physiotherapists, occupational therapists, and speech therapists), pharmacists, dietitians, and social workers in 2 community hospitals in Singapore. MethodsEligible health care workers were invited to fill in anonymous, self-reported questionnaires consisting of sociodemographic, lifestyle, and work-related factors together with the Connor-Davidson Resilience Scale (CD-RISC-10). Univariate analysis and multiple linear regression were conducted to study the relationship between each factor and resilience scores. ResultsA total of 574 responses were received, giving a response rate of 81.1%. The mean CD-RISC-10 score reported was 28.4. Multiple linear regression revealed that male gender (B = 1.49, P = .003), Chinese (B = −3.18, P < .001), active smokers (B = −3.82, P = .01), having perceived work crisis support (B = 2.95, P < .001), work purpose (B = 1.84, P = .002), job satisfaction (B = 1.01, P = .04), and work control (B = 2.53, P < .001) were significantly associated with psychological resilience scores among these health care workers. Conclusion and ImplicationsOur study highlights the importance of certain individual and organizational factors that are associated with psychological resilience. These findings provide valuable insight into developing tailored interventions to foster resilience, such as strengthening work purpose and providing effective work crisis support, thus reducing burnout among health care workers in the post-acute care setting.

Hypnotic drug use and rehabilitation outcomes in post-acute geriatric hip fracture patients: A retrospective study

IntroductionThe use of hypnotic drugs is common in the elderly and is associated with negative health outcomes. Our aim was to evaluate the prevalence of hypnotic drug usage amongst hip fracture patients undergoing a rehabilitation program and investigate any potential associations between hypnotic drug use and rehabilitation outcomes in a post-acute care setting. MethodsA retrospective analysis of 440 geriatric hip fracture patients was conducted from 1/1/2019 to 12/2021 in a geriatric rehabilitation center. The main outcome measures were the Functional Independence Measure (FIM), the motor FIM effectiveness and length of stay (LOS). ResultsTwo hundred and twenty-eight (51.7 %) patients out of the entire cohort (440)), were prescribed hypnotic drugs. These patients exhibited a significantly lower rate of diabetes (p = 0.025), a higher rate of depression (p = 0.003), and lower albumin levels (p = 0.023) upon admission to rehabilitation in comparison to untreated patients. No significant differences were observed between the two patient groups in functional rehabilitation outcomes or LOS. Moreover, no correlation was established between the hypnotic drug burden during rehabilitation and the outcome measures. Furthermore, no significant differences were found between patients treated with hypnotic drugs on admission and those who were prescribed these drugs during rehabilitation. The type of hypnotic drug did not affect these results. ConclusionThe use of hypnotic drugs by elderly individuals undergoing a rehabilitation program after a hip fracture is unlikely to have an adverse impact on their short-term rehabilitation outcomes. Consequently, there may not be an immediate necessity to discontinue these drugs upon admission. Nevertheless, the use of hypnotic drugs should be approached with caution and minimized whenever possible due to an increased fall risk and other adverse effects.

Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care

Discharge from hospitals to postacute care settings is a vulnerable time for many older adults, when they may be at increased risk for errors occurring in their care. We developed...

Preferences for Postacute Care at Home vs Facilities

Two in 5 US hospital stays result in rehabilitative postacute care, typically through skilled nursing facilities (SNFs) or home health agencies (HHAs). However, a lack of clear guidelines and understanding of patient and caregiver preferences make it challenging to promote high-value patient-centered care. To assess preferences and willingness to pay for facility-based vs home-based postacute care among patients and caregivers, considering demographic variations. In September 2022, a nationally representative survey was conducted with participants 45 years or older. Using a discrete choice experiment, participants acting as patients or caregivers chose between facility-based and home-based postacute care that best met their preferences, needs, and family conditions. Survey weights were applied to generate nationally representative estimates. Preferences and willingness to pay for various attributes of postacute care settings were assessed, examining variation based on demographic factors, socioeconomic status, job security, and previous care experiences. A total of 2077 adults were invited to participate in the survey; 1555 (74.9%) completed the survey. In the weighted sample, 52.9% of participants were women, 6.5% were Asian or Pacific Islander, 1.7% were American Indian or Alaska Native, 11.2% were Black or African American, 78.4% were White; the mean (SD) age was 62.6 (9.6) years; and there was a survey completion rate of 74.9%. Patients and caregivers showed a substantial willingness to pay for home-based and high-quality care. Patients and caregivers were willing to pay an additional $58.08 per day (95% CI, 45.32-70.83) and $45.54 per day (95% CI, 31.09-59.99) for HHA care compared with a shared SNF room, respectively. However, increased demands on caregiver time within an HHA scenario and socioeconomic challenges, such as insecure employment, shifted caregivers' preferences toward facility-based care. There was a strong aversion to below average quality. To avoid below average SNF care, patients and caregivers were willing to pay $75.21 per day (95% CI, 61.68-88.75) and $79.10 per day (95% CI, 63.29-94.91) compared with average-quality care, respectively. Additionally, prior awareness and experience with postacute care was associated with willingness to pay for home-based care. No differences in preferences among patients and caregivers based on race, educational background, urban or rural residence, general health status, or housing type were observed. The findings of this survey study underscore a prevailing preference for home-based postacute care, aligning with current policy trends. However, attention is warranted for disadvantaged groups who are potentially overlooked during the shift toward home-based care, particularly those facing caregiver constraints and socioeconomic hardships. Ensuring equitable support and improved quality measure tools are crucial for promoting patient-centric postacute care, with emphasis on addressing the needs of marginalized groups.

Medicare's Post-Acute Care Reimbursement Models as of 2023: Past, Present, and Future.

The Centers for Medicare & Medicaid Services is continually working to mitigate unnecessary expenditures, particularly in post-acute care (PAC). Medicare reimburses for orthopaedic surgeon services in varied models, including fee-for-service, bundled payments, and merit-based incentive payment systems. The goal of these models is to improve the quality of care, reduce health-care costs, and encourage providers to adopt innovative and efficient health-care practices.This article delves into the implications of each payment model for the field of orthopaedic surgery, highlighting their unique features, incentives, and potential impact in the PAC setting. By considering the historical, current, and future Medicare reimbursement models, we hope to provide an understanding of the optimal payment model based on the specific needs of patients and providers in the PAC setting.

Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery.

Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.

Inpatient Rehabilitation of Hematopoietic Stem Cell Transplant Patients: Managing Challenging Impairments and Medical Fragility.

Hematopoietic stem cell transplants play an important role in the treatment of cancer, particularly hematologic malignancies. These patients can encounter functional impairments unique to hematopoietic stem cell transplant, including deconditioning, cancer-related fatigue, steroid myopathy, graft versus host disease, and capillary leak syndrome. Medical fragility and increased risk of infection may make rehabilitation challenging on the acute care and postacute care settings. Patients admitted to acute inpatient rehabilitation experience a high rate of transfer to the primary acute service and high rate of mortality after transfer back. Physical medicine and rehabilitation physicians can use a number of strategies to mitigate these patients' risk of medical complications including evidence-based predictive models to assist with postacute rehabilitation triage, physiatry-led consult-based rehabilitation, and oncology hospitalist comanagement on inpatient rehabilitation.

Nurses’ Knowledge, Confidence, Detection and Actions Related to Delirium Care in the Post-Acute Setting

Background Delirium is a common and under-recognized condition affecting patients during times of illness or injury and is associated with poor short and long- term outcomes. Although primarily considered a complication during hospitalization, delirium can persist, recur, or initially present during a post-acute stay in a skilled nursing facility. Little is known about delirium care knowledge, confidence, and practices by nurses in post-acute facilities. Objectives Measure post-acute care nurses’ knowledge and confidence levels related to delirium prevention, identification and management Describe post-acute care nurses’ documented assessments and actions related to delirious patients. Methods Nursing knowledge and confidence data was obtained from a query of 114 nurses working in three post-acute facilities. Documentation of nursing assessment and actions were analyzed from records of 22 patients determined to have experienced post-acute delirium using CHART-DEL methodology. Results Nurses averaged 75% correct on a written delirium knowledge test, with most deficits in identifying the key features of delirium and the assessment of delirium superimposed upon dementia. Most (89%) nurses accurately applied the Confusion Assessment Method Short Form to a video of an individual displaying hypoactive delirium with visual hallucinations, while only 49% did the same with the video depicting hypoactive delirium superimposed on mild cognitive impairment. The majority (85%) of nurses reported lack of confidence in performing delirium screening, specifically surrounding the identification of an acute change in mental status from baseline and the presence of inattention and 56% lacked confidence discussing results of a positive delirium screen with a provider. The term “confusion” was the most documented descriptor in records of patients experiencing delirium with nurses recognizing 40% of verified delirious cases and acting upon 83% of cases they recognized. Conclusion Nurses working in the post-acute care setting displayed gaps in knowledge, confidence and skills related to delirium prevention, assessment and management.

Abstract WMP58: Underrepresentation of Racial and Ethnic Minorities in Stroke Clinical Trials

Background: Stroke impacts Black and Hispanic individuals disproportionately compared to White individuals. Equitable inclusion in stroke research for disproportionately affected populations is critical for addressing stroke inequities. Prior literature has reported a lack of racial diversity in acute stroke trials, but data are lacking for trials conducted across the stroke care continuum. Methods: We performed a comprehensive review of completed trials registered from January 1, 1990, to April 20, 2023, in the ClinicalTrials.gov registry. Trials for stroke treatment in hyperacute, acute, and post-acute care settings were included if they were at least partially conducted in the U.S., enrolled ≥ 50 participants aged 18 and older, and published their results in a peer-reviewed journal available on PubMed or Embase. Results: 2461 trial records were retrieved, of which 69 stroke trials were included and are reported in this analysis. Overall, 34 of 69 trials (49%) included data on some racial or ethnic demographics in the primary manuscript. For trials conducted exclusively in the U.S., 20 of 30 trials (67%) reported data on race. Among international trials which also included the U.S., 14 of 39 trials (36%) reported data on race. Among trials exclusively conducted in the U.S., 74% of study participants were white. Among trials conducted exclusively in the U.S., 57% of trials funded by government reported race, whereas, 71% of trials funded by industry reported on race. Conclusion: This review shows under-reporting of race, ethnicity, and other sociodemographic data in stroke trials across the care continuum. When race and ethnicity are reported, most studies show over-presentation of White individuals, especially considering the disproportionate burden of stroke in Black and Hispanic groups. There is an urgent need to develop and implement strategies to increase diversity in stroke clinical trials to effectively understand and address inequities in stroke care and outcomes.

Abstract HUP12: Underrepresentation Of Racial And Ethnic Minorities In Stroke Clinical Trials

Background: Stroke impacts Black and Hispanic individuals disproportionately compared to White individuals. Equitable inclusion in stroke research for disproportionately affected populations is critical for addressing stroke inequities. Prior literature has reported a lack of racial diversity in acute stroke trials, but data are lacking for trials conducted across the stroke care continuum. Methods: We performed a comprehensive review of completed trials registered from January 1, 1990, to April 20, 2023, in the ClinicalTrials.gov registry. Trials for stroke treatment in hyperacute, acute, and post-acute care settings were included if they were at least partially conducted in the U.S., enrolled ≥ 50 participants aged 18 and older, and published their results in a peer-reviewed journal available on PubMed or Embase. Results: 2461 trial records were retrieved, of which 69 stroke trials were included and are reported in this analysis. Overall, 34 of 69 trials (49%) included data on some racial or ethnic demographics in the primary manuscript. For trials conducted exclusively in the U.S., 20 of 30 trials (67%) reported data on race. Among international trials which also included the U.S., 14 of 39 trials (36%) reported data on race. Among trials exclusively conducted in the U.S., 74% of study participants were white. Among trials conducted exclusively in the U.S., 57% of trials funded by government reported race, whereas, 71% of trials funded by industry reported on race. Conclusion: This review shows under-reporting of race, ethnicity, and other sociodemographic data in stroke trials across the care continuum. When race and ethnicity are reported, most studies show over-presentation of White individuals, especially considering the disproportionate burden of stroke in Black and Hispanic groups. There is an urgent need to develop and implement strategies to increase diversity in stroke clinical trials to effectively understand and address inequities in stroke care and outcomes.

Abstract 31: Let Me Be Your Guide: The Impact of Stroke Navigators on Post-Acute Stroke Follow Up

Introduction: Stroke patients often require complex post-discharge management in an outpatient setting. At this Comprehensive Stroke Center, stroke patients are to receive a 30-day, 90 day, and 1 year follow up with the stroke clinic. Post-acute follow up appointments are typically established after discharge, leading to scheduling delays for the 30-day appointment, patients lost to follow up, or no showing to appointments. Stroke Navigators are an emerging role that can bridge the gap between acute and post-acute care settings and integral to ensuring stroke patients receive optimal follow up care. Methods: In 2022, a Stroke Navigator was added to the care team and collaborated with the Stroke Clinic to project volume of clinic slots needed for ischemic and TIA hospital discharges. The Stroke Navigator implemented follow up scheduling with patient/family prior to discharge and emphasized the importance of the 30-day appointment. Pre and postintervention data was then collected and analyzed from Q2 2022 to Q1 2023 regarding timeliness of scheduling, appointment type, and rate of no shows for all ischemic stroke/TIA patients. Results: The pre-intervention scheduling process resulted in an average wait time of 19 days to schedule appointments. Post intervention, no wait time identified as appointments were scheduled prior to discharge. Pre-intervention data on 30-day appointments showed only 23% of patients were scheduled and attended their provider visit, while post-intervention data showed 60% (Table 1). The clinic no show rate went from 19%, down to 10% in the post intervention phase. Conclusion: The Stroke Navigator has made a significant impact on the number of patients with 30-day visits, eliminated the wait time for appointments due to scheduling prior to discharge, and decreased the no show rate for patients at 30 days. Further financial analysis will be critical to validate the impact of a Stroke Navigator, as they are critical to closing the gap in post-acute care.

Developing a clinical curriculum for hospitalists newly practicing in post-acute and long-term care settings: A pre-post study.

Developing a clinical curriculum for hospitalists newly practicing in post-acute and long-term care settings: A pre-post study.

HARMONIZATION OF CHRONIC CONDITIONS WAREHOUSE DATA FOR OUTCOMES RESEARCH ON GERIATRIC SYNDROMES

Abstract Geriatric syndromes such as cognitive impairment, falls, depression, urinary incontinence, pressure ulcers, and polypharmacy are common conditions and syndromes that affect older adults. Studying geriatric syndromes in Medicare beneficiaries may provide important insights for improving health outcomes and quality of life. As a result of the Improving Medicare Post-Acute Care Transformation Act of 2014, it is now easier to compare standardized geriatric assessment data (including information about geriatric syndromes) collected in post-acute and long-term care settings with corresponding data from claims, encounter, Part D, and durable medical equipment files. However, to our knowledge, methods to link and harmonize post-acute and long-term care assessment data (available for 75% of decedents) are yet to be utilized in the health services research community. The goal of this project is to develop harmonized datasets that can be used to identify geriatric syndromes and study their prevalence, cost, health outcomes, and service delivery factors over time. This work will allow our team and other researchers to fully leverage these data for use in predictive algorithms and artificial intelligence and machine learning (AI/ML) research. The project uses the five most recent years of data available from the Centers for Medicare and Medicaid Services (CMS) Chronic Conditions Data Warehouse. Data sources include Medicare and Medicaid claims, encounter, MedPAR, Hospice claims, Minimum Data Set (MDS), MDS-Swing Bed (SB), Outcome and Assessment Information Set (OASIS), Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), Pharmacy (Part D), and Durable Medical Equipment (DME).