Receipt Of Rehabilitation Services Research Articles

Team-based digital communication reduced patient-initiated phone calls to the hospital and improved patient satisfaction after orthopedic surgery: a randomized controlled trial in 70 patients.

Post-discharge inquiries to the hospital are predominantly conducted through phone calls. The rigid timing of these calls is inconvenient for patients and disrupts the workflows of healthcare professionals. The aim of this study was to investigate the effect of a team-based digital communication intervention (eDialogue) facilitated through a messenger-like commercial solution on patient-initiated phone calls to the hospital after discharge. Secondarily, we investigated other patient-initiated contacts, patients' perception of continuity of care, and their perception of feeling safe and satisfied after hospital discharge. On the day of discharge, 70 surgically treated orthopedic patients were randomized to the intervention group with access to eDialogue (n = 35) or the control group with standard communication pathways by phone call (n = 35) for the following 8 weeks. Through eDialogue, the intervention group had access to team-based asynchronous digital communication in text and photos with healthcare professionals across disciplines and sectors. Inclusion criteria were discharge to own home and receipt of rehabilitation services from both hospital and primary care after discharge. We found a significant reduction in the mean number of patient-initiated phone calls to the hospital from 2.3 (95% confidence interval [CI] 1.4-4.1) in the control group to 0.5 (CI 0.3-1.0) in the intervention group (P = 0.004). Across groups, patients reported similar perceptions of continuity of care; however, the participants in the intervention group expressed significantly improved perceptions of, and satisfaction with, access to healthcare after discharge. Access to eDialogue reduced patient-initiated phone calls to the hospital, enhanced patient satisfaction with healthcare accessibility, and did not compromise patients' perception of continuity of care after discharge compared with standard communication pathways.

Profiles of Home Health Patients Who Receive Rehabilitation Services

Abstract Date Presented 04/01/2022 Studies examining OT services within home health (HH) are scarce. New health care policies incentivize patients receiving care at home. The first step to understanding the value of OT services with HH is to characterize patients who receive rehabilitation services. Findings from this study provides key information for OT practitioners to understand which patient- and facility-level factors are associated with receipt of rehabilitation services in HH. Primary Author and Speaker: Chih-Ying Li Additional Authors and Speakers: Tracy Mroz, Allen Haas

LATE-LIFE DEPRESSIVE SYMPTOMS FOLLOWING NURSING HOME OR INPATIENT REHABILITATION IN MEDICARE BENEFICIARIES

Introduction Millions of Medicare beneficiaries receive rehabilitation services in skilled nursing facilities or inpatient rehabilitation facilities. This study was designed to study whether receipt of rehabilitation services in nursing homes or inpatient settings is associated with clinically significant depressive symptoms at follow-up among older adult Medicare beneficiaries. Methods We utilized data from National Health and Aging Trends Study (NHATS), which is an annual survey of a nationally representative sample of Medicare beneficiaries aged 65 years and older. Our study included 6,329 participants of the 2015 and 2016 NHATS interviews. The PHQ-2 assessed for the presence of clinically significant depression, and interview questions addressed rehabilitation, demographic characteristics, socioeconomic status, and health and functioning variables. Results Medicare beneficiaries who received rehabilitation services in nursing home or inpatient settings had higher levels of depression at follow-up than those who did not receive these services (25.2% vs. 11.1%; p Conclusions Even after accounting for factors such as medical conditions, baseline depressive symptoms, and changes in ability to engage in self-care and household activities, older adults who receive nursing home or inpatient rehabilitation services comprise an at-risk group for having depression. As depression is associated with considerable morbidity and can interfere with the rehabilitation process, additional efforts to identify and treat depression in these older adults may be warranted. This research was funded by The National Health and Aging Trends Study dataset is publicly available and is sponsored by the National Institute on Aging (grant number NIA U01AG032947) through a cooperative agreement with the Johns Hopkins Bloomberg School of Public Health. Dr. Simning was supported by the National Institute on Aging (K23AG058757). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH.

Socioeconomic determinants of outcome after childhood arterial ischemic stroke.

To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS). From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days-18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<US $10,000), but not other markers of SES, was associated with worse outcomes (odds ratio [OR] 3.13, 95% confidence interval [CI] 1.43-6.88, p = 0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI 1.18-8.47, p = 0.02). Income did not correlate with receiving rehabilitation services at 1 year after stroke; however, quality and quantity of services were not assessed. In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.

Abstract 26: Disparities in Post-Acute Stroke Rehabilitation Services Delivery: Preliminary Findings From the COMprehensive Post-Acute Stroke Services (COMPASS) Study

Background: Timely rehabilitation after stroke is essential for optimizing recovery. Patients discharged home can experience unnecessary service delays and gaps in care. Our aim was to examine sociodemographic characteristics associated with receipt of rehabilitation services within 30 days after discharge home in stroke or transient ischemic attack (TIA) patients. Methods: COMPASS is a cluster-randomized pragmatic trial measuring the effectiveness of the COMPASS model of care vs. usual care on functional status 90 days after stroke or TIA for patients discharged home. We analyzed data from 369 participants who enrolled in the intervention arm of the COMPASS trial, completed the post-acute clinic visit within 14 days, and the 30-day call between July 2016 and May 15, 2017. For those who were referred to rehabilitation services at hospital discharge or at the clinic visit, receipt of home health (HH) and outpatient (OP) rehabilitation services was reported by the participant during the 30-day call. Sociodemographic differences between those who did and did not receive these services were evaluated. We computed adjusted odds ratios with 95% confidence intervals using logistic regression to identify factors associated with receipt of rehabilitation services. Results: Of the 369 patients, 176 (47.7%) had ascertainment of receipt of services. Of the 115 patients referred to HH, 50 (43.5%) received it, and of 85 patients referred to OP therapy, 29 (34.1%) received it. There were no statistically significant differences in sociodemographic characteristics related to receipt of HH, but non-whites were less likely (3 of 20, or 15%) than whites (25 of 64, 34.9%) to receive OP therapy. After adjustment for NIHSS, ambulatory status at hospital admission, and age, non-white participants had a 78% decreased odds (OR 0.22; 95% CI 0.05, 0.95; p=0.04) of receiving OP therapy. Conclusion: These findings indicate that a significant gap exists between referral to and receipt of recommended post-acute stroke rehabilitation services. In addition, despite the small sample size, our results suggest that there may be a disparity in receipt of OP therapy for non-white patients relative to white patients.

Factors Associated With Home Discharge Among Veterans With Stroke

ObjectiveTo determine which patient-, treatment-, and facility-level characteristics were associated with home discharge among patients hospitalized for stroke within the Department of Veterans Affairs. DesignRetrospective observational study. SettingVeterans Affairs facilities nationwide. ParticipantsVeterans hospitalized for stroke during fiscal year 2007 to fiscal year 2008 (N=12,565). InterventionNot applicable. Main Outcome MeasureDischarge location after hospitalization. ResultsThere were 10,130 (80.6%) veterans discharged home after hospitalization for acute stroke. Married veterans were more likely than nonmarried veterans to be discharged home (odds ratio [OR]=1.23; 95% confidence interval [CI]=1.11–1.35). Compared with veterans admitted to the hospital from home, patients admitted from extended care were less likely to be discharged home (OR=.04; 95% CI=.03–.07). Compared with those with occlusion of cerebral arteries, patients with intracerebral hemorrhage (OR=.61; 95% CI=.50–.74) or other central nervous system hemorrhage (OR=.78; 95% CI=.63–.96) were less likely to be discharged home, whereas patients with occlusion of precerebral arteries (OR=1.36; 95% CI=1.07–1.73) were more likely to return home. Evidence of congestive heart failure (OR=.85; 95% CI=.76–.95), fluid and electrolyte disorders (OR=.86; 95% CI=.77–.96), internal organ procedures and diagnostics (OR=.87; 95% CI=.78–.97), and serious nutritional compromise (OR=.49; 95% CI=.40–.62) during hospitalization remained independently associated with lower odds of home discharge. Longer hospitalizations and receipt of rehabilitation services while hospitalized acutely were negatively associated, whereas treatment on more bed sections and rehabilitation accreditation of the facility were positively associated with home discharge. Region exerted a statistically significant effect on home discharge. ConclusionsWe found sociological, clinical, and facility-level factors associated with home discharge after hospitalization for acute stroke. Findings document the importance of considering a broad range of characteristics rather than focusing only on a few specific traits during discharge planning.

An examination of factors influencing delayed discharge of older people from hospital

This study aimed to investigate the factors associated with the delayed discharge of older people from hospital and their length of stay (LOS). Data were collected retrospectively from inpatient records and adult social care services on older patients referred to the latter prior to hospital discharge. Data on two related measures--delayed discharge and LOS--were analysed separately within a four-stage sequential framework. Using bivariate analysis, we found that cognitive impairment and dependency were significantly associated with delay. Patients admitted to trauma and orthopaedics specialties were significantly more likely to be delayed on discharge. Respiratory illness was negatively associated with delay. Factors related to care received as an inpatient associated with delayed discharge from hospital were not being in the responsible consultant's bed for part of their stay, two or more moves between specialties and receipt of rehabilitation services. Admission to a care home and receipt of domiciliary care if returning to a private dwelling on discharge were associated with delay. In the multivariate analysis, dependence and cognitive impairment impacted differently on delay and LOS. Hospital variables were the most important predictors of LOS and social care variables in respect of delayed discharge. Patient characteristics and especially the organisation of care in hospital and the provision of services on discharge are related to the likelihood of delayed discharge and LOS. Improved services and structures to systematically assess and treat patient needs in hospital, together with the timely provision of services providing post-discharge services tailored to individual circumstances, are required.

Factors Associated With Utilization of Preoperative and Postoperative Rehabilitation Services by Patients With Amputation in the VA System: An Observational Study

The Department of Veterans Affairs (VA) and the Department of Defense published evidence-based guidelines to standardize and improve rehabilitation of veterans with lower limb amputations; however, no studies have examined the guidelines' impact. The purposes of this study were: (1) to describe the utilization of rehabilitative services in the acute care setting by people who underwent major lower limb amputation in the VA from 2005 to 2010, (2) to identify factors associated with receipt of rehabilitation services, and (3) to examine the impact of the guidelines on service receipt. A cross-sectional study of 12,599 patients, who underwent major surgical amputation of the lower limb at a VA medical center from January 1, 2005, to December 31, 2010, was conducted. Data were obtained from main and surgical inpatient datasets and the inpatient encounters files of the Veterans Health Administration databases. Rehabilitation services were categorized as physical therapy, occupational therapy, and either (any therapy), before or after amputation. Separate multivariate logistic regressions examined the impact of guideline implementation and identified factors associated with service receipt. Patients were 1.45 and 1.73 times more likely to receive preoperative physical therapy and occupational therapy and 1.68 and 1.79 times more likely to receive postoperative physical therapy and occupational therapy after guideline implementation. Patients in the Northeast had the lowest likelihood of receiving preoperative and postoperative rehabilitation services, whereas patients in the West had the highest likelihood. Other patient characteristics associated with service receipt were identified. The sample included only veterans who had surgeries at VA Medical Centers and cannot be generalized to veterans with surgeries outside the VA or to nonveteran patients and settings. Further quality improvement efforts are needed to standardize delivery of rehabilitation services for veterans with amputations in the acute care setting.

Employment at Closure Is Associated With Enhanced Quality of Life and Subjective Well-Being for Persons With Spinal Cord Injuries

This study assessed whether persons with spinal cord injuries who had been successfully rehabilitated into employment following receipt of rehabilitation services had better quality of life and subjective well-being than the unsuccessfully rehabilitated who did not obtain employment following receipt of rehabilitation services. Persons who were successfully rehabilitated had a significantly higher overall quality of life and health and higher quality of life in their physical health, psychological health, social relationships, and environmental domains than the unsuccessfully rehabilitated. The successfully rehabilitated also had higher psychological, financial, and physical well-being than the unsuccessfully rehabilitated. Rehabilitation counselors can use quality of life and subjective well-being measures to provide more focused interventions during rehabilitation and as an outcome measure in addition to employment upon completion of rehabilitation services.

Risk factors for depression among older adults with dual sensory loss

Objectives: The purpose of this study was to identify risk factors that are associated with depression among older adults with dual sensory loss, evaluating variables typically associated with depression in an elderly population and variables related to sensory loss. Method: Survey data was collected from a sample of 203 adults aged 55 years and older with significant hearing and vision loss. Independent variables included demographics (as control variables), sensory loss-related factors, activity factors, and social factors. Correlation and hierarchical linear regression were used to analyze the data. Results: A large proportion of participants experienced depression. Risk factors typically associated with depression in the elderly were also significant for this group, with the exception of functional disability, but only one variable directly related to sensory loss was significant in the final model. The block of variables with the greatest relationship to depression was the social factor. Discussion: Receipt of rehabilitation services and use of assistive devices are two strategies that could be used to address the issue of depression with this population. Interventions could target some of the variables found to be associated with depression in this study: communication problems, loss of activity, and physical activity.

Ethnic Differences in Rehabilitation Placement and Outcome After TBI

To determine whether race/ethnicity and proficiency with the English language influence access to rehabilitation services, and ultimately outcome after traumatic brain injury (TBI). A retrospective correlational investigation. Postrehabilitation outpatients with blunt TBI. A total of 476 patients were examined 6 months postinjury, of which 109 (23%) were Hispanics, and of those 42 were predominantly Spanish speaking. Access to rehabilitation services, Glasgow Outcome Scale-Extended. Insurance, age, and injury severity had the greatest influence on receipt of rehabilitation services; however, higher rates of severe disability were found among Hispanics and Spanish speakers than non-Hispanic whites and non-Hispanic English speakers, respectively. Insurance status has a larger influence on receipt of rehabilitation services than ethnicity or proficiency with the English language, but language proficiency is a significant predictor of severe disability.

Predicting discharge outcomes of VA nursing home residents.

This article's purpose was to identify predictors of discharge outcomes of VA nursing home stays. Using data tapes, diagnostic and assessment data were assembled on elderly individuals admitted to VA nursing homes nationwide during Fiscal Year 1987. Six-month outcomes for 3 groups were considered: all residents (n = 5,895), and those remaining in care after 6 (n = 2,815) and 12 months (n = 1,812), respectively. Logistic regression was used to evaluate predictors of death and community discharge. Limited activities of daily living (ADL) dependency, younger age, and receipt of rehabilitation services most consistently predicted community discharge. ADL dependency, older age, oxygen use, terminally ill prognosis, malignancy, and congestive heart failure most consistently predicted mortality. For both dependent variables, predictive ability declined as stay length increased. Predicting death and community discharge become increasingly problematic as stay lengthens. Comparing observed versus expected discharge outcomes has limited usefulness as a quality-improvement tool.

The differential receipt of rehabilitation services among an aftercare population

This article reports on a study of discharged state psychiatric hospital patients who subsequently received community mental health services. All received standard services, including case management, chemotherapy, emergency services, and group and/or individual therapy. A comparison of those who received both rehabilitation and standard services and those who received only standard services, revealed that blacks were less likely to receive rehabilitation. Nonschizophrenic and substance abusing clients were less likely to receive rehabilitation services. Those clients who received rehabilitation services generally received a greater amount of all types of services.