Subacute Services Research Articles

Physiotherapy Services Provided Outside of Business Hours in Australian Hospitals: A National Survey

Physiotherapy services provided outside of business hours may improve patient and hospital outcomes, but there is limited understanding of what services are provided. This study described current services provided outside of business hours across Australian hospitals. Design Descriptive, cross-sectional, Web-based survey. Participants A random sample of Australian hospitals from the public or private sector located in either metropolitan or rural/regional areas. A total of 112 completed surveys were submitted. The most common service outside of business hours was a Saturday service, provided by 61% of participating hospitals with a median (interquartile range [IQR]) of 1.0 hour (0.0 and 3.4) of physiotherapy per 30 beds. Sunday services were provided by 43% of hospitals, and services provided outside of business hours from Monday to Friday were provided by 14% of hospitals. More private hospitals provided some form of physiotherapy service outside of business hours (91%) than public hospitals (48%). More metropolitan hospitals provided some form of physiotherapy service outside of business hours (90%) than rural/regional hospitals (28%). Few of the hospitals providing sub-acute services had weekend physiotherapy (30%), but the majority of highly acute wards provided weekend physiotherapy (81%). Highly acute wards also provided more hours of service on a Saturday (median 8.1 hours per 30 beds, IQR 0.6-22.5) compared with acute wards (median 0.8 hours per 30 beds, IQR 0.0-2.8). There is limited availability of physiotherapy services in Australian hospitals outside of business hours. There are inequalities in physiotherapy services provided outside of business hours, with public, rural/regional and sub-acute facilities receiving fewer services outside of business hours than private, metropolitan and highly acute facilities.

The Care Coordination Program: a virtually integrated care delivery model for complex, high-needs patients

Background The South African healthcare sector is fragmented. The increasing prominence of non-communicable, or chronic, diseases in both the private and public healthcare sectors contributes to the country’s complex and costly “quadruple burden of disease” (the others being HIV/AIDS, tuberculosis, maternal and child mortality, and violence). These chronic diseases, once they have progressed, are inherently difficult to manage due to their underlying psychosocial components and their characteristically complex co-morbidities. High costs, without the desired improved clinical outcomes, are common. Elsewhere in the world, such as in the United States, where similar fragmented systems exist, new care-delivery models have emerged to better manage patients with complex conditions. These include vertical payerprovider integration, patient-centered medical homes, and accountable care organizations. Enablers of similar structural reforms are lacking in South Africa, however, where regulatory rules bar the employment of salaried doctors by hospital networks. Moreover, a looming nation-wide dearth of healthcare professionals diminishes the potential for systemic structural changes to the status quo. Discovery Health (DH) is the country’s largest private healthcare payer, providing health insurance coverage to over 2.5 million people. The Care Co-ordination Program (CCP) is DH’s response to the fragmented care received by its members who present with complex healthcare needs, including psychological and social vulnerabilities. Methods The target DH population of members likely to benefit in the CCP is identified geographically using the Johns Hopkins Adjusted Clinical Group tool. This tool categorizes members into Resource Utilization Bands. Further, a Disease Burden Index (DBI) is employed to narrow the focus of the CCP to DH members with the greatest complexity and highest disease burden. The DBI for the CCP population is 17.071 compared to a significantly lower DBI for the general DH population of 1.024 (see Figure 1). Sub-acute service providers in the identified highneeds geographic areas who meet structural, service and management criteria are contracted with DH to participate in a CCP network. At the time of a patient’s admission into an acute facility, a DH care recruiter employs pre-set clinical, social, and psychological entry criteria combined with a FIM (Functional Independence Measure) score to identify patients at risk of sub-optimal quality of care associated with repeated costly admissions. The identified patients are voluntarily enrolled in the CCP and, at this point, a DH care co-coordinator joins the care team of the contracted service provider. The care co-coordinator ensures that the patient’s unique needs are carefully and methodically addressed by the service provider’s interdisciplinary care team. Integrating the family into the care plan is central to ensuring a successful transition to the home. The care co-coordinator shares the transition plan and the patient’s electronic medical record with all involved providers, thus ensuring the co-ordination of care following discharge. The co-coordinator is a valuable resource for the patient, managing vulnerabilities during the transition to home and community. * Correspondence: roshinin@discovery.co.za Risk and Quality Management, Discovery Health, Sandton, 2146, South Africa Naidoo and Steenkamp BMC Health Services Research 2011, 11(Suppl 1):A18 http://www.biomedcentral.com/1472-6963/11/S1/A18

Pulmonary Rehabilitation in a Subacute/LTC Setting

Introduction/Objective: Patients with COPD have many medical and psychosocial needs, and often require subacute services after an acute hospitalization for exacerbation of their disease. Although pulmonary rehabilitation is a known resource, most of these programs are located in acute rehabilitation centers which may not be the appropriate discharge location for many patients with multiple comorbidities. The objective of this pilot study was to determine if residents enrolled in this new program felt benefited by it.

Operating environment and USA nursing homes' participation in the subacute care market: a longitudinal analysis

We examined the impact of environmental factors on USA nursing homes' participation in the subacute care market. Findings suggest that the Balanced Budget Act of 1997 did not have a significant impact in the participation of nursing homes in the subacute care market from 1998 to 2000. However, there was a declining trend in the participation of nursing homes in the subacute care market after the implementation of Medicare prospective payment system (PPS). Furthermore, nursing homes with a higher proportion of Medicare residents were more likely to exit the subacute care market after PPS. Results also suggest that nursing homes have responded strategically to the environmental demand for subacute care services. Nursing homes located in markets with higher Medicare managed care penetration were more likely to offer subacute care services. Environmental munificence was also an important predictor of nursing home innovation into subacute care. Nursing homes in states with higher Medicaid reimbursement and those in less competitive markets were more likely to participate in the subacute care market.

Transition care: will it deliver?

Transition care is a new program to Australia that is designed to facilitate transitions of frail older people between the hospital and aged care systems. This program is designed to deliver potentially important improvements to the Australian health care system--but will it deliver? The current evidence base regarding the efficacy of this type of program is mixed, and there is little evidence to indicate improved patient outcomes. An average transition care episode is expensive (about $11 000). Therefore, careful consideration of the relative cost-effectiveness compared with other interface programs such as inpatient subacute services is essential. Transition care services should be established within the context of overall regional plans for aged care, incorporating hospital acute and subacute inpatient services, and long-term community and residential care programs.

CMS May Establish Rule for NH Dialysis Units

CMS May Establish Rule for NH Dialysis Units

Musculoskeletal Medicine in Practice

Objectives To provide a rapid access treatment facility in the primary care setting for patients with acute low back pain. To implement the recommendations of the Clinical Standards Advisory Group for back pain (CSAG).Design A pilot scheme was initially run with a treatment centre in each of Plymouth’s three locality care groups (LCGs). 12 months funding was obtained from each locality’s development funds. All GPs in the area were invited to refer patients according to an agreed protocol and targets for waiting times were set. Each centre was run by a practitioner with special skills and experience in the management of back pain.Setting Consulting rooms in three general practice surgeries with facilities for carrying out examinations, spinal manipulations, acupuncture and caudal epidurals.Participants The protocol for referral included patients between 18 and 60 with symptoms of six weeks duration or less who were not making progress and who would otherwise have been referred to secondary care.Results In the pilot year, 651 patients were referred and 92% were seen within two weeks of the request. 50% were off work at the time of referral. At discharge, 72% were more than 70% improved and only four percent required further referral, in the majority of cases for a neurosurgical opinion. The average cost per patient treated was £91, considerably less than hospital outpatient treatment.Conclusion A rapid response service for patients with acute back pain has been adopted by Plymouth’s PCT. This service has shown itself to be both effective and economical. A multidisciplinary sub-acute service was added after 12 months. The acute and the sub acute clinics together with the existing hospital pain clinic, provide a seamless service for patients with back pain that satisfies the principal recommendations in the CSAG (HMSO 1994) report.

Wernicke's Encephalopathy: The Subacute Setting as Safety Net

Wernicke's encephalopathy is a disease forgotten but not gone. In the subacute setting, it is likely to appear after a (typically brief) hospital stay requires vigilance and skill to diagnose. Treatment with parenteral thiamine, a safe intervention, is often successful in reversing the neurological manifestations. We argue that the subacute setting is an appropriate setting in which to diagnose and treat Wernicke's encephalopathy and that this disease is but one of many for which the subacute service will be increasingly responsible.

The role of subacute rehabilitation services after brain injury

Subacute rehabilitation is increasingly being used as a treatment option in the continuum of care. What constitutes subacute rehabilitation has not been uniformly defined. Therefore, considerable variability exists in subacute rehabilitation programs. This review outlines assessment and management of early recovery brain-injured individuals and offers a pragmatic schema for levels of care which are best suited to each recovery stage based on the Rancho Los Amigos cognitive scale.

The role of subacute rehabilitation services after brain injury

The role of subacute rehabilitation services after brain injury

Occupational Therapy Intervention for the Geriatric Client Receiving Acute and Subacute Services Following Total Hip Replacement and Femoral Fracture Repair

This article addresses acute and subacute occupational therapy treatment techniques for older adults status-post total hip replacement and repair. Emphasis is on stimulating musculoskeletal, postural, sensory, cognitive, and psychosocial human components to maximize independence in activities of dai

Financial performance of safety-net hospitals in a changing health care environment.

Safety-net hospitals serving the poor and indigent in inner-cities have received inadequate research attention regarding the determinants of their financial performance in the changing health care environment. We analyze how the 1990-92 financial performance of 275 such hospitals is related to exogenous and endogenous factors such as payer mix, service mix, staffing and ownership. Models of hospital financial performance are developed using operating margin, cost per discharge and revenue per discharge as measures of performance. Stepwise regression is used to test the model with data from the American Hospital Association (AHA) and Health Care Investment Analysts (HCIA). Results suggest that: 1) The profitability of inner-city hospitals appears positively related with technical complexity of care; 2) High interest and low operating surplus may constrain the addition of technically sophisticated services to enhance profitability; 3) There is some evidence that new governmental programs, e.g. Medicaid managed care and Medicaid Diagnosis Related Groups (DRGs), may not have improved operating margins, though Medicaid DRGs appear to have contained costs. Follow-up research is needed on this issue; 4) Given external fiscal realities, internal management strategies for inner-city hospitals require research, e.g. developing appropriate managed care systems and timely expansion of sub-acute services and; 5) Services such as AIDS treatment and community health education represent opportunities to respond to community needs, especially since unit cost of such services will decline with high volume.

Understanding and Operationalizing Subacute Services

Providers are now viewing subacute care as an opportunity to market to managed care businesses. Many existing subacute units claim they can provide quality post-acute-care hospital services for considerably less cost than traditional inpatient stays. Subacute units will have to demonstrate both cost savings and quality to be attractive to the market place. Therefore, it is important for nursing managers to understand operational and other aspects of this business.

Guidelines for the medical management of the home-care patient. American Medical Association Home Care Advisory Panel

Increasing numbers of patients of all ages are receiving needed health care services in non-institutional settings. Acute, subacute, rehabilitative, preventive, long-term, and hospice services are provided in the home under the physician's supervision. The safe and appropriate treatment of these patients involves the physician in a team effort as most home care is provided by nurses, other allied health professionals, and family members. The guidelines cover such areas as the role of the physician; the physician-patient relationship; the elements of medical management in home care, including the evaluation/assessment process, the selection of the interdisciplinary team, and the development of the care plan; patient's rights and responsibilities; the coordination of care; and the use of community resources.