Measuring Inpatient Rehabilitation Facility Quality of Care: Discharge Self-Care Functional Status Quality Measure

Physical Therapy Provider Continuity Predicts Functional Improvements in Inpatient Rehabilitation

BACKGROUND AND PURPOSE

Health care continuity has been linked to improved patient outcomes in a variety of professions and settings. Patients in inpatient rehabilitation receive a consistent dosage of physical therapy (PT) treatment; however, the providing physical therapist may vary. Despite the potential influence of PT provider continuity on functional outcomes in the inpatient rehabilitation setting, this association has not yet been studied.

METHODS

An observational retrospective chart review was conducted on 555 discharged inpatient rehabilitation patients. The relationship between the number of PT providers from whom a patient received care and Quality Indicator (QI) Mobility discharge scores was examined with Pearson product-moment correlation coefficients, initially with the entire patient group and secondarily with distinct diagnostic groups. Data from subgroups for whom a significant relationship was established were then included in a hierarchical linear regression analysis accounting for relevant covariates.

RESULTS

The number of PT providers correlated negatively with QI Mobility discharge scores ( r = -0.41, P ≤ 0.001). When controlling for QI Mobility admission scores, the "Stroke" (partial r = -0.17, P = 0.02), "Spinal Cord Injury" (partial r = -0.28, P = 0.002), and "Other Neuromuscular" (partial r = -0.35, P = 0.03) groups demonstrated significant inverse relationships. A hierarchical linear regression incorporating these 3 diagnostic groups revealed that the number of PT providers remained a significant predictor of QI Mobility discharge scores ( B = -1.50, P ≤ 0.001) when accounting for covariates.

DISCUSSION AND CONCLUSIONS

PT provider continuity is related to the functional improvement of neurologically impaired patients in inpatient rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A405 , which discusses the findings of this work in a narrative format).

Validation of the Standardized Function Data Elements among Medicare Skilled Nursing Facility Residents

OBJECTIVE

To examine the distribution of admission and discharge functional abilities among Medicare fee-for-service beneficiaries with a skilled nursing facility (SNF) stay. Further, to assess the validity of the standardized discharge self-care and mobility data by examining their association to community discharge.

DESIGN

Observational study of SNF Medicare fee-for-service residents' self-care and mobility scores at admission and discharge.

SETTING AND PARTICIPANTS

Medicare beneficiaries with Medicare Part A SNF stays in 2017 from 15,127 Medicare-certified SNFs.

METHODS

We calculated self-care and mobility score frequencies and percentages at admission and discharge to describe the functional abilities of SNF residents; we examined discharge scores by percentage discharge to the community to evaluate item construct validity.

RESULTS

Between admission and discharge, SNF resident scores showed overall improvements in function for all self-care and most mobility activities. For example, between admission and discharge the percentage of residents independent with toileting hygiene and sit to lying increased from 3.7% and 8.2%, to 25.3% and 32.7%, respectively. For all but 2 data elements, residents with lower functional abilities had a lower percentage of being discharged into the community, and the percentage of residents discharged into the community increased as residents performed functional activities of self-care and mobility at higher score ratings. There was a consistent monotonic relationship between residents' discharge self-care and mobility scores and community discharge rates for all but 2 data elements.

CONCLUSIONS AND IMPLICATIONS

Our study found measurable improvements for each self-care and mobility function item for SNF Medicare Part A resident stays in 2017. The results also demonstrated a positive association between higher discharge self-care and mobility scores and higher discharge to community rates. These findings support the validity of the data elements in measuring functional abilities among SNF Medicare Part A residents.

Cognitive impairment and functional change in COVID-19 patients undergoing inpatient rehabilitation

Cognitive impairment is increasingly recognized as a sequela of COVID-19. It is unknown how cognition changes and relates to functional gain during inpatient rehabilitation. We administered the Montreal Cognitive Assessment (MoCA) at admission to 77 patients undergoing inpatient rehabilitation for COVID-19 in a large US academic medical center. Forty-five patients were administered the MoCA at discharge. Functional gain was assessed by change in the quality indicator for self-care (QI-SC). In the full sample, 80.5% of patients exhibited cognitive impairment on admission, which was associated with prior delirium. Among 45 patients with retest data, there were significant improvements in MoCA and QI-SC. QI-SC score gain was higher in patients who made clinically meaningful changes on the MoCA, an association that persisted after accounting for age and delirium history. Cognitive impairment is frequent among COVID-19 patients, but improves over time and is associated with functional gain during inpatient rehabilitation.

Rehabilitation Outcomes for Patients With Severe Presentation of COVID-19: A Case Series

To provide an outline of the timeline from acute care admission to inpatient rehabilitation facility discharge and describe the functional progress and tolerance of 2 individuals who were hospitalized but not intubated because of COVID-19.

METHOD

Retrospective data were collected from the electronic medical record to describe the rehabilitation course of the first 2 consecutive patients admitted to the rehabilitation facility who were recovering from COVID-19. Both patients were octogenarian men who experienced functional decline while hospitalized for symptoms of COVID-19 and were recommended for further inpatient rehabilitation services. Progress during inpatient rehabilitation was tracked using the following outcome measures: Centers for Medicare & Medicaid Services Quality Indicators (QI), 6-Minute Walk Test, 10-Meter Walk Test, Timed Up and Go, and Berg Balance Scale.

RESULTS

Patient 1 had an 18-day acute care stay, a 13-day inpatient rehabilitation facility stay, and was discharged to home. Patient 2 had an interrupted 19-day acute care stay, a 15-day inpatient rehabilitation facility stay, and was discharged to a skilled nursing facility. Patient 1 improved 160.98 m in the 6-Minute Walk Test, 0.08 m/s in self-selected walking speed, and 85 points in the total Quality Indicators score. Patient 2 improved 115.22 m in the 6-Minute Walk Test, 0.14 m/s in self-selected walking speed, and 39 points in the total Quality Indicators score.

CONCLUSION

The patients made clinically meaningful improvements in each outcome measure during their length of stay for inpatient rehabilitation. This reveals the positive rehabilitation potential of 2 older adult patients with COVID-19 and demonstrates the patients' ability to maintain inpatient rehabilitation facility level of activity. With individualized care and discharge planning, similar patients may make significant gains in function despite advanced age and comorbid conditions.

Key Characteristics of Rehabilitation Quality Improvement Publications: Scoping Review From 2010 to 2016

OBJECTIVE

To characterize the peer-reviewed quality improvement (QI) literature in rehabilitation.

DATA SOURCES

Five electronic databases were searched for English-language articles from 2010 to 2016. Keywords for QI and safety management were searched for in combination with keywords for rehabilitation content and journals. Secondary searches (eg, references-list scanning) were also performed.

STUDY SELECTION

Two reviewers independently selected articles using working definitions of rehabilitation and QI study types; of 1016 references, 112 full texts were assessed for eligibility.

DATA EXTRACTION

Reported study characteristics including study focus, study setting, use of inferential statistics, stated limitations, and use of improvement cycles and theoretical models were extracted by 1 reviewer, with a second reviewer consulted whenever inferences or interpretation were involved.

DATA SYNTHESIS

Fifty-nine empirical rehabilitation QI studies were found: 43 reporting on local QI activities, 7 reporting on QI effectiveness research, 8 reporting on QI facilitators or barriers, and 1 systematic review of a specific topic. The number of publications had significant yearly growth between 2010 and 2016 (P=.03). Among the 43 reports on local QI activities, 23.3% did not explicitly report any study limitations; 39.5% did not used inferential statistics to measure the QI impact; 95.3% did not cite/mention the appropriate reporting guidelines; only 18.6% reported multiple QI cycles; just over 50% reported using a model to guide the QI activity; and only 7% reported the use of a particular theoretical model. Study sites and focuses were diverse; however, nearly a third (30.2%) examined early mobilization in intensive care units.

CONCLUSIONS

The number of empirical, peer-reviewed rehabilitation QI publications is growing but remains a tiny fraction of rehabilitation research publications. Rehabilitation QI studies could be strengthened by greater use of extant models and theory to guide the QI work, consistent reporting of study limitations, and use of inferential statistics.