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Fernandes S, Bula C, Krief H, Carron PN, Seematter-Bagnoud L. Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes. BMC Geriatr 2024; 24:456. [PMID: 38789942 PMCID: PMC11127364 DOI: 10.1186/s12877-024-05081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients' functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. METHODS Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients' socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients' characteristics and unplanned transfers. RESULTS One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53-0.94, P = .016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53-0.99, P = .046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29-2.26, P < .001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02-1.07, P < .001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05-2.70, P = .029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P < .001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46-29.42, P < .001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. CONCLUSION A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes.
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Affiliation(s)
- Sofia Fernandes
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Christophe Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Hélène Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland.
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland.
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Chang CH, Lopez K, Wasser T, Mei H. Risk factors for readmission of patients with amputation to acute care from inpatient rehabilitation: A retrospective cohort study. PM R 2024; 16:231-238. [PMID: 37584174 DOI: 10.1002/pmrj.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 04/24/2023] [Accepted: 07/28/2023] [Indexed: 08/17/2023]
Abstract
INTRODUCTION Amputation is a major condition that requires inpatient rehabilitation. Some research has been conducted to explore the risk factors for readmission of patients from inpatient rehabilitation facilities to acute care hospitals. However, few studies have included patients with amputation in the study population. OBJECTIVE To identify the risk factors for readmission of patients with amputation to acute care hospitals from an inpatient rehabilitation facility. DESIGN Retrospective cohort study. SETTING An acute rehabilitation hospital associated with a community-based tertiary medical center. PATIENTS A retrospective review of 156 independent admissions of 145 patients from June 2019 to July 2022. MAIN OUTCOME MEASURE The study outcome measure was readmission to acute care from an acute rehabilitation unit. RESULTS Of the 156 independent admissions, the readmission rate was 19% (29/156). The most common cause of transfer was incision-site complications (9/29, 31%), including wound infection and wound dehiscence. Patients with amputation readmitted to acute care are more likely to be receiving dialysis (p < .001), have a longer length of stay in acute care before admission to the rehabilitation facility (p = .039), and have a lower Section GG score on admission (p < .001). Age, sex, ethnicity, amputation level, and history of diabetes mellitus were not associated with acute care hospital readmission. The logistic regression model revealed that patients being on dialysis was the only significant risk factor predictive of readmission to acute care (odds ratio [OR] 4.82, p = .006). CONCLUSIONS This study showed that incision-site complications were the most common cause of disruption in inpatient rehabilitation via acute hospital readmission in patients with amputation. Being on dialysis was associated with a higher risk of readmission to acute care hospitals. Based on the results of this study, specific rehabilitation plans might be required for patients with amputation who carry certain risk factors to reduce rehospitalization to the acute care unit.
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Affiliation(s)
- Chin-Hen Chang
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
| | - Kevin Lopez
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
| | - Thomas Wasser
- Consult-Stat: Complete Statistical Service, Wernersville, Pennsylvania, USA
| | - Haiping Mei
- Department of Physical Medicine and Rehabilitation, Reading Hospital, Tower Health System, Reading, Pennsylvania, USA
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Sparling TL, Yih ET, Goldstein R, Slocum CS, Ryan CM, Zafonte R, Schneider JC. Development of a 30-Day Readmission Risk Calculator for the Inpatient Rehabilitation Setting. J Am Med Dir Assoc 2022; 23:1964-1970. [PMID: 36150407 PMCID: PMC9926973 DOI: 10.1016/j.jamda.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Readmission to acute care from the inpatient rehabilitation facility (IRF) setting is potentially preventable and an important target of quality improvement and cost savings. The objective of this study was to develop a risk calculator to predict 30-day all-cause readmissions from the IRF setting. DESIGN Retrospective database analysis using the Uniform Data System for Medical Rehabilitation (UDSMR) from 2015 through 2019. SETTING AND PARTICIPANTS In total, 956 US inpatient rehabilitation facilities and 1,849,768 IRF discharges comprising patients from 14 impairment groups. METHODS Logistic regression models were developed to calculate risk-standardized 30-day all-cause hospital readmission rates for patients admitted to an IRF. Models for each impairment group were assessed using 12 common clinical and demographic variables and all but 4 models included various special variables. Models were assessed for discrimination (c-statistics), calibration (calibration plots), and internal validation (bootstrapping). A readmission risk scoring system was created for each impairment group population and was graphically validated. RESULTS The mean age of the cohort was 68.7 (15.2) years, 50.7% were women, and 78.3% were Caucasian. Medicare was the primary payer for 73.1% of the study population. The final models for each impairment group included between 4 and 13 total predictor variables. Model c-statistics ranged from 0.65 to 0.70. There was good calibration represented for most models up to a readmission risk of 30%. Internal validation of the models using bootstrap samples revealed little bias. Point systems for determining risk of 30-day readmission were developed for each impairment group. CONCLUSIONS AND IMPLICATIONS Multivariable risk factor algorithms based upon administrative data were developed to assess 30-day readmission risk for patients admitted from IRF. This report represents the development of a readmission risk calculator for the IRF setting, which could be instrumental in identifying high risk populations for readmission and targeting resources towards a diverse group of IRF impairment groups.
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Affiliation(s)
- Tawnee L Sparling
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Erika T Yih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Chloe S Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Colleen M Ryan
- Surgical Services, Shriners Hospitals for Children, Boston, MA, USA; Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Stockly OR, Wolfe AE, Goldstein R, Roaten K, Wiechman S, Trinh NH, Goverman J, Stoddard FJ, Zafonte R, Ryan CM, Schneider JC. Predicting Depression and Post-Traumatic Stress Symptoms Following Burn Injury: A Risk Scoring System. J Burn Care Res 2021; 43:899-905. [PMID: 34751379 DOI: 10.1093/jbcr/irab215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Depression and post-traumatic stress are common psychiatric comorbidities following burn injury. The purpose of this study was to develop an admission scoring system that assesses the risk of development of depression or post-traumatic symptoms in the burn population. This study is a retrospective review of the prospectively collected Burn Model System National Database. Adult burn survivors enrolled from 2014-2018 (n=486) were included. The primary outcome was the presence of depression or post-traumatic stress symptoms at 6, 12, or 24 months post-injury. Logistic regression analysis was used to identify demographic and clinical predictors of depression and post-traumatic stress symptoms. A risk scoring system was then created based on assigning point values to relevant predictor factors. The study population had a mean age of 46.5±15.8 years, mean burn size of 18.3±19.7%, and was 68.3% male. Prior to injury, 71.3% of the population was working, 47.9% were married, and 50.8% had completed more than a high school education. An 8-point risk scoring system was developed using the following predictors of depression or post-traumatic stress symptom development: gender, psychiatric treatment in the past year, graft size, head/neck graft, etiology of injury, and education level. This study is the first to develop a depression and post-traumatic stress symptom risk scoring system for burn injury. This scoring system will aid in identifying burn survivors at high risk of long-term psychiatric symptoms that may be used to improve screening, monitoring, timely diagnosis and interventions.
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Affiliation(s)
- Olivia R Stockly
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Audrey E Wolfe
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shelley Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Nhi-Ha Trinh
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jeremy Goverman
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Frederick J Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
| | - Colleen M Ryan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.,Harvard Medical School, Boston, MA.,Shriners Hospitals for Children-Boston, Boston, MA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA.,Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.,Harvard Medical School, Boston, MA
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Bhakta A, Roy I, Huang K, Spangenberg J, Jayabalan P. Factors associated with unplanned transfers among cancer patients at a freestanding acute rehabilitation facility. PM R 2021; 14:1037-1043. [PMID: 34296529 DOI: 10.1002/pmrj.12681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cancer patients undergoing inpatient rehabilitation often have high risk of complications leading to unplanned transfer to acute care. Prior studies have identified factors associated with these transfers but have been limited to examining factors that pertain to initial admission to rehabilitation and were not conducted in a freestanding inpatient rehabilitation facility. OBJECTIVE The study aimed to include these prerehabilitation factors in addition to factors upon initial assessment in rehabilitation. It was hypothesized that specific factors from each of these periods would be associated with unplanned transfer to acute care. DESIGN Retrospective cohort study. SETTING Freestanding academic inpatient rehabilitation facility affiliated with an academic tertiary care facility with a comprehensive cancer center. PATIENTS Retrospective review of 330 specific encounters unique to 250 patients from March 2017 to September 2018. MAIN OUTCOME MEASURES The outcome measure was unplanned transfer to acute care. A binary logistic regression model was used to examine the relationship between factors from oncologic history, acute care course, and factors upon admission to rehabilitation to unplanned transfer to acute care. RESULTS From 330 encounters, there were 111 unplanned transfers (34%). Unplanned transfer to acute care was independently associated with gastrointestinal malignancy (odds ratio [OR] 4.4, p = .01), 6-minute walk test less than 90 m (OR 4.6, p = .003), and prior unplanned transfer (OR 3.5, p = .007). CONCLUSIONS The study suggests that oncologic and functional prerehabilitation markers are associated with an increased likelihood of unplanned transfer during inpatient cancer rehabilitation. These findings will provide a framework for creating predictive tools for unplanned transfers in cancer rehabilitation patients.
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Affiliation(s)
- Akash Bhakta
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Huntington Hospital, Pasadena, California, USA
| | - Ishan Roy
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin Huang
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jacqueline Spangenberg
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Prakash Jayabalan
- Shirley Ryan AbilityLab, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Roberts PS, Ouellette D, Solis N, Walters R, Chambers K, Brown D, DiVita MA. Retrospective study demonstrating therapy time impact on inpatient rehabilitation functional gains. Disabil Rehabil 2021; 44:4639-4647. [PMID: 33899629 DOI: 10.1080/09638288.2021.1912836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this retrospective study is to evaluate the association of total therapy time during inpatient rehabilitation and gain in functional independence for patients admitted to an inpatient rehabilitation facility (IRF). MATERIALS AND METHODS The study utilized a retrospective design that included all IRF patients from three IRFs in California from January 1, 2012 to December 31, 2013. Patient data collected as part of usual, routine medical, and rehabilitation care were used and includes demographics, medical variables, and functional outcomes data. RESULTS There were 3212 patients discharged from the three IRFs, with 2,777 patients having received speech language pathology (SLP) therapy along with occupational therapy and physical therapy. Speech language pathology services were not provided for 435 patients in the database. Our results support that among all types of patients, increased therapy hours were associated with increased functional gains. For total functional independence measure (FIM) gain, an additional hour of PT therapy per day was associated with an increase of 7.55 FIM gain points (p < 0.001) and an additional hour of OT therapy per day was associated with an increase of 1.16 FIM gain points (p = 0.045), when adjusted for other variables in the model. SLP hours per day did not remain in the FIM gain model. CONCLUSIONS The findings of this study add to the understanding of therapy time and functional gain in an inpatient rehabilitation program. There is a positive relationship between total therapy time and functional gain. In the future determining the intensity and the related therapy activities provided will be needed to impact functional change. This has implications for shaping rehabilitation practice in the future.Implications for rehabilitationIncreased number of therapy hours were associated with functional gains in an inpatient rehabilitation program for all types of patients.An additional hour of physical therapy per day was associated with an increase of 7.55 functional independence measure (FIM) point gain.An additional hour of occupational therapy per day was associated with an increase of 1.16 FIM point gain.Determining the intensity and related activities are needed to impact functional change which has implications for shaping rehabilitation practice.
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Affiliation(s)
- Pamela S Roberts
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
| | - Debra Ouellette
- Casa Colina Hospital and Centers for Healthcare, Pomona, CA, USA
| | - Nuvia Solis
- Department of Physical Medicine and Rehabilitation, Cedars-Sinai, Los Angeles, CA, USA
| | | | | | - David Brown
- Sharp Memorial Medical Center, San Diego, CA, USA
| | - Margaret A DiVita
- Health Department, State University of New York at Cortland, Cortland, NY, USA
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7
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McKechnie D, Fisher MJ, Pryor J, Mckechnie R. An examination of the nature and characteristics of patients readmitted to acute care from inpatient brain injury rehabilitation. J Adv Nurs 2020; 76:2586-2596. [PMID: 32748979 DOI: 10.1111/jan.14475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
AIM To describe the nature of readmission to acute care and identify patient characteristics associated with avoidable readmission to acute care from inpatient brain injury rehabilitation. DESIGN A retrospective cohort design. METHODS Data prospectively documented between 1 January 2012 -31 December 2018 in local clinical and administrative database were used. Patient medical records were accessed when missing data were identified. Descriptive statistics were used to describe the nature of readmission episodes and univariate and multivariable logistic regression were used to identify patient characteristics associated with readmission to acute care. RESULTS Of the 383 patients admitted for rehabilitation, 83 (22%) experienced readmission to acute care for a total of 171 episodes. Thirty-seven percent of readmission episodes were due to hospital acquired complications and therefore potentially avoidable. Infection accounted for 63% of hospital acquired complications. Patients with an avoidable readmission episode (N = 38) were more likely to have a significantly lower Functional Independence Measure score, be incontinent, have a tracheostomy, require a mobility aid, and be prescribed a dysphagia diet on rehabilitation admission. Patients with a tracheostomy on rehabilitation admission had a 56% probability for an avoidable readmission to acute care. CONCLUSION Brain injury rehabilitation patients with an avoidable readmission to acute care were more likely to have a higher burden of care on rehabilitation admission and infection was the leading cause of avoidable readmission episodes. IMPACT Research into readmission to acute care in the mixed brain injury inpatient rehabilitation population is limited. In this patient population, readmission to acute care is a contemporary issue that can occur at any time during a patient's rehabilitation admission. This study provides valuable information informing practice change for preventing avoidable readmission episodes. Locally developed policy aimed at preventing readmission episodes should include proactive prevention, early recognition of complications and discrete escalation care pathways.
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Affiliation(s)
| | - Murray J Fisher
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Ryde, NSW, Australia
| | - Julie Pryor
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Ryde, NSW, Australia
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Evaluation of Hospitalizations Preventable with Idealized Outpatient Care and Continuity of Care. J Healthc Qual 2020; 43:145-152. [PMID: 32168121 DOI: 10.1097/jhq.0000000000000259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Unnecessary hospitalizations may pose the risk of iatrogenic complications, suboptimal patient experience, and increased cost. Administrative data lack granularity to understand the proportion and causes of hospitalizations preventable through optimizing care continuum (HPOCC). We aim to identify the incidence and causes of HPOCC through clinician-adjudicated chart review. METHODS A retrospective review was performed for inpatient admissions from the emergency department (ED) over 1 week. Each admission was reviewed by a clinician to determine whether it is an HPOCC defined as not requiring inpatient care with the assumption of idealized outpatient care and social support. RESULTS Of the 515 patients admitted from the ED, 31 (6.0%) patients were judged to have had an HPOCC. Causes of HPOCC include urgent diagnostics (9, 29.0%), unnecessary transfer from a long-term facility (7, 23.0%), needing IV therapy (5, 16.0%), benign incidental finding (5, 16.0%), diagnostic uncertainty in complex chronic illness (3, 10.0%), and lack of access to care for disposition (2, 6.0%). CONCLUSION Hospitalizations preventable through optimizing care continuum account for about 1 in every 15 hospitalizations in an urban academic medical center. The need for urgent diagnostics accounts for a plurality of HPOCC and could be an important target for quality improvement.
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Hodosevich Z, Wheeler KK, Shi J, Coffey R, Bailey JK, Jones LM, Thakkar RK, Fabia RB, Groner JI, Xiang H. Incidence of Unplanned 30-Day Readmissions in Adult Burn Patients in the United States. J Burn Care Res 2020. [PMID: 29534188 DOI: 10.1093/jbcr/iry008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study characterizes adult burn readmissions in the United States using a nationally representative hospital inpatient sample. Readmission rates, diagnoses, and risk factors are discussed. We analyzed the 2013 and 2014 Nationwide Readmission Database for adult burn patients. The data were weighted to estimate national 30-day readmission rates. Principal readmission diagnoses were sorted into burn-specific or other readmission categories. We used multivariable logistic regression to assess the effects of patient and hospital stay risk factors on readmissions. An estimated 42,957 U.S. adult burn patients were discharged between January and November of 2013 and 2014. Of these patients, an estimated 3203 had unscheduled readmissions within 30 days (all-cause readmission rate: 7.5%, 95% CI: 6.7-8.2). An estimated 55.4 per cent of unplanned readmissions were for burn-specific principal readmission diagnoses. Burn-specific readmission was associated with burn severity and increased with both patient age and the number of comorbidities. Patients whose length of stay was less than 1 day per % total body surface area (%TBSA) burned had higher readmission risk (Adjusted odds ratio = 2.10, 95% CI = 1.48-2.99). The results of logistic regression models were similar for burn-specific readmissions and all-cause readmissions. In a nationally representative sample of adult burn patients, 4.1 per cent had unplanned 30-day readmissions for burn-specific reasons; 7.5 per cent were readmitted for any reason. Patient comorbidities and discharge before 1 day per %TBSA from the hospital impact readmission risk. Healthcare providers can use this information to identify at-risk patients, modify their treatment plans, and prevent readmissions.
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Affiliation(s)
- Zachary Hodosevich
- The Ohio State University College of Medicine, Columbus, Ohio.,Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Krista K Wheeler
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Junxin Shi
- Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Rebecca Coffey
- Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Kevin Bailey
- Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Larry M Jones
- Department of Surgery, Division of Trauma, Critical Care, and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rajan K Thakkar
- The Ohio State University College of Medicine, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Renata B Fabia
- The Ohio State University College of Medicine, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonathan I Groner
- The Ohio State University College of Medicine, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Henry Xiang
- The Ohio State University College of Medicine, Columbus, Ohio.,Center for Injury Research and Policy, Nationwide Children's Hospital, Columbus, Ohio.,Center for Pediatric Trauma Research, Nationwide Children's Hospital, Columbus, Ohio
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10
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Bushi S, Barrett AM, Oh-Park M. Inpatient Rehabilitation Delirium Screening: Impact on Acute Care Transfers and Functional Outcomes. PM R 2019; 12:766-774. [PMID: 31840935 DOI: 10.1002/pmrj.12304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 12/02/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Delirium is well studied in the acute care setting, but there is limited understanding of its impact in the postacute care setting, particularly in the inpatient rehabilitation facility (IRF). OBJECTIVE To investigate the prevalence and related outcomes of delirium in the IRF setting, particularly patients' transfers to acute care hospitals. DESIGN Retrospective cohort study. SETTING A freestanding IRF. PARTICIPANTS Patients discharged from an IRF between January 2016 and December 2016 (12 months). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Transfer to acute care hospitals, motor and cognitive Functional Independence Measures (FIM), length of stay, discharge disposition. RESULTS A total of 1567 patients (53.9% female, mean age 72.9 ± 13.9) were included in the analysis. Positive scores were found among 142 (9.1%) patients on a 3-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM), indicating delirium on admission. Fifty-nine (3.8%) were unscorable on 3D-CAM. Twice as many delirium patients were transferred to acute care hospitals compared to non-delirium patients (22.5% vs. 10.8%, P < .001). Multivariate logistic regression showed that, for patients with 3D-CAM positive scores, there was an increased risk of transfers to acute care hospitals at an odds ratio of 1.61 (1.03-2.53, P = .04) after adjusting for age, gender, neurological diagnosis, and motor FIM score. The delirium group also showed lower gains in motor function, increased lengths of stay, and reduced discharges to home when compared to the non-delirium group (P < .001). CONCLUSIONS This study finds that delirium on admission to an IRF is associated with worsened outcomes related to function, length of stay, discharge status, and transfer to acute care hospitals. Positive delirium screening is an independent predictor for transfer to acute care hospitals from an IRF. Early identification of delirium is recommended in order to mitigate preventable transfers.
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Affiliation(s)
- Sharon Bushi
- Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers - the State University of New Jersey, Newark, NJ.,Kessler Institute for Rehabilitation, West Orange, NJ
| | - A M Barrett
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Health System, Atlanta, GA.,Neurorehabilitation Division, Emory University School of Medicine, Atlanta, GA
| | - Mooyeon Oh-Park
- Burke Rehabilitation Hospital, White Plains, NY.,Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, New York, NY
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11
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A systematic review and meta-analysis of 30-day readmission rates following burns. Burns 2019; 46:1013-1020. [PMID: 31843287 DOI: 10.1016/j.burns.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/05/2019] [Accepted: 11/05/2019] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Unplanned hospital readmissions in surgical areas account for high costs and have become an area of focus for health care providers and insurance companies. The aim of this systematic review is to identify the rate and common reasons for unplanned 30-day readmission following burns. METHODS This study was performed following the PRISMA guidelines. Pubmed, Web of Science and CENTRAL databases were searched for publications without date or language restrictions. Extracted outcomes included 30-day readmission rate and reasons for readmission. Pooled 30-day readmission rate was estimated from weighted individual study estimates using random-effect models. Pooled estimates for risk factors are reported as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS A total of eight studies were included into qualitative analysis and six (four adults, two children) into quantitative analysis. The overall readmission rate was 7.4% (95% CI 4.1-10.7) in adults and 2.7% (95% CI 2.2-3.2) in children. Based on two studies in 112,312 adult burn patients, burn size greater than 20% total body surface area (TBSA) was not a significant predictor of readmission rate (OR 1.75, 95% CI 0.64-4.75; NS). The most common reasons were infection/sepsis, wound healing complications, and pain in both adults and children. DISCUSSION Unplanned readmissions following burns are generally low and appear more common in adults than in pediatric patients. However, only few studies are reporting on 30-day readmission rates following burns. Evidence is limited to support a significant association between greater burn size and higher readmission rates. Since cost effectiveness and utilized hospital capacity are becoming an area of focus for improvement in health care, future studies should assess the risk factors of unplanned readmission following burns. Follow-up assessments and outpatient resources, even if not underlined by this data, could reduce readmission rates. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42019117649.
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McKechnie D, Fisher MJ, Pryor J, McKechnie R. Predictors of unplanned readmission to acute care from inpatient brain injury rehabilitation. J Clin Nurs 2019; 29:593-601. [PMID: 31769573 DOI: 10.1111/jocn.15118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/19/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To identify the predictors of unplanned readmission to acute care (RTAC) from inpatient brain injury rehabilitation and to develop a risk prediction model. BACKGROUND RTAC from inpatient rehabilitation is not uncommon. Individual rehabilitation patient populations require their own body of evidence regarding predictors of RTAC. DESIGN Retrospective cohort study. METHODS Adult patients with new onset acquired brain injury admitted to a stand-alone rehabilitation facility between 1 January 2012-31 December 2018 were included in the study. The main measures were RTAC, sensitivity, specificity, the C-statistic and Youden's index. This paper is reported using the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. RESULTS Of 383 patients admitted for rehabilitation, 83 (22%) experienced a RTAC; 69 (18%) patients had at least one unplanned RTAC episode. Patients requiring unplanned RTAC were more likely to have lower Glasgow Coma Scale (GCS) and Functional Independence Measure (FIM) scores on rehabilitation admission, a higher burden of care on rehabilitation discharge and be discharged to a nonhome residence. Rehabilitation admission GCS and motor FIM were identified as the independent RTAC predictors in multivariate regression modelling. The combined C-statistic was 0.86. A GCS cut-off score of ≤14 and motor FIM cut-off score of ≤40 were identified as optimal, yielding a combined Youden's index of 0.56 (sensitivity = 0.72; specificity = 0.83). CONCLUSION Patients requiring an unplanned RTAC had a lower functional status on rehabilitation admission. A prediction model for unplanned RTAC has been developed using validated and readily available clinical measures. RELEVANCE TO CLINICAL PRACTICE The developed RTAC risk prediction model is the first step in preventing unplanned RTAC from inpatient brain injury rehabilitation. Future research should focus on discrete interventions for preventing unplanned RTAC from inpatient brain injury rehabilitation.
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Affiliation(s)
| | - Murray J Fisher
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
| | - Julie Pryor
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia.,Nursing Research & Development, Royal Rehab, Sydney, NSW, Australia
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McKechnie D, Pryor J, McKechnie R, Fisher MJ. Predictors of Readmission to Acute Care from Inpatient Rehabilitation: An Integrative Review. PM R 2019; 11:1335-1345. [PMID: 31041836 DOI: 10.1002/pmrj.12179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 11/09/2022]
Abstract
Readmission to acute care (RTAC) from inpatient rehabilitation can have negative consequences for individuals and associated financial costs are increasing. Consequently, preventing avoidable RTAC represents a target for improvement in quality of care. The aim of this integrative review was to identify predictors of RTAC from inpatient rehabilitation. A systematic search of MEDLINE, EMBASE, ProQuest, and CINAHL databases was used. Thematic analysis was used to examine extracted data. Strong evidence indicating that the principal predictors of RTAC are lower functional status on admission to rehabilitation, a more severe injury and a higher number of comorbidities was identified in this review. This is despite the heterogeneous nature of impairment groups and factors/measures examined. However, the relevance of some predictors of RTAC (such as patient demographics, invasive devices and primary diagnoses) may be dependent on rehabilitation setting, impairment group or time between rehabilitation admission and RTAC (eg, below 3 vs 30 days). Consequently, findings of this integrative review highlight that RTAC is a complex, multifactorial patient issue with a complex interplay between the predictors and reasons for RTAC. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
| | - Julie Pryor
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
| | | | - Murray J Fisher
- Royal Rehab, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia
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Huang D, Slocum C, Silver JK, Morgan JW, Goldstein R, Zafonte R, Schneider JC. Functional status predicts acute care readmission in the traumatic spinal cord injury population. J Spinal Cord Med 2019; 42:20-31. [PMID: 29596035 PMCID: PMC6340280 DOI: 10.1080/10790268.2018.1453436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Acute care readmission has been identified as an important marker of healthcare quality. Most previous models assessing risk prediction of readmission incorporate variables for medical comorbidity. We hypothesized that functional status is a more robust predictor of readmission in the spinal cord injury population than medical comorbidities. DESIGN Retrospective cross-sectional analysis. SETTING Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation data from 2002 to 2012. PARTICIPANTS traumatic spinal cord injury patients. OUTCOME MEASURES A logistic regression model for predicting acute care readmission based on demographic variables and functional status (Functional Model) was compared with models incorporating demographics, functional status, and medical comorbidities (Functional-Plus) or models including demographics and medical comorbidities (Demographic-Comorbidity). The primary outcomes were 3- and 30-day readmission, and the primary measure of model performance was the c-statistic. RESULTS There were a total of 68,395 patients with 1,469 (2.15%) readmitted at 3 days and 7,081 (10.35%) readmitted at 30 days. The c-statistics for the Functional Model were 0.703 and 0.654 for 3 and 30 days. The Functional Model outperformed Demographic-Comorbidity models at 3 days (c-statistic difference: 0.066-0.096) and outperformed two of the three Demographic-Comorbidity models at 30 days (c-statistic difference: 0.029-0.056). The Functional-Plus models exhibited negligible improvements (0.002-0.010) in model performance compared to the Functional models. CONCLUSION Readmissions are used as a marker of hospital performance. Function-based readmission models in the spinal cord injury population outperform models incorporating medical comorbidities. Readmission risk models for this population would benefit from the inclusion of functional status.
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Affiliation(s)
- Donna Huang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA,Correspondence to: Donna Huang, MD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, 300 First Ave, Charlestown, MA02129, USA; Ph: 404-667-1138.
| | - Chloe Slocum
- Commonwealth Fund Mongan Fellow, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - James W. Morgan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
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Robinson DM, Bazzi MS, Millis SR, Bitar AA. Predictors of readmission to acute care during inpatient rehabilitation for non-traumatic spinal cord injury. J Spinal Cord Med 2018; 41:444-449. [PMID: 29355465 PMCID: PMC6055975 DOI: 10.1080/10790268.2018.1426235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To investigate the frequency of and reasons for readmissions to acute care (RTAC) during inpatient rehabilitation (IPR) after non-traumatic spinal cord injury (NT-SCI). To develop a predictive model for RTAC using identified risk factors. DESIGN Retrospective case-control. SETTING Academic IPR hospital. PARTICIPANTS Individuals with NT-SCI admitted to an academic SCI rehabilitation unit from January 2014-December 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Readmissions to acute care services from IPR. RESULTS Thirty-seven participants (20%) experienced a RTAC for a total of 39 episodes. Thirty-five experienced 1 RTAC, while two had 2. The most common medical reasons for RTAC were infection (27%), neurological (27%), and noninfectious respiratory (16%). Multivariable logistic regression was used to develop a model to predict RTAC. Paraplegia was associated with 3.2 times increase in the odds of RTAC (P = 0.03). For every unit increase in FIM-Motor, there was a 5% reduction in the odds of RTAC (P = 0.03) Body mass index less than 30 decreased odds of RTAC by 61% (P = 0.004). CONCLUSION RTACs were associated with body mass index greater than 30, decreased FIM-Motor subscore on admission, and paraplegia. Physiatrists caring for the non-traumatic SCI patient need be more circumspect of individuals with these parameters to potentially prevent the problems necessitating acute care transfer.
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Affiliation(s)
- David M. Robinson
- School of Medicine, Wayne State University, Detroit, Michigan, USA,Correspondence to: David M. Robinson, MD. 5420 Wessex Ct. Apt 106, Dearborn, MI 48126, USA.
| | - Moussa S. Bazzi
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Scott R. Millis
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Ali A. Bitar
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
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Impact of Early Inpatient Rehabilitation on Adult Burn Survivors' Functional Outcomes and Resource Utilization. J Burn Care Res 2018; 38:e311-e317. [PMID: 27380119 DOI: 10.1097/bcr.0000000000000377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
On July 2012, a rehabilitation hospital merged with a trauma center where the regional burn center is located. That rehabilitation center provides the only burn rehabilitation program in our region. The objective of this study was to determine if earlier initiation of inpatient rehabilitation after merger had an effect on burn survivors' functional outcomes and resource utilization. A retrospective review of electronic data of burn survivors' functional outcomes (functional independence measure [FIM] ratings on admission, at discharge, and percent change), and resource utilization (waiting time for rehab, burn center length of stay [LOS], rehab LOS, physiotherapy and occupational therapy rehabilitation workload [RehabWorkload], and discharge destination) was undertaken. Adult burn survivors who required inpatient rehabilitation and were transferred from the burn center to the inpatient rehabilitation service before the merger (July 2010-June 2012) were compared with those transferred after the merger (July 2012-June 2014). One hundred thirty-eight burn survivors were transferred from the burn center to the inpatient rehabilitation service during the study period. Sixty (43.5%) were transferred before and 78 (56.5%) were transferred after the merger. There were 97 (70.3%) men and 41 (29.7%) women with a mean age of 47.9 ± 17.9 years. TBSA burn was 24.2 ± 16.9%, and full thickness burn was 13.1 ± 16.4%. The etiology of these burns were flame (72.5%), scald (19.6%), electrical (5.1%), chemical (2.2%), and contact (0.7%). Patients in both groups had similar age, inhalation injury, TBSA, full thickness burn, FIM ratings, RehabWorkload, and burn etiology. Patients transferred before the merger had significantly more chemical burns (5% vs 0%, P = .046), and more work-related burns (26.7% vs 7.7%, P = .004). Patients transferred after the merger had significantly shorter burn center LOS (28.5 ± 20.9 days vs 38.8 ± 34.2 days, P = .043), and shorter waiting time for rehab (0.7 ± 1.1 days vs 1.5 ± 2.3 days, P = .010) than patients transferred before the merger. Early initiation of inpatient rehabilitation, after the burn center and the inpatient rehabilitation service were located in the same hospital, improved burn survivors' resource utilization.
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Romanowski KS, Curtis E, Palmieri TL, Greenhalgh DG, Sen S. Frailty Is Associated With Mortality in Patients Aged 50 Years and Older. J Burn Care Res 2017; 39:703-707. [DOI: 10.1093/jbcr/irx024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | - Soman Sen
- Department of Surgery, University of California, Davis
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Thevathasan T, Shih S, Safavi K, Berger D, Burns S, Grabitz S, Glidden R, Zafonte R, Eikermann M, Schneider J. Association between intraoperative non-depolarising neuromuscular blocking agent dose and 30-day readmission after abdominal surgery. Br J Anaesth 2017; 119:595-605. [DOI: 10.1093/bja/aex240] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 01/16/2023] Open
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Return to the Primary Acute Care Service Among Patients With Multiple Myeloma on an Acute Inpatient Rehabilitation Unit. PM R 2017; 9:571-578. [DOI: 10.1016/j.pmrj.2016.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/08/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022]
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Bajorek AJ, Slocum C, Goldstein R, Mix J, Niewczyk P, Ryan CM, Hendricks CT, Zafonte R, Schneider JC. Impact of Cognition on Burn Inpatient Rehabilitation Outcomes. PM R 2017; 9:1-7. [PMID: 27404335 PMCID: PMC9968425 DOI: 10.1016/j.pmrj.2016.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/26/2016] [Accepted: 06/24/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied. OBJECTIVE To assess how cognitive function affects rehabilitation outcomes in the burn injury population. DESIGN Retrospective study. SETTING Inpatient rehabilitation facilities in the United States. PARTICIPANTS A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011. METHODS OR INTERVENTIONS Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates. MAIN OUTCOME MEASUREMENTS FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency. RESULTS Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting. CONCLUSIONS Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Alexander J. Bajorek
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Jacqueline Mix
- Uniform Data System for Medical Rehabilitation, Amherst, NY
| | | | - Colleen M. Ryan
- Sumner Redstone Burn Center, Surgical Services Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | | | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Spaulding Rehabilitation Hospital, 300 First Ave, Charlestown, MA 02129
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Functional Status Outperforms Comorbidities as a Predictor of 30-Day Acute Care Readmissions in the Inpatient Rehabilitation Population. J Am Med Dir Assoc 2016; 17:921-6. [PMID: 27424092 DOI: 10.1016/j.jamda.2016.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/02/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Functional status is associated with patient outcomes, but is rarely included in hospital readmission risk models. The objective of this study was to determine whether functional status is a better predictor of 30-day acute care readmission than traditionally investigated variables including demographics and comorbidities. DESIGN Retrospective database analysis between 2002 and 2011. SETTING 1158 US inpatient rehabilitation facilities. PARTICIPANTS 4,199,002 inpatient rehabilitation facility admissions comprising patients from 16 impairment groups within the Uniform Data System for Medical Rehabilitation database. MEASUREMENTS Logistic regression models predicting 30-day readmission were developed based on age, gender, comorbidities (Elixhauser comorbidity index, Deyo-Charlson comorbidity index, and Medicare comorbidity tier system), and functional status [Functional Independence Measure (FIM)]. We hypothesized that (1) function-based models would outperform demographic- and comorbidity-based models and (2) the addition of demographic and comorbidity data would not significantly enhance function-based models. For each impairment group, Function Only Models were compared against Demographic-Comorbidity Models and Function Plus Models (Function-Demographic-Comorbidity Models). The primary outcome was 30-day readmission, and the primary measure of model performance was the c-statistic. RESULTS All-cause 30-day readmission rate from inpatient rehabilitation facilities to acute care hospitals was 9.87%. C-statistics for the Function Only Models were 0.64 to 0.70. For all 16 impairment groups, the Function Only Model demonstrated better c-statistics than the Demographic-Comorbidity Models (c-statistic difference: 0.03-0.12). The best-performing Function Plus Models exhibited negligible improvements in model performance compared to Function Only Models, with c-statistic improvements of only 0.01 to 0.05. CONCLUSION Readmissions are currently used as a marker of hospital performance, with recent financial penalties to hospitals for excessive readmissions. Function-based readmission models outperform models based only on demographics and comorbidities. Readmission risk models would benefit from the inclusion of functional status as a primary predictor.
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Using Functional Status in the Acute Hospital to Predict Discharge Destination for Stroke Patients. Am J Phys Med Rehabil 2016; 95:416-24. [DOI: 10.1097/phm.0000000000000412] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Abstract
Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.
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Slocum C, Gerrard P, Black-Schaffer R, Goldstein R, Singhal A, DiVita MA, Ryan CM, Mix J, Purohit M, Niewczyk P, Kazis L, Zafonte R, Schneider JC. Functional Status Predicts Acute Care Readmissions from Inpatient Rehabilitation in the Stroke Population. PLoS One 2015; 10:e0142180. [PMID: 26599009 PMCID: PMC4657881 DOI: 10.1371/journal.pone.0142180] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/19/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Acute care readmission risk is an increasingly recognized problem that has garnered significant attention, yet the reasons for acute care readmission in the inpatient rehabilitation population are complex and likely multifactorial. Information on both medical comorbidities and functional status is routinely collected for stroke patients participating in inpatient rehabilitation. We sought to determine whether functional status is a more robust predictor of acute care readmissions in the inpatient rehabilitation stroke population compared with medical comorbidities using a large, administrative data set. METHODS A retrospective analysis of data from the Uniform Data System for Medical Rehabilitation from the years 2002 to 2011 was performed examining stroke patients admitted to inpatient rehabilitation facilities. A Basic Model for predicting acute care readmission risk based on age and functional status was compared with models incorporating functional status and medical comorbidities (Basic-Plus) or models including age and medical comorbidities alone (Age-Comorbidity). C-statistics were compared to evaluate model performance. FINDINGS There were a total of 803,124 patients: 88,187 (11%) patients were transferred back to an acute hospital: 22,247 (2.8%) within 3 days, 43,481 (5.4%) within 7 days, and 85,431 (10.6%) within 30 days. The C-statistics for the Basic Model were 0.701, 0.672, and 0.682 at days 3, 7, and 30 respectively. As compared to the Basic Model, the best-performing Basic-Plus model was the Basic+Elixhauser model with C-statistics differences of +0.011, +0.011, and + 0.012, and the best-performing Age-Comorbidity model was the Age+Elixhauser model with C-statistic differences of -0.124, -0.098, and -0.098 at days 3, 7, and 30 respectively. CONCLUSIONS Readmission models for the inpatient rehabilitation stroke population based on functional status and age showed better predictive ability than models based on medical comorbidities.
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Affiliation(s)
- Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Paul Gerrard
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Randie Black-Schaffer
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aneesh Singhal
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Margaret A. DiVita
- Uniform Data System for Medical Rehabilitation, Amherst, New York, United States of America
| | - Colleen M. Ryan
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Shriners Hospitals for Children®-Boston, Boston, Massachusetts, United States of America
| | - Jacqueline Mix
- Uniform Data System for Medical Rehabilitation, Amherst, New York, United States of America
| | - Maulik Purohit
- Neurorehabilitation and Traumatic Brain Injury, National Intrepid Center of Excellence: Intrepid Spirit One, Fort Belvoir Community Hospital, Fort Belvoir, Virginia, United States of America
| | - Paulette Niewczyk
- Uniform Data System for Medical Rehabilitation, Amherst, New York, United States of America
- Daemen College, Health Care Studies Dept., Amherst, New York, United States of America
| | - Lewis Kazis
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Shih SL, Gerrard P, Goldstein R, Mix J, Ryan CM, Niewczyk P, Kazis L, Hefner J, Ackerly DC, Zafonte R, Schneider JC. Functional Status Outperforms Comorbidities in Predicting Acute Care Readmissions in Medically Complex Patients. J Gen Intern Med 2015; 30:1688-95. [PMID: 25956826 PMCID: PMC4617914 DOI: 10.1007/s11606-015-3350-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/02/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine functional status versus medical comorbidities as predictors of acute care readmissions in medically complex patients. DESIGN Retrospective database study. SETTING U.S. inpatient rehabilitation facilities. PARTICIPANTS Subjects included 120,957 patients in the Uniform Data System for Medical Rehabilitation admitted to inpatient rehabilitation facilities under the medically complex impairment group code between 2002 and 2011. INTERVENTIONS A Basic Model based on gender and functional status was developed using logistic regression to predict the odds of 3-, 7-, and 30-day readmission from inpatient rehabilitation facilities to acute care hospitals. Functional status was measured by the FIM(®) motor score. The Basic Model was compared to six other predictive models-three Basic Plus Models that added a comorbidity measure to the Basic Model and three Gender-Comorbidity Models that included only gender and a comorbidity measure. The three comorbidity measures used were the Elixhauser index, Deyo-Charlson index, and Medicare comorbidity tier system. The c-statistic was the primary measure of model performance. MAIN OUTCOME MEASURES We investigated 3-, 7-, and 30-day readmission to acute care hospitals from inpatient rehabilitation facilities. RESULTS Basic Model c-statistics predicting 3-, 7-, and 30-day readmissions were 0.69, 0.64, and 0.65, respectively. The best-performing Basic Plus Model (Basic+Elixhauser) c-statistics were only 0.02 better than the Basic Model, and the best-performing Gender-Comorbidity Model (Gender+Elixhauser) c-statistics were more than 0.07 worse than the Basic Model. CONCLUSIONS Readmission models based on functional status consistently outperform models based on medical comorbidities. There is opportunity to improve current national readmission risk models to more accurately predict readmissions by incorporating functional data.
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Affiliation(s)
- Shirley L Shih
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul Gerrard
- New England Rehabilitation Hospital of Portland, Portland, ME, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline Mix
- Uniform Data System for Medical Rehabilitation, Amherst, NY, USA
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services, Massachusetts General Hospital, Boston, MA, USA
- Shriners Hospital for Children®-Boston, Boston, MA, USA
| | - Paulette Niewczyk
- Uniform Data System for Medical Rehabilitation, Amherst, NY, USA
- Daemen College, Health Care Studies Department, Amherst, NY, USA
| | - Lewis Kazis
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jaye Hefner
- Department of Internal Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - D Clay Ackerly
- Department of Internal Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine and Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey. J Gen Intern Med 2015; 30:965-72. [PMID: 25691236 PMCID: PMC4471038 DOI: 10.1007/s11606-014-3170-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored . OBJECTIVE We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population. DESIGN This was a retrospective observational study (2003-2011). PATIENTS The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged. MEASUREMENTS The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area. RESULTS A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72. CONCLUSION Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.
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Assessing the ability of comorbidity indexes to capture comorbid disease in the inpatient rehabilitation burn injury population. Am J Phys Med Rehabil 2015; 94:373-84. [PMID: 25171665 DOI: 10.1097/phm.0000000000000180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burn patients exhibit comorbidities that influence outcomes. This study examines whether existing comorbidity measures capture comorbidities in the burn inpatient rehabilitation population. DESIGN Data were obtained from the Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury. International Classification of Diseases, 9th Revision, codes were used to assess three comorbidity measures (Charlson Comorbidity Index, Elixhauser Comorbidity Index, Centers for Medicare and Medicaid Services Comorbidity Tiers). The number of subjects and unique comorbidity codes (>1% of frequency) captured by each comorbidity measure was calculated. RESULTS The study included 5347 patients with a median total body surface area burn decile of 20%-29%, mean age of 51.6 yrs, and mean number of comorbidities of 7.6. There were 2809 unique International Classification of Diseases, 9th Revision, comorbidity codes. The Charlson Comorbidity Index, Elixhauser Comorbidity Index, and Centers for Medicare and Medicaid Services Comorbidity Tiers did not capture 67%, 27%, and 58% of the subjects, respectively. There were 107 unique comorbidities that occurred with a frequency of greater than 1%. Of these, 67% were not captured in all three comorbidity measures. CONCLUSIONS Commonly used comorbidity indexes do not reflect the extent of comorbid disease in the burn rehabilitation population. Future work is needed to assess the need for comorbidity indexes specific to the inpatient rehabilitation setting.
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Roberts PS, Robinson MR. Occupational therapy's role in preventing acute readmissions. Am J Occup Ther 2015; 68:254-9. [PMID: 24797188 DOI: 10.5014/ajot.2014.683001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Pamela S Roberts
- Pamela S. Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, is Manager, Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 915 East, Los Angeles, CA 90048;
| | - Marla R Robinson
- Marla R. Robinson, MSc, OTR/L, BCPR, is Assistant Director, Inpatient Therapy Services, University of Chicago Medicine, Chicago
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DiVita MA, Mix JM, Goldstein R, Gerrard P, Niewczyk P, Ryan CM, Kowalske K, Zafonte R, Schneider JC. Rehabilitation Outcomes Among Burn Injury Patients With a Second Admission to an Inpatient Rehabilitation Facility. PM R 2014; 6:999-1007. [DOI: 10.1016/j.pmrj.2014.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 05/12/2014] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
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Purohit M, Goldstein R, Nadler D, Mathews K, Slocum C, Gerrard P, DiVita MA, Ryan CM, Zafonte R, Kowalske K, Schneider JC. Cognition in patients with burn injury in the inpatient rehabilitation population. Arch Phys Med Rehabil 2014; 95:1342-9. [PMID: 24582616 DOI: 10.1016/j.apmr.2014.01.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 01/22/2014] [Accepted: 01/23/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To analyze potential cognitive impairment in patients with burn injury in the inpatient rehabilitation population. DESIGN Rehabilitation patients with burn injury were compared with the following impairment groups: spinal cord injury, amputation, polytrauma and multiple fractures, and hip replacement. Differences between the groups were calculated for each cognitive subscale item and total cognitive FIM. Patients with burn injury were compared with the other groups using a bivariate linear regression model. A multivariable linear regression model was used to determine whether differences in cognition existed after adjusting for covariates (eg, sociodemographic factors, facility factors, medical complications) based on previous studies. SETTING Inpatient rehabilitation facilities. PARTICIPANTS Data from Uniform Data System for Medical Rehabilitation from 2002 to 2011 for adults with burn injury (N=5347) were compared with other rehabilitation populations (N=668,816). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comparison of total cognitive FIM scores and subscales (memory, verbal comprehension, verbal expression, social interaction, problem solving) for patients with burn injury versus other rehabilitation populations. RESULTS Adults with burn injuries had an average total cognitive FIM score ± SD of 26.8±7.0 compared with an average FIM score ± SD of 28.7±6.0 for the other groups combined (P<.001). The subscale with the greatest difference between those with burn injury and the other groups was memory (5.1±1.7 compared with 5.6±1.5, P<.001). These differences persisted after adjustment for covariates. CONCLUSIONS Adults with burn injury have worse cognitive FIM scores than other rehabilitation populations. Future research is needed to determine the impact of this comorbidity on patient outcomes and potential interventions for these deficits.
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Affiliation(s)
- Maulik Purohit
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; National Intrepid Center of Excellence, Intrepid Spirit One, Fort Belvoir Community Hospital, Fort Belvoir, VA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Deborah Nadler
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Katie Mathews
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Paul Gerrard
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA
| | - Margaret A DiVita
- Uniform Data System for Medical Rehabilitation, Amherst, NY; Health Department, State University of New York at Cortland, Cortland, NY
| | - Colleen M Ryan
- Sumner Redstone Burn Center, Surgical Services Massachusetts General Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Jeffrey C Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA; Shriners Hospitals for Children-Boston, Boston, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.
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Transferring Inpatient Rehabilitation Facility Cancer Patients Back to Acute Care (TRIPBAC). PM R 2014; 6:808-13. [DOI: 10.1016/j.pmrj.2014.01.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/31/2013] [Accepted: 01/12/2014] [Indexed: 11/22/2022]
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Fu JB, Lee J, Smith DW, Shin K, Guo Y, Bruera E. Frequency and reasons for return to the primary acute care service among patients with lymphoma undergoing inpatient rehabilitation. PM R 2013; 6:629-34. [PMID: 24384360 DOI: 10.1016/j.pmrj.2013.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/28/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the frequency and risk factors for return to the primary acute care service among patients with lymphoma undergoing inpatient rehabilitation. DESIGN Retrospective study. SETTING Tertiary referral-based cancer center. PATIENTS All patients with a history of lymphoma admitted to an inpatient rehabilitation between October 1, 2003, and January 30, 2013. MAIN OUTCOME MEASURES Items analyzed from patient records included return to the primary acute care service with demographic information, lymphoma characteristics, medications, hospital admission characteristics, and laboratory values. RESULTS A total of 143 unique patient admissions were analyzed, and 54 of these 143 lymphoma inpatient rehabilitation admissions (38%) returned to the primary acute care service. However, 16 of 54 (30%) returned because they needed additional chemotherapy. Excluding patients who returned to the primary acute care service for chemotherapy, statistically significant or approaching statistically significant factors (P < .10) associated with return to the primary acute care service included a creatinine level ≥ 1.3 mg/dL (P = .0002), male gender (P = .001), history of hematopoietic stem cell transplantation (P = .0355), and presence of an intravenous antifungal agent (P = .0717). Of the patients transferred back to the primary acute care service, 13 of 38 (34%) were discharged directly home, 10 of 38 (26%) died in the hospital, 7 of 38 (18%) were transferred to a subacute rehabilitation facility, and 4 of 38 (11%) were transferred to inpatient rehabilitation. CONCLUSIONS When excluding patients who returned for chemotherapy, patients with lymphoma who were male, had undergone hematopoietic stem cell transplantation, and had a creatinine level ≥ 1.3 mg/dL demonstrated increased risk for return to the primary acute care service.
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Affiliation(s)
- Jack B Fu
- Department of Palliative Care and Rehabilitation Medicine, Unit 1414, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030(∗).
| | - Jay Lee
- Department of Educational Psychology, University of Houston, Houston, TX(†)
| | - Dennis W Smith
- Department of Educational Psychology, University of Houston, Houston, TX(‡)
| | - Ki Shin
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX(§)
| | - Ying Guo
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX(‖)
| | - Eduardo Bruera
- Department of Palliative Care and Rehabilitation Medicine, University of Texas M. D. Anderson Cancer Center, Houston, TX(¶)
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Abstract
Approximately 2457 research articles were published with burns in the title, abstract, and/or keyword in 2012. This number continues to rise through the years; this article reviews those selected by the Editor of one of the major journals in the field (Burns) and his colleague that are most likely to have the greatest likelihood of affecting burn care treatment and understanding. As done previously, articles were found and divided into these topic areas: epidemiology of injury and burn prevention, wound and scar characterization, acute care and critical care, inhalation injury, infection, psychological considerations, pain and itching management, rehabilitation, long-term outcomes, and burn reconstruction. Each selected article is mentioned briefly with comment from the authors; readers are referred to the full papers for further details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas - Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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Kornhaber R, Wilson A, Abu-Qamar MZ, McLean L. Adult burn survivors' personal experiences of rehabilitation: an integrative review. Burns 2013; 40:17-29. [PMID: 24050979 DOI: 10.1016/j.burns.2013.08.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 07/12/2013] [Accepted: 08/02/2013] [Indexed: 11/29/2022]
Abstract
Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey.
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Affiliation(s)
- R Kornhaber
- Severe Burns Injury Unit, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Adelaide, School of Nursing, South Australia, Australia.
| | - A Wilson
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia; Prince of Wales Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - M Z Abu-Qamar
- Department of Adult Health Nursing, Faculty of Nursing, Mútah University, Mútah, Jordan
| | - L McLean
- Westmead Psychotherapy Program, Discipline of Psychiatry, Sydney Medical School, University of Sydney, Australia; Consultation-Liaison Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney West and Greater Southern Psychiatry Training Network, WSLHD, Sydney, NSW, Australia
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