Service Use and Barriers with Post-Acute-Care Rehabilitation Following Acquired Brain Injury: Family Caregiver Perspectives

2016 ◽  
Vol 22 (2) ◽  
pp. 128-134 ◽  
Author(s):  
Charles Edmund Degeneffe ◽  
Richard Green ◽  
Clair Jones
Keyword(s):  
Brain Injury ◽  
Acute Care ◽  
Service Use ◽  
Care Facility ◽  
Acquired Brain Injury ◽  
The United States ◽  
Post Discharge ◽  
Service Areas ◽  
Barriers To Use ◽  
Post Acute Care

The study aimed to understand the use and barriers to use of post-acute-care services by persons with acquired brain injury (ABI). A total of 21 primary family caregivers of persons recently discharged from an ABI acute-care facility in a large southwestern city in the United States participated. Service use in 14 domains appeared consistent with post-discharge needs. In five service areas, participants were not aware the service was available. Professionals in acute ABI rehabilitation units need to be fully aware of the range of available potential supports and diligent in informing injured persons and their families about available post-discharge services.

Service Use and Satisfaction Following Acquired Brain Injury: A Preliminary Analysis of Family Caregiver Outcomes

2016 ◽  
Vol 30 (4) ◽  
pp. 421-428 ◽  
Author(s):  
Charles Edmund Degeneffe ◽  
Richard Green ◽  
Clair Jones
Keyword(s):  
Brain Injury ◽  
Acute Care ◽  
Effect Size ◽  
Family Caregiver ◽  
Service Use ◽  
Care Facility ◽  
Acquired Brain Injury ◽  
Family Dysfunction ◽  
Medium Effect ◽  
Medium Effect Size

Purpose:The study aimed to understand how use and satisfaction with services following discharge from an acquired brain injury (ABI) acute-care facility related to family caregiver outcomes.Methods:A correlational and descriptive study design was used. Nineteen primary family caregivers of persons recently discharged from an ABI acute-care facility in a large city in the southwestern part of the United States participated.Results:Satisfaction with the services provided during post–acute-care rehabilitation demonstrated medium effect size relationships to family caregiver depression, family dysfunction, and extent of rehabilitation needs met. Service use demonstrated a medium effect size relationship to caregiver family dysfunction.Conclusion:Findings present a call for future research to examine the role of service use and service satisfaction during the continuum of care from acute-care to long-term community integration following ABI.

Satisfaction with Post-Acute-Care Rehabilitation Services Following Acquired Brain Injury: Family Perspectives

2017 ◽  
Vol 23 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Charles Edmund Degeneffe ◽  
Richard Green ◽  
Clair Jones
Keyword(s):  
Brain Injury ◽  
Acute Care ◽  
Acute Phase ◽  
Acquired Brain Injury ◽  
Satisfaction Rating ◽  
Care Services ◽  
Service Areas ◽  
Acute Care Services ◽  
Professional Consultation ◽  
Post Acute Care

The study is aimed to better understand how post-acute-care services help persons with acquired brain injury (ABI) and their families following acute-care discharge. Participants included 21 primary family caregivers of persons with ABI. Participants reported their level of satisfaction with 14 different post-acute-care ABI services following discharge from an acute-care ABI facility in a large south-western city in the United States. Participants completed a survey following the discharge (on average 8.1 months) of their family member from acute-care services. Surveys included both quantitative and open-ended questions. The present study focused on participant satisfaction ratings and perceptions of helpfulness among the 14 different service areas. The average satisfaction rating across the 14 service areas was 73.4%. Professional consultation and assessment (81.8%) received the highest satisfaction rating, followed by therapy and intervention (77.9%), and peer support (51.9%). Open-ended question responses on the helpfulness of post-acute-care services focused on (a) therapy and intervention and (b) professional consultation and assessment. Study findings highlight the need to track the use of ABI services from the acute-phase through long-term community adjustment. Findings also underscore the importance of targeting interventions and services specific to the post-acute phase of ABI rehabilitation.

scholarly journals Post-acute care use patterns among Hospital Service Areas by older adults in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julianna M. Dean ◽  
Kimberly Hreha ◽  
Ickpyo Hong ◽  
Chih-Ying Li ◽  
Daniel Jupiter ◽  
...  
Keyword(s):  
Acute Care ◽  
Care Service ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Service Area ◽  
Hospital Service ◽  
Medicare Beneficiaries ◽  
Skilled Nursing ◽  
Service Areas ◽  
Post Acute Care

Abstract Background Despite the success of stroke rehabilitation services, differences in service utilization exist. Some patients with stroke may travel across regions to receive necessary care prescribed by their physician. It is unknown how availability and combinations of post-acute care facilities in local healthcare markets influence use patterns. We present the distribution of skilled nursing, inpatient rehabilitation, and long-term care hospital services across Hospital Service Areas among a national stroke cohort, and we describe drivers of post-acute care service use. Methods We extracted data from 2013 to 2014 of a national stroke cohort using Medicare beneficiaries (174,498 total records across 3232 Hospital Service Areas). Patients’ ZIP code of residence was linked to the facility ZIP code where care was received. If the patient did not live in the Hospital Service Area where they received care, they were considered a “traveler”. We performed multivariable logistic regression to regress traveling status on the care combinations available where the patient lived. Results Although 73.4% of all Hospital Service Areas were skilled nursing-only, only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas; 40.8% of all patients received care in Hospital Service Areas with only inpatient rehabilitation and skilled nursing, which represented only 18.2% of all Hospital Service Areas. Thirty-five percent of patients traveled to a different Hospital Service Area from where they lived. Regarding “travelers,” for those living in a skilled nursing-only Hospital Service Area, 49.9% traveled for care to Hospital Service Areas with only inpatient rehabilitation and skilled nursing. Patients living in skilled nursing-only Hospital Service Areas had more than five times higher odds of traveling compared to those living in Hospital Service Areas with all three facilities. Conclusions Geographically, the vast majority of Hospital Service Areas in the United States that provided rehabilitation services for stroke survivors were skilled nursing-only. However, only about one-third lived in skilled nursing-only Hospital Service Areas; over 35% traveled to receive care. Geographic variation exists in post-acute care; this study provides a foundation to better quantify its drivers. This study presents previously undescribed drivers of variation in post-acute care service utilization among Medicare beneficiaries—the “traveler effect”.

Abstract WP311: Early Lessons Learned in the Stroke Bundled Payment Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
David Ermak ◽  
Raymond Reichwein ◽  
Kathy Morrison ◽  
Alicia Richardson ◽  
Travis M Lehman
Keyword(s):  
Acute Care ◽  
The United States ◽  
Cost Of Care ◽  
Lessons Learned ◽  
Case Review ◽  
Target Price ◽  
Post Discharge ◽  
Prohibitive Cost ◽  
The Impact ◽  
Post Acute Care

Introduction: The Bundled Payments for Care improvement (BPCI) initiative was launched by the Centers for Medicare and Medicaid Services (CMS) in 2014. Our organization contracted for Model 2, making us responsible for all costs associated with index hospital stay plus 90 days post discharge for straight Medicare patients. It was anticipated that we would find opportunity for reduction in readmission rates, which would lead to reduced cost of care. Analysis of Q1 & Q2 2014 data revealed other opportunities. First, cases coded as non-traumatic Subdural Hematoma (SDH) - regardless of readmission - accounted for significant financial deficit. Second, 67% of patients utilized Post-Acute Care (PAC - SNF, acute rehab, home health) at least once and 54% utilized a second PAC. All patients discharged to acute rehab who then transitioned to SNF exceeded the target price for the bundle. Methods: A case review of SDH episodes revealed that many were traumatic but not documented as such. A summary of these cases was presented to providers with recommendations for appropriate wording to ensure appropriate coding. Education was also provided to coders related to BPCI regarding the impact of clarifying traumatic cause of SDH. Protocols for post-acute management were developed with partners in acute rehab & SNF’s in the region and gain-sharing agreements were developed. Partner facilities reviewed each bundled stroke patient for opportunities to reduce post-acute care LOS. Results: Analysis of Q3 2015 demonstrated that the number of SDH cases in the bundle dropped significantly, improving the financial picture six-fold. A reduction in SNF LOS of 25% was appreciated. Conclusion: Stroke is a leading cause of disability in the United States and post-acute care for a 90 day episode carries a prohibitive cost. Accurate documentation and partnering with post-acute facilities does improve the financial position. Ultimately though, post-acute care - not readmissions - is the major driving force for dollars spent in Stroke BPCI.

scholarly journals Hospital to Post-Acute Care Facility Transfers: Identifying Targets for Information Exchange Quality Improvement

2017 ◽  
Vol 18 (1) ◽  
pp. 70-73 ◽  
Author(s):  
Christine D. Jones ◽  
Ethan Cumbler ◽  
Benjamin Honigman ◽  
Robert E. Burke ◽  
Rebecca S. Boxer ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Acute Care ◽  
Information Exchange ◽  
Care Facility ◽  
Acute Care Facility ◽  
Post Acute Care

scholarly journals 566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S268-S268
Author(s):  
Adriana Jimenez ◽  
Kathleen Sposato ◽  
Alicia de Leon-Sanchez ◽  
Regina Williams ◽  
Reynande Francois ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Care Facility ◽  
The United States ◽  
Adult Patients ◽  
Care Hospital ◽  
Icu Patients ◽  
Improvement Project ◽  
Contact Precautions ◽  
The Impact

Abstract Background MRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility. Methods This quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test. Results We observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1). Conclusion Our bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

111 Misaligned Incentives for Lumbar Spine Surgery in the Bundled Payment for Care Initiative

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 223-223
Author(s):  
Joseph E Tanenbaum ◽  
Dominic Pelle ◽  
Edward C Benzel ◽  
Michael P Steinmetz ◽  
Thomas Mroz
Keyword(s):  
Acute Care ◽  
Lumbar Fusion ◽  
Hospital Costs ◽  
Care Facility ◽  
Thoracolumbar Fracture ◽  
Acute Care Facility ◽  
Patient Demographics ◽  
Episode Of Care ◽  
Hospital Characteristics ◽  
Post Acute Care

Abstract INTRODUCTION Under the Bundled Payments for Care Initiative (BPCI), Medicare reimburses for lumbar fusion without adjusting for the patient's underlying pathology. We compared the hospital resource use of two lumbar fusion cohorts that BPCI groups into the same payment bundle: patients with spondylolisthesis and patients with thoracolumbar fracture. METHODS With BPCI, hospitals are reimbursed for a lumbar fusion episode of care if patients are assigned diagnosis related group (DRG) 459 or 460. Vertebroplasty and kyphoplasty use different DRGs. National Inpatient Sample data from 2013 were queried to identify all patients that underwent lumbar fusion to treat a primary diagnosis of thoracolumbar fracture or spondylolisthesis and that were assigned DRG 459 or 460. Multivariable linear and logistic regression were used to compare length of hospital stay (LOS), direct hospital costs, and odds of discharge to a post-acute care facility for thoracolumbar fracture patients and spondylolisthesis patients. All models adjusted for patient demographics, 29 comorbidities, and hospital characteristics. The complex survey design of the NIS was taken into account in all models. RESULTS >After adjusting for patient demographics, insurance status, hospital characteristics, and 29 comorbidities, spondylolisthesis patients had a mean LOS that was 36% shorter (95% CI 26% - 44%, P< 0.0001), a mean cost that was 13% less (95% CI 3.7% - 21%, P< 0.0001), and had 3.6 times greater odds of being discharged home (95% CI 2.5 5.4, P< 0.0001) than thoracolumbar fracture patients. CONCLUSION Under the proposed DRG-based BPCI, hospitals would be reimbursed the same amount for lumbar fusion regardless of whether a patient had spondylolisthesis or thoracolumbar fracture. However, compared with fusion for spondylolisthesis, fusion for thoracolumbar fracture was associated with longer LOS, greater direct hospital costs, and increased likelihood of being discharged to a post-acute care facility. Our findings suggest that the BPCI episode of care for lumbar fusion dis-incentivizes treating trauma patients.

Costs and Resource Utilization in Prolonged Critical Illness

2014 ◽  
Author(s):  
Christopher E Cox
Keyword(s):  
Health Care ◽  
Critical Illness ◽  
Acute Care ◽  
Patient Population ◽  
Health Care Policy ◽  
Patient Flow ◽  
Prolonged Mechanical Ventilation ◽  
Post Discharge ◽  
Chronic Critical Illness ◽  
Post Acute Care

Patients who have chronic critical illness, operationally defined as those requiring prolonged mechanical ventilation, are markedly increasing in number and commonly experience profound, persistent physical and psychological debilitation. This patient population consumes an extraordinary amount of health care resources attributed to both the acute hospitalization as well as complex post-discharge treatments provided across multiple post-acute care facilities. Currently, the US health care system incentivizes these patient flow dynamics. Health care policy changes addressing post-acute care payment are inevitable. This chapter highlights potential patient, family, physician, and systems targets for current and future interventions, designed to improve quality and reduce costs for this patient population.

Provision of resource facilitation services for individuals with acquired brain injury across the United States: results of a 2018 resource facilitator provider survey

Brain Injury ◽  
2020 ◽  
Vol 34 (6) ◽  
pp. 732-740 ◽  
Author(s):  
Summer Ibarra ◽  
Devan Parrott ◽  
Wendy Waldman ◽  
Flora M. Hammond ◽  
Christina Dillahunt-Aspillaga ◽  
...  
Keyword(s):  
United States ◽  
Brain Injury ◽  
Acquired Brain Injury ◽  
The United States ◽  
Provider Survey
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