Post‐Acute Care Locations: Hospital Discharge Destination Reports vs Medicare Claims

2019 ◽  
Vol 68 (4) ◽  
pp. 847-851 ◽  
Author(s):  
Ye Zhu ◽  
Sally C. Stearns
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Discharge Destination ◽  
Medicare Claims ◽  
Post Acute Care

Use of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form and National Institutes of Health Stroke Scale to Predict Hospital Discharge Disposition After Stroke

2020 ◽  
Vol 100 (9) ◽  
pp. 1423-1433
Author(s):  
Stephanie Covert ◽  
Joshua K Johnson ◽  
Mary Stilphen ◽  
Sandra Passek ◽  
Nicolas R Thompson ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Short Form ◽  
Predictive Ability ◽  
National Institutes Of Health ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Activity Measure ◽  
Mobility Score ◽  
Post Acute Care

Abstract Objective Therapists in the hospital are charged with making timely discharge recommendations to improve access to rehabilitation after stroke. The objective of this study was to identify the predictive ability of the Activity Measure for Post-Acute Care “6 Clicks” Basic Mobility Inpatient Short Form (6 Clicks mobility) score and the National Institutes of Health Stroke Scale (NIHSS) score for actual hospital discharge disposition after stroke. Methods In this retrospective cohort study, data were collected from an academic hospital in the United States for 1543 patients with acute stroke and a 6 Clicks mobility score. Discharge to home, a skilled nursing facility (SNF), or an inpatient rehabilitation facility (IRF) was the primary outcome. Associations among these outcomes and 6 Clicks mobility and NIHSS scores, alone or together, were tested using multinomial logistic regression, and the predictive ability of these scores was calculated using concordance statistics. Results A higher 6 Clicks mobility score alone was associated with a decreased odds of actual discharge to an IRF or an SNF. The 6 Clicks mobility score alone was a strong predictor of discharge to home versus an IRF or an SNF. However, predicting discharge to an IRF versus an SNF was stronger when the 6 Clicks mobility score was considered in combination with the NIHSS score, age, sex, and race. Conclusion The 6 Clicks mobility score alone can guide discharge decision making after stroke, particularly for discharge to home versus an SNF or an IRF. Determining discharge to an SNF versus an IRF could be improved by also considering the NIHSS score, age, sex, and race. Future studies should seek to identify which additional characteristics improve predictability for these separate discharge destinations. Impact The use of outcome measures can improve therapist confidence in making discharge recommendations for people with stroke, can enhance hospital throughput, and can expedite access to rehabilitation, ultimately affecting functional outcomes.

The “Permanent” Patient Problem

2014 ◽  
Vol 42 (1) ◽  
pp. 88-92 ◽  
Author(s):  
Courtenay R. Bruce ◽  
Mary A. Majumder
Keyword(s):  
Health Care ◽  
Hospital Discharge ◽  
Acute Care ◽  
Affordable Care Act ◽  
Financial Incentive ◽  
Legal Obligation ◽  
Medicaid Enrollment ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care

Patients who enter the health care system for acute care may become “permanent” patients of the hospital when a lack of resources precludes discharge to the next level of post-acute care. The care of these patients contributes to the rising costs of health care and will remain largely unaffected by the Affordable Care Act. For example, some resources may be available for treatment of undocumented persons, but Medicaid enrollment is unavailable for this population. Even where patients have access to Medicaid, it takes up to three months between applying for and actually receiving Medicaid benefits. During that time, patients may be ready for hospital discharge. However, post-acute care facilities have no financial incentive or legal obligation to accept patients with no insurance or only pending Medicaid coverage.

Staff Perceptions of Adult Day Centers Providing Post-Acute Care for Persons With Dementia

2018 ◽  
Vol 39 (2) ◽  
pp. 192-200 ◽  
Author(s):  
Holly Dabelko-Schoeny ◽  
Ji Won Shin ◽  
Emily Kowal ◽  
Janine Overcash ◽  
Jeffrey M. Caterino ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Staff Perceptions ◽  
Adult Day Services ◽  
Adult Day Centers ◽  
Communication Challenges ◽  
Ed Visits ◽  
Day Services ◽  
Post Acute Care ◽  
Lack Of Knowledge

The purpose of this study was to examine the perception of adult day services (ADS) staff and hospital discharge planners regarding the feasibility of ADS to provide post-acute care (PAC) for persons with dementia. We conducted key informant interviews with emergency department (ED) and inpatient hospital discharge planners ( n = 9), and two focus groups with ADS staff ( n = 15) representing five ADS programs. Four thematic categories were identified from the discharge planners, including concerns for patients, factors influencing discharge, experience with ADS, and conditions for ADS referrals. Four categories identified from ADS staff interviews include public lack of knowledge of ADS, communication challenges, ADS to prevent hospitalization and ED visits, and barriers to providing PAC. Lack of knowledge about ADS, the role of family in PAC decisions, and the lack of reimbursement for PAC in ADS were identified as the most significant drivers in the ability of ADS to provide PAC.

scholarly journals 88 Profiling Clinical Frailty in Older Adults in an Irish Post-Acute Care Ortho-Geriatric Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Edel McDaid ◽  
Elaine Ross ◽  
Lisa Cogan
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Long Term Care ◽  
Discharge Destination ◽  
Clinical Frailty Scale ◽  
Geriatric Population ◽  
Term Care ◽  
Geriatric Unit ◽  
Post Acute Care

Abstract Background Clinical frailty upon admission to acute care has been shown to independently predict adverse discharge destination in geriatric patients (1). However, the prevalence of clinical frailty in post-acute care and its impact on length of stay and discharge destination has not been explored to date (2). The aims of this study were to measure clinical frailty upon admission and discharge to a post-acute Ortho-geriatric Unit (OGU) and identify its impact on length of stay (LOS) and discharge destination. Methods A retrospective data analysis was completed of all patients admitted and discharged within a 6-month period. All received routine Multidisciplinary team (MDT) rehabilitation care. Clinical Frailty was assessed within first week of admission and the week prior to discharge using the Clinical Frailty Scale (CFS). Data was analysed using Microsoft Excel. Results Fifty-four patients were admitted over the 6-month period. All were female, mean age 81 years and over half (55%) had a primary diagnosis of hip fracture (n=30). All were deemed frail on admission (CFS score >5). The Mild to Moderate (CFS 5 and CFS 6) Group (n=36) had a mean age 81.1 years, mean LOS 38.75 days, 96.6% independently mobile on discharge and 97.2% discharged home. The Severe (CFS 7 and CFS 8) Group (n=18) had a mean age 85.2 years, mean LOS 85.2 days, 59.4% independently mobile on discharge and 83.3%% discharged home. 75% (n=3) of patients that transitioned to long-term care were in the Severe Group. At discharge 54% of the total participants were deemed frail(CFS>5), 46% less compared to admission scores. Conclusion All admissions to OGU were frail. MDT rehabilitation reduced frailty levels for the majority of subjects’ in this study. Higher admission CFS scores resulted in increased LOS and a trend towards long-term care transition. Further research is warranted to evaluate the efficacy of CFS in post-acute geriatric population.

scholarly journals Which Patients Require More Care after Hospital Discharge? An Analysis of Post-Acute Care Use among Elderly Patients Undergoing Elective Surgery

2015 ◽  
Vol 220 (6) ◽  
pp. 1113-1121.e2 ◽  
Author(s):  
Greg D. Sacks ◽  
Elise H. Lawson ◽  
Aaron J. Dawes ◽  
Melinda M. Gibbons ◽  
David S. Zingmond ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Hospital Discharge ◽  
Acute Care ◽  
Elective Surgery ◽  
More Care ◽  
Post Acute Care

Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil

2017 ◽  
Vol 35 (2) ◽  
pp. 198-202
Author(s):  
Luiz Guilherme L. Soares ◽  
André M. Japiassu ◽  
Lucia C. Gomes ◽  
Rogéria Pereira
Keyword(s):  
Palliative Care ◽  
Acute Care ◽  
Care Facility ◽  
Discharge Destination ◽  
Care Needs ◽  
Care Services ◽  
Lengths Of Stay ◽  
Hospital Stays ◽  
Acute Care Facilities ◽  
Post Acute Care

Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.

Use of Home Nursing and Post-Acute Care Following Hospital Discharge for Children: A National Study

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 342A-342A
Author(s):  
Jay Berry ◽  
Matthew Hall ◽  
Edwin Simpser ◽  
Helene Dumas ◽  
Michael Dribbon ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
National Study ◽  
Home Nursing ◽  
Post Acute Care

Rise of Post–Acute Care Facilities as a Discharge Destination of US Hospitalizations

2015 ◽  
Vol 175 (2) ◽  
pp. 295 ◽  
Author(s):  
Robert E. Burke ◽  
Elizabeth Juarez-Colunga ◽  
Cari Levy ◽  
Allan V. Prochazka ◽  
Eric A. Coleman ◽  
...  
Keyword(s):  
Acute Care ◽  
Discharge Destination ◽  
Care Facilities ◽  
Acute Care Facilities ◽  
Post Acute Care
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