ONE OF THE MORE COMMON traumatic events among

Size: px
Start display at page:

Download "ONE OF THE MORE COMMON traumatic events among"

Transcription

1 ORIGINAL ARTICLE Inpatient Rehabilitation Outcome After Hip Fracture Surgery in Elderly Patients: A Prospective Cohort Study of 946 Patients Devora Lieberman, MD, Michael Friger, PhD, David Lieberman, MD ABSTRACT. Lieberman D, Friger M, Lieberman D. Inpatient rehabilitation outcome after hip fracture surgery in elderly patients: a prospective cohort study of 946 patients. Arch Phys Med Rehabil 2006;87: Objective: To identify the factors associated with inpatient rehabilitation outcome after surgical repair of hip fracture in elderly patients. Design: A noninterventional prospective cohort study. Setting: Geriatric inpatient rehabilitation center in a tertiary university medical center in southern Israel. Participants: Patients (N 946) aged 65 years of age or older who were hospitalized for rehabilitation after surgery for hip fracture. Interventions: Not applicable. Main Outcome Measures: Functional studies by the FIM instrument and a broad spectrum of clinical, demographic, and social variables. Stepwise multiple regression was used to assess the relative contribution of the variables to the variance of the percentage change in the FIM score during the course of rehabilitation in relation to the severity of the functional impairment at its inception. Results: Eight variables were significantly and independently associated with rehabilitation outcome. Prefracture FIM scale (standardized regression coefficient in multiple regression [ ].261, P.001), serum albumin at discharge (.222, P.001), Folstein Mini-Mental State Examination (.174, P.001), visual impairment (.089, P.002), dyspnea at mild exertion (New York Heart Association class III) (.080, P.005), age (.080, P.007), poststroke motor impairment (.072, P.011), and decreased serum folic acid (.055, P.047). The total percentage of the explained variance of the primary rehabilitation outcome measure accounted for by these 8 variables (adjusted R 2 ) was 31.9%. Conclusions: The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 clinical and nutritional correctable parameters. The other 4 variables that are associated with the process cannot be corrected but may help predict outcomes and adjust expectations. Key Words: Frail elderly; Hip fractures; Rehabilitation by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation From the Department of Geriatrics (Devora Lieberman) and Division of Internal Medicine (Devora Lieberman, David Lieberman), Soroka University Medical Center, Klalit Health Services, Beer-Sheva, Israel; and Department of Epidemiology (Friger) and Faculty of Health Sciences (Devora Lieberman, David Lieberman), Ben-Gurion University of the Negev, Beer-Sheva, Israel. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. Reprint requests to Devora Lieberman, MD, Dept of Geriatrics, Soroka Medical Center, POB 151, Beer-Sheva 84101, Israel, /06/ $32.00/0 doi: /j.apmr ONE OF THE MORE COMMON traumatic events among elderly patients is hip fracture, which can cause significant mortality and morbidity. In addition to the increase in life expectancy seen over recent decades, there has been an ageadjusted increase in the incidence of hip fracture. 1 Taken together, these 2 trends have led to an exponential rise in morbidity in the elderly age group, 2 with all the associated medical, social, and economic ramifications. The treatment of choice for hip fracture is surgical repair, which is followed by rehabilitation. Rehabilitation is designed to facilitate the return of elderly patients to their premorbid status to the greatest possible extent. Among the various outcomes of rehabilitation, the elderly patient s functional condition at the end of the process is the most valuable outcome to assess in this population. This is because the functional condition represents an integrated summation of many factors that affect the elderly patient s physical and mental health. It also has the strongest effect on the patient s well-being and is critically important in assessing his/her degree of dependence on the close environment and the community. To implement this rehabilitation process in an optimal manner, it is important to identify the factors that are associated with its functional outcome. The list of factors that could affect this outcome includes modifiable and nonmodifiable ones. The former are important because treating them at the beginning of and throughout the rehabilitation process can lead to improved outcomes. The latter are important in that they can help determine the chances of successful rehabilitation. Identification of these factors was the aim of this prospective study. METHODS 167 Participants We recruited all patients 65 years and older hospitalized in the geriatric ward of the Soroka Medical Center for rehabilitation after surgical repair of hip fracture over a 92-month period between March 1, 1996, and October 31, The methods of the study have been presented in detail previously. 3 In brief, after surgery for hip fracture, patients were assessed for suitability for rehabilitation and, if found suitable, were transferred to the geriatric ward for a conventional rehabilitation program. Patients with advanced dementia and/or a low premorbid functional status were not considered suitable. The Helsinki Committee of the Soroka Medical Center approved the study, and all patients gave informed consent before enrollment. Measurements Within 48 hours of transfer to the geriatric ward, and after giving informed consent to participate in the study, patients or 1 of their family members provided demographic information and data relating to chronic comorbidity including smoking history. Blood samples drawn at this time were tested by conventional methods for levels of hemoglobin, serum albu-

2 168 REHABILITATION AFTER HIP FRACTURE SURGERY IN ELDERLY, Lieberman min, thyroid-stimulating hormone, folic acid, and vitamin B 12. Hemoglobin and serum albumin were retested at discharge. At this stage, each patient underwent a mental evaluation using the Folstein Mini-Mental State Examination (MMSE), with a scale ranging from 1 to 30 and a cutoff for normal of 23 and above. 4 In addition, each patient underwent an assessment of symptoms of depression using the Geriatric Depression Scale (GDS), with scores ranging from 0 to 30 and a cutoff for normal of 10 or less. 5 Functional assessments and evaluation of the progress of rehabilitation were done using the FIM instrument 6 that ranges from 18 to 126 and is based on a score of 1 to 7 for each of 18 different items, in accordance with the level of independence for each item. By using this scoring system, a patient with totally independent function would have a score of 126 points. The FIM score is applied to the following areas: eating; grooming; bathing; dressing (upper body); dressing (lower body); using the toilet; bladder management; bowel management; transferring (to go from 1 place to another) in a bed, chair, and/or wheelchair; transferring on and off a toilet; transferring into and out of a shower; locomotion (moving) for walking or in a wheelchair; locomotion going up and down stairs; comprehension; expression; social interaction; problem solving; and memory. A senior geriatrician determined the prefracture FIM score during the course of an interview with the patient or his/her family, close to admission. FIM scores on admission to rehabilitation and at its end were determined at a staff meeting of the geriatric ward in which the medical, rehabilitation, and nursing staffs took part. If the FIM scores were stable at 2 successive determinations at a 1-week interval, staff decided to end the rehabilitation process and discharge the patient. The type of fracture, surgical fixation, and type of anesthesia were recorded from the chart in the orthopedic surgery department. Various complications during the rehabilitation process were recorded, when they occurred, by the study staff. During rehabilitation, screening for corrected visual acuity in the better of the 2 eyes was performed by using the standard Snellen eye chart with the patients wearing their own eyeglasses; optimal acuity was set at 6/6 (in meters), and reduced vision was indicated by a higher denominator. Screening for hearing impairment was performed by using an audiometer a at 500, 1000, 2000, and 4000Hz. For purposes of analysis, mean decibel levels in the better of the 2 ears over the 4 frequencies were computed. Statistical Analysis Data were collected by using the Epi Info b and analyzed by using the SPSS c statistical software. Univariate statistical analysis was performed for all independent and dependent variables by using chi-square test, t tests, 1-way analysis of variance, and correlations, as appropriate. Independent variables that were found to have statistical significance were included in the multiple regression model. For multivariate analysis, forward stepwise multiple regression was used to assess the relative contribution of the various dependent variables to the variance of the absolute efficacy of rehabilitation, which was defined as follows: change in FIM during rehabilitation, divided by (126 [maximum FIM] admission FIM) 100. We decided to assess the rehabilitation outcome by absolute efficacy of rehabilitation in light of its simplicity and advantages. This measure reflects both the absolute severity of the functional impairment at the beginning of rehabilitation and the improvement in functional status achieved in its course. This important combination is unique to this index and is not expressed by any other index in use for this purpose. Each of the variables that was assessed in the course of the study was chosen based on medical logic relating to the possibility that it could be associated with the rehabilitation outcome. The 40 variables that met these criteria and, therefore, served as dependent variables for the analyses were age; sex; marital status; years of education; type of fracture; type of fixation; type of anesthesia; previous hip fracture; length of hospitalization in the orthopedic surgery department; dyspnea on mild exertion (New York Heart Association [NYHA] class III); ischemic heart disease; congestive heart failure; atrial fibrillation; chronic lung disease; hypertension; diabetes mellitus; previous stoke with motor impairment; total number of comorbid illnesses; smoking in the past only; smoking in the present; elevated serum thyroid-stimulating hormone ( 5 IU/ ml); decreased serum folic acid ( 3.0 g/l); decreased serum vitamin B 12 ( 250ng/L), hemoglobin, and serum albumin at admission and at discharge; MMSE score; GDS score; complications during rehabilitation (especially urinary tract infection, pneumonia, infection of the surgical wound, acute ischemia, deep venous thrombosis, and stroke); visual and hearing impairment; prefracture FIM score; admission FIM score; and length of rehabilitation in the geriatrics ward. Statistical significance was set as P less than.05. RESULTS Nine hundred sixty-two patients over the age of 65 were hospitalized in the geriatric ward for rehabilitation after surgery for hip fracture during the study period. A random sample over a period of 1 year in the orthopedic surgery department showed that the percentage of elderly patients that were not transferred for rehabilitation was 9.8% of all patients in this age group undergoing surgery for hip fracture. Sixteen (1.7%) of the patients who were transferred for rehabilitation died during its course. The other 946 patients who were discharged at the end of the hospitalization comprised the study group. Table 1 presents the principal characteristics of the study group, in particular sex, age, cognitive state, length of hospitalization in the orthopedic surgery department, length of hospitalization for rehabilitation in the geriatrics ward, and functional status at the 3 time points in relation to the rehabilitation process. Only 8 of the 40 tested variables were significantly and independently associated with absolute efficacy of rehabilitation. These 8 variables are listed in table 2, and their order of importance is expressed by the absolute value of the standardized regression coefficient ( ). The positive or negative value of this coefficient reflects a corresponding positive or negative Table 1: Sociodemographic Characteristics, Functional Status, and Hospitalization Variables of the Study Population (N 946) Variable Value Range Women, n (%) 717 (76) NA Mean age SD (y) Mean MMSE score SD* Mean prefracture FIM score SD Mean days in orthopedic surgery ward SD Mean days hospitalized for rehabilitation SD Mean admission FIM score SD Mean discharge FIM score SD Abbreviations: NA, not applicable; SD, standard deviation. *Available for only 937 of the 946 patients.

3 REHABILITATION AFTER HIP FRACTURE SURGERY IN ELDERLY, Lieberman 169 Variable Table 2: Results of the Multivariate Analysis Regression Coefficient Standard Error P Cumulative Adjusted R 2 Prefracture FIM score (recall) Serum albumin at discharge (g/dl) MMSE Dyspnea on mild exertion, NYHA class III (1 yes, 0 no) Visual impairment (1 yes, 0 no) Age (y) Prior stroke with motor impairment (1 yes, 0 no) Decreased serum folic acid ( 3 g/l) (1 yes, 0 no) NOTE. Variables independently associated with the absolute efficacy of rehabilitation in the order of their adjusted R 2 value. contribution of the specific variable to the absolute efficacy of rehabilitation. The total percentage of the explained variance of the absolute efficacy of rehabilitation accounted for by these variables (adjusted R 2 ) was 31.9%. To avoid the pitfall of overlooking or discounting other important modifiable factors that could be lost in the stepwise regression, we looked at each of the other 4 modifiable factors individually to see if any of them predicts the dependent variable after adjusting for the 4 nonmodifiable covariates (prefracture FIM score, MMSE score, age, prior stroke with motor impairment). This analysis showed that hemoglobin concentration at discharge significantly predicted the dependent variable (P.009), but elevated serum thyroid-stimulating hormone, decreased serum vitamin B 12, and hearing impairment did not. DISCUSSION Two methodologic aspects of our study need to be addressed. First, not all patients who underwent surgical repair of hip fracture were included in the study. This situation led to an inevitable selection bias in the study population. Second, we assessed rehabilitation outcome at the time of discharge from the hospital. We chose this particular point from the entire time sequence of the rehabilitation process that continues beyond discharge as well because we believe that it represents the central point in time in the process. In most cases, completion of the inpatient phase of rehabilitation enables continuation of the process in the framework of the community, where the patient returns to his/her natural environment. It also represents the end of the large expenses incurred in the hospital phase of the process. Of the 8 parameters that were found in this study to be significantly and independently associated with rehabilitation outcome, 5 were identified in previous studies. However, the point in time and the rehabilitation framework in which the rehabilitation outcome was assessed were different among the various studies and from the present one. These 5 parameters include the prefracture functional status, 7-14 the mental status, 9,10,12-16 age, 13,14,16-18 previous stroke, 19,20 and serum albumin level. 21,22 In relation to the last variable, our study introduced an important new dimension (ie, that serum albumin level at discharge rather than at admission has a significant association with the outcome of rehabilitation). This result does not enable us to determine whether this positive association represents a cause or an effect of the outcome but does enable us to propose interventions to raise the serum albumin level by appropriate dietary adjustments and supplementation. Dyspnea on mild exertion (NYHA class III), which was identified in this study as a negative, independent factor associated with rehabilitation outcome, was not reported in previous studies. This significant negative association is striking in light of the absence of such an association for cardiovascular and pulmonary diseases, which are usually the clinical cause of dyspnea, and is in contrast with the results of a previous study in which these diseases were found to have a negative prognostic effect on rehabilitation among hip fracture patients. 23 We believe that these findings reflect the fact that only the severe functional impairment caused by these diseases is associated with the outcome of rehabilitation and not the diseases per se. The negative association between visual impairment and rehabilitation outcome is not surprising. However, it should be noted that this association was not found for hearing impairment. This aspect of the association of visual and hearing impairments with the outcome of rehabilitation in hip fracture patients was described and discussed in a previous article that was dedicated to that issue. 3 The finding that decreased serum folic acid has a negative association with the success of rehabilitation after hip fracture is interesting and expresses, in our opinion, the influence of the nutritional state of the patients in the weeks before the hip fracture, in contrast to decreased serum vitamin B 12 that reflects a more prolonged nutritional deficit that was not found in our study to be an independently significant factor for the success of rehabilitation. During the course of rehabilitation, patients who were found to have decreased serum folic acid levels received supplementation. Despite this strategy, a decreased serum folic acid level at the beginning of rehabilitation had a negative association with its outcome. We assume that the short period of time in which this treatment was given in relation to the length of hospitalization for rehabilitation was not sufficient for the supplementation therapy to affect the outcome of rehabilitation. The interesting association of low folic acid levels with poor functional recovery after hip fracture may be linked, indirectly, to the association that has recently been found between risk for hip fracture and elevated homocysteine in older persons 24 and the association between low levels of folic acid and elevated levels of homocysteine. 25 The hemoglobin concentration at discharge was also found to have a significant effect on the results of rehabilitation, although this effect was identified only through secondary analyses of the results. The significance of this finding is that this variable has an effect on the results of rehabilitation but is less important than the 4 other modifiable factors that were identified in the primary study analyses. In rehabilitation of elderly patients, it is common clinical practice to correct anemia at the beginning of and throughout the rehabilitation process by transferring blood until a serum hemoglobin concentration of around 10mg/dL is achieved and by stimulating the

4 170 REHABILITATION AFTER HIP FRACTURE SURGERY IN ELDERLY, Lieberman blood marrow to continue correcting anemia by supplementation with iron and folic acid. It is possible that the finding on the effect of the hemoglobin concentration at discharge on the outcome of rehabilitation indicates a need to increase the hemoglobin concentration to an even higher level at the beginning of and throughout rehabilitation, but this issue should be addressed in a specifically designed study. In addition to the list of variables that had an independent, significant association with the results of rehabilitation, the 32 variables that did not have an effect are noteworthy. Intuitively, some of those variables were expected to have a significant association, but the results of our study did not support these intuitions. The model that we used to analyze the results negates variables that affect another, more significant variable. This method of analysis led to the situation in which a relatively large number of specific diseases that are common in this age group, the total number of comorbid diseases, the GDS score, hypothyroidism, and a decreased serum vitamin B 12 level that have a significant effect on the prefracture functional status were neutralized, in effect, by the recall FIM instrument, which had the most significant association with rehabilitation outcome. This result supports our contention, described previously, that the impaired functional state that stems from certain diseases, rather than the diseases per se, has the greatest association with the results of rehabilitation. Apparently, the results of our study point to the possibility of improving rehabilitation outcome by therapeutic intervention in its early phases. The aim of this intervention should be to increase the serum albumin level by appropriate dietary adjustments and supplementation, to correct those visual defects that can be corrected such as prescription of suitable eyeglasses, to improve dyspnea by optimal treatment of the diseases that cause it, and to correct decreased serum folic acid levels by supplementation. However, the results of our study can only support an association and not causality between these 4 parameters and rehabilitation outcome. This situation prevents us from concluding that intervening with these factors may alter the outcome. The issue of causality should be investigated in interventional studies specifically designed to address this question. The other 4 variables that were identified as having a significant association with rehabilitation outcome (prefracture functional state, mental status, age, prior stroke) cannot be changed by intervention during rehabilitation. However, the importance of these variables lies in their value as predictors of rehabilitation outcome. This assessment is important to help patients, families, and staff develop realistic expectations from the process and for directors of health care services for the elderly to reach reasonable decisions relating to rehabilitation strategies. Two of these 4 nonmodifiable variables (prefracture functional state, mental status) might be targets for rehabilitation in patients at high risk. Recipients of these interventions could benefit from such a preventive strategy. In relation to the variable of age, it should be noted that, although age was found to be a negative prognostic factor in this study, successful rehabilitation has been achieved in patients 85 years of age and above. 26 CONCLUSIONS The outcome of rehabilitation of elderly patients after surgical repair of hip fracture is associated with 4 correctable clinical and nutritional parameters. The other 4 associated significant variables cannot be corrected but may help in predicting outcomes and adjusting expectations of all individuals involved in the rehabilitation process. References 1. Lyons AR. Clinical outcomes and treatment of hip fractures. Am J Med 1997;103:51S-63S. 2. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int 1992;2: Lieberman D, Friger M, Lieberman D. Visual and hearing impairment in elderly patients hospitalized for rehabilitation following hip fracture. J Rehabil Res Dev 2004;41: Folstein MF, Folstein SE, McHugh PR. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12: Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983;17: Keith RA, Granger CV, Hamilton BB, Sherwin FS. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1987;1: Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture. A prospective study in geriatric patients. Clin Orthop Relat Res 1995;Jan(310): Myers AH, Palmer MH, Engel BT, Warrenfeltz DJ, Parker JA. Mobility in older patients with hip fractures: examining prefracture status, complications, and outcomes at discharge from the acute-care hospital. J Orthop Trauma 1996;10: Marottoli RA, Berkman LF, Leo-Summers L, Cooney LM Jr. Predictors of mortality and institutionalization after hip fracture: the New Haven EPESE cohort. Established Populations for Epidemiologic Studies of the Elderly. Am J Pub Health 1994;84: Kaehrle P, Maljanian R, Bohannon RW, Horowitz S. Factors predicting 12-month outcome of elderly patients admitted with hip fracture to an acute care hospital. Outcomes Manag Nurs Pract 2001;5: Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 1998;Mar(348): Cree M, Carriere KC, Soskolne CL, Suarez-Almazor M. Functional dependence after hip fracture. Am J Phys Med Rehabil 2001;80: Parker MJ, Palmer CR. Prediction of rehabilitation after hip fracture. Age Ageing 1995;24: Cree AK, Nade S. How to predict return to the community after fractured proximal femur in the elderly. Aust N Z J Surg 1999; 69: Heruti RJ, Lusky A, Barell V, Ohry A, Adunsky A. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil 1999; 80: Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 1990; 45:M Barnes B, Dunovan K. Functional outcomes after hip fracture. Phys Ther 1987;67: Broos PL, Van Haaften KI, Stappaerts KH, Gruwez JA. Hip fractures in the elderly: mortality, functional results and social readaptation. Int Surg 1989;74: Lieberman D, Fried V, Castel H, Weitzmann S, Lowenthal MN, Galinsky D. Factors related to successful rehabilitation after hip fracture: a case-control study. Disabil Rehabil 1996;18: Youm T, Aharonoff G, Zuckerman JD, Koval KJ. Effect of previous cerebrovascular accident on outcome after hip fracture. J Orthop Trauma 2000;14: Cummings SR, Phillips SL, Wheat ME, et al. Recovery of function after hip fracture. The role of social supports. J Am Geriatr Soc 1988;36:801-6.

5 REHABILITATION AFTER HIP FRACTURE SURGERY IN ELDERLY, Lieberman Van Hoang H, Silverstone FA, Leventer S, Wolf-Klein GP, Foley CJ. The effect of nutritional status on length of stay in elderly hip fracture patients. J Nutr Health Aging 1998;2: Stavrou ZP, Erginousakis DA, Loizides AA, Tzevelekos SA, Papagiannakos KJ. Mortality and rehabilitation following hip fracture. A study of 202 elderly patients. Acta Orthop Scand Suppl 1997;275: McLean RR, Jacques PF, Selhub J, et al. Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med 2004;350: Lowering blood homocysteine with folic acid based supplements: meta-analysis of randomised trials. Homocysteine Lowering Trialists Collaboration. BMJ 1998;316: Lieberman D, Lieberman D. Rehabilitation after proximal femur fracture surgery in the oldest old. Arch Phys Med Rehabil 2002; 83: Suppliers a. GSI-16 audiometer; Grason-Stadler Inc, 1 Westchester Dr, Milford, NH b. Epi Info, Centers for Disease Control and Prevention, Epidemiology Program Office, 1600 Clifton Rd, Mail Stop E-91, Atlanta, GA c. SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL

Impact of Osteoarthritis on Rehabilitation for Persons With Hip Fracture

Impact of Osteoarthritis on Rehabilitation for Persons With Hip Fracture Arthritis & Rheumatism (Arthritis Care & Research) Vol. 55, No. 6, December 15, 2006, pp 920 924 DOI 10.1002/art.22345 2006, American College of Rheumatology ORIGINAL ARTICLE Impact of Osteoarthritis on

More information

A Comparative Study of Rehabilitation Outcomes of Elderly Hip Fracture Patients: The Advantage of a Comprehensive Orthogeriatric Approach

A Comparative Study of Rehabilitation Outcomes of Elderly Hip Fracture Patients: The Advantage of a Comprehensive Orthogeriatric Approach Journal of Gerontology: MEDICAL SCIENCES 2003, Vol. 58A, No. 6, 542 547 Copyright 2003 by The Gerontological Society of America A Comparative Study of Rehabilitation Outcomes of Elderly Hip Fracture Patients:

More information

Journal of Orthopaedics, Trauma and Rehabilitation

Journal of Orthopaedics, Trauma and Rehabilitation Journal of Orthopaedics, Trauma and Rehabilitation 14 (2010) 14e20 Contents lists available at ScienceDirect Journal of Orthopaedics, Trauma and Rehabilitation Journal homepage: www.e-jotr.com Original

More information

APROXIMAL FEMUR FRACTURE (hip fracture) is a

APROXIMAL FEMUR FRACTURE (hip fracture) is a ARTICLES Effect of Rehabilitation Site on Functional Recovery After Hip Fracture Michael C. Munin, MD, Karen Seligman, MS, Mary Amanda Dew, PhD, Tanya Quear, BS, Elizabeth R. Skidmore, PhD, OTR/L, Gary

More information

Using Objective Measures to Facilitate Rehabilitation Referral

Using Objective Measures to Facilitate Rehabilitation Referral Using Objective Measures to Facilitate Rehabilitation Referral Mark Bayley MD, FRCPC Medical Director, Neuro Rehabilitation Program, Toronto Rehabilitation Institute Associate Professor, Division of Physiatry,

More information

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health

Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Big data size isn t enough! Irene Petersen, PhD Primary Care & Population Health Introduction Reader (Statistics and Epidemiology) Research team epidemiologists/statisticians/phd students Primary care

More information

Falls Risk Assessment: A Literature Review. The purpose of this literature review is to determine falls risk among elderly individuals and

Falls Risk Assessment: A Literature Review. The purpose of this literature review is to determine falls risk among elderly individuals and Falls Risk Assessment: A Literature Review Purpose The purpose of this literature review is to determine falls risk among elderly individuals and identify the most common causes of falls. Also included

More information

Background. Does the Organization of Post- Acute Stroke Care Really Matter? Changes in Provider Supply. Sites for Post-Acute Care.

Background. Does the Organization of Post- Acute Stroke Care Really Matter? Changes in Provider Supply. Sites for Post-Acute Care. Does the Organization of Post- Acute Stroke Care Really Matter? Pamela W. Duncan, PhD, FAPTA University of Florida Brooks Center for Rehabilitation Studies Department of Veteran Affairs Rehabilitation

More information

Jon S. Howell, LNHA President & CEO Georgia Health Care Association November 18, 2013

Jon S. Howell, LNHA President & CEO Georgia Health Care Association November 18, 2013 Jon S. Howell, LNHA President & CEO Georgia Health Care Association November 18, 2013 GEORGIA HEALTH CARE ASSOCIATION Represents 336 skilled nursing facilities 13 SOURCE agencies 15 assisted living communities

More information

Rehabilitation Integrated Transition Tracking System (RITTS)

Rehabilitation Integrated Transition Tracking System (RITTS) Rehab Criteria The patient must have a physical impairment requiring rehabilitation OR have a known cognitive impairment requiring ongoing rehabilitation support or services. The patient is medically stable:

More information

PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE:

PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY / PROCEDURE: PARTNERSHIP HEALTHPLAN OF CALIFORNIA POLICY/PROCEDURE Policy Number: MCUP3003 (previously UP100303) Reviewing Entities: Credentialing IQI P & T QUAC Approving Entities: BOARD CEO COMPLIANCE FINANCE PAC

More information

Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling

Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling Fourth Year Medical Students Required Written Patient Care Assignments Reflecting Awareness of Use of Vitamin D in Older Patients at Risk for Falling John Agens, M.D. Associate Professor in Geriatrics

More information

PRINTED: 07/09/2013 FORM APPROVED CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391 (X2) MULTIPLE CONSTRUCTION A.

PRINTED: 07/09/2013 FORM APPROVED CENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 0938-0391 (X2) MULTIPLE CONSTRUCTION A. CENTERS FOR MEDICARE & MEDICA SERVICES OMB NO. 0938-0391 (X1) PROVER/SUPPLIER/CLIA ENTIFICATION NUMBER: (X3) SURVEY NAME OF PROVER OR SUPPLIER (X4) FINAL OBSERVATIONS LICENSURE VIOLATIONS: 300.610)a) 300.1210)a)

More information

Predicting Fall Risk in Acute Rehabilitation Facilities Stephanie E. Kaplan, PT, DPT, ATP Emily R. Rosario, PhD

Predicting Fall Risk in Acute Rehabilitation Facilities Stephanie E. Kaplan, PT, DPT, ATP Emily R. Rosario, PhD Objectives Predicting Fall Risk in Acute Inpatient Rehabilitation Facilities Director of Rehabilitation and Director of Research Casa Colina Centers for Rehabilitation March 16, 2012 Current Falls Assessment

More information

Stroke Rehabilitation Triage Severe Strokes

Stroke Rehabilitation Triage Severe Strokes The London Stroke Rehab Data Base Project Robert Teasell MD FRCPC Professor and Chair-Chief Department of Phys Med Rehab London Ontario Retrospective Data Bases In stroke rehab limited funding for clinical

More information

Service delivery interventions

Service delivery interventions Service delivery interventions S A S H A S H E P P E R D D E P A R T M E N T O F P U B L I C H E A L T H, U N I V E R S I T Y O F O X F O R D CO- C O O R D I N A T I N G E D I T O R C O C H R A N E E P

More information

Efficiency, Effectiveness, and Duration of Stroke Rehabilitation

Efficiency, Effectiveness, and Duration of Stroke Rehabilitation 241 Efficiency, Effectiveness, and Duration of Stroke Rehabilitation Surya Shah, MEd OTR/L, Frank Vanclay, MSocSci, and Betty Cooper, BAppSc This prospective multicenter study identifies the variables

More information

Nebraska Health Data Reporter

Nebraska Health Data Reporter Nebraska Health Data Reporter Volume 3, Number 1 May 2000 Demographic, health, and functional status characteristics of new residents to Nebraska nursing homes: A summary Joan Penrod, Ph.D. Jami Fletcher,

More information

Race/Ethnicity and Outcomes Following Inpatient Rehabilitation for Hip Fracture

Race/Ethnicity and Outcomes Following Inpatient Rehabilitation for Hip Fracture Journal of Gerontology: MEDICAL SCIENCES 2008, Vol. 63A, No. 8, 860 866 Copyright 2008 by The Gerontological Society of America Race/Ethnicity and Outcomes Following Inpatient Rehabilitation for Hip Fracture

More information

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis

Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Performance Measurement for the Medicare and Medicaid Eligible (MME) Population in Connecticut Survey Analysis Methodology: 8 respondents The measures are incorporated into one of four sections: Highly

More information

Spinal cord injury hospitalisation in a rehabilitation hospital in Japan

Spinal cord injury hospitalisation in a rehabilitation hospital in Japan 1994 International Medical Society of Paraplegia Spinal cord injury hospitalisation in a rehabilitation hospital in Japan Y Hasegawa MSW, l M Ohashi MD, l * N Ando MD, l T. Hayashi MD, l T Ishidoh MD,

More information

Administration of Emergency Medicine

Administration of Emergency Medicine doi:10.1016/j.jemermed.2005.07.008 The Journal of Emergency Medicine, Vol. 30, No. 4, pp. 455 460, 2006 Copyright 2006 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/06 $ see front matter

More information

Compassionate Allowance Outreach Hearing on Brain Injuries. Social Security Administration. November 18, 2008. Statement of

Compassionate Allowance Outreach Hearing on Brain Injuries. Social Security Administration. November 18, 2008. Statement of Compassionate Allowance Outreach Hearing on Brain Injuries Social Security Administration November 18, 2008 Statement of Jerome E. Herbers, Jr., M.D. Office of Healthcare Inspections Office of Inspector

More information

Because there is some evidence that falls in hospital can

Because there is some evidence that falls in hospital can BRIEF METHODOLOGICAL REPORTS A Comparative Study of the Use of Four Fall Assessment Tools on Acute Medical Wards Michael Vassallo, FRCP, PhD, Rachel Stockdale, MRCP (UK), w Jagdish C. Sharma, FRCP, Roger

More information

Where Should Rehabilitation Take Place?!

Where Should Rehabilitation Take Place?! Where Should Rehabilitation Take Place?! Three Basic Questions! 1. Is rehabilitation effective in improving a patient s functional abilities?!yes" yes" 2. Is rehabilitation cost effective?!yes" where"

More information

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Identifying Dying

Staff Resources Dying & Death in an Acute Hospital. End-of-Life Care Resources. Identifying Dying Staff Resources Dying & Death in an Acute Hospital End-of-Life Care Resources Identifying Dying Identifying Introduction Dying The information below is from the Hospice Friendly Hospital Programme s Map

More information

Geriatr Gerontol Int 2015 ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH

Geriatr Gerontol Int 2015 ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH bs_bs_banner Geriatr Gerontol Int 2015 ORIGINAL ARTICLE: EPIDEMIOLOGY, CLINICAL PRACTICE AND HEALTH Impact of board-certificated physiatrists on rehabilitation outcomes in elderly patients after hip fracture:

More information

Functional recovery of hip fracture patients

Functional recovery of hip fracture patients Functional recovery of hip fracture patients Lauren Beaupre July 7, 2011 ABSTRACT Hip fractures are common in the older population and are associated with loss of independence as well as high morbidity

More information

Comparison of Discharge Functional Status Rehabilitation: Hip Fracture Repair. Trudy Mallinson, PhD, OTR/L

Comparison of Discharge Functional Status Rehabilitation: Hip Fracture Repair. Trudy Mallinson, PhD, OTR/L Comparison of Discharge Functional Status Rehabilitation: Hip Fracture Repair Trudy Mallinson, PhD, OTR/L Acknowledgements Co-authors Anne Deutsch, PhD, CRRN Jillian Bateman, OTD, OTR/L Hsiang-Yi Tseng,

More information

Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased.

Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased. Quality Measures for Long-stay Residents Percent of residents whose need for help with daily activities has increased. This graph shows the percent of residents whose need for help doing basic daily tasks

More information

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Biomedical & Pharmacology Journal Vol. 6(2), 259-264 (2013) The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Vadod Norouzi 1, Ali

More information

Determinants of Nonrecovery following Hip Fracture in Older Adults: A Chronic Disease Trajectory Analysis Chapter I Introduction According to the

Determinants of Nonrecovery following Hip Fracture in Older Adults: A Chronic Disease Trajectory Analysis Chapter I Introduction According to the Determinants of Nonrecovery following Hip Fracture in Older Adults: A Chronic Disease Trajectory Analysis Chapter I Introduction According to the American Academy of Orthopedic Surgeons (AAOS), the incidence

More information

The JOURNEY OF ELDERCARE

The JOURNEY OF ELDERCARE The JOURNEY OF ELDERCARE ELDERSPEAK Glossary Terms commonly used by Professionals in Aging Acute v. Chronic Acute - care delivered in a hospital that is usually shortterm and recuperative. Chronic - condition

More information

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS

GENERAL ADMISSION CRITERIA INPATIENT REHABILITATION PROGRAMS Originator: Case Management Original Date: 9/94 Review/Revision: 6/96, 2/98, 1/01, 4/02, 8/04, 3/06, 03/10, 3/11, 3/13 Stakeholders: Case Management, Medical Staff, Nursing, Inpatient Therapy GENERAL ADMISSION

More information

THE ACUTE CARE INPATIENT PPS implemented in

THE ACUTE CARE INPATIENT PPS implemented in 184 ORIGINAL ARTICLE Impact of Mental on Cost and Reimbursement for Patients in Inpatient Rehabilitation Facilities Deborah Dobrez, PhD, Allen W. Heinemann, PhD, Anne Deutsch, RN, PhD, CRRN, Elizabeth

More information

FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE

FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE www.bpac.org.nz keyword: warfarinaspirin FOR THE PREVENTION OF ATRIAL FIBRILLATION RELATED STROKE Key Concepts In atrial fibrillation (AF) warfarin is more effective than aspirin for stroke prevention.

More information

NHS outcomes framework and CCG outcomes indicators: Data availability table

NHS outcomes framework and CCG outcomes indicators: Data availability table NHS outcomes framework and CCG outcomes indicators: Data availability table December 2012 NHS OF objectives Preventing people from dying prematurely DOMAIN 1: preventing people from dying prematurely Potential

More information

Patient / Carer Empowerment in Rehabilitation: Challenges and Success Factors

Patient / Carer Empowerment in Rehabilitation: Challenges and Success Factors 東 華 三 院 黃 大 仙 醫 院 Tung Wah Group of Hospitals Wong Tai Sin Hospital Patient / Carer Empowerment in Rehabilitation: Challenges and Success Factors HA Convention 2015 Li KY, Tang IFK, Kwong MWY, Chan RWH,

More information

Laura K Chiodo Meghan B Gerety Cynthia D Mulrow Mary C Rhodes Michael R Tuley. Key Words: Geriatncs, Long-term care, Nursing homes, Physical therapy.

Laura K Chiodo Meghan B Gerety Cynthia D Mulrow Mary C Rhodes Michael R Tuley. Key Words: Geriatncs, Long-term care, Nursing homes, Physical therapy. Research Report The Impact of Physical Therapy on Nursing Home Patient Outcomes The objective of this retrospective study was to assess the intensity and outcome of individual components of interdisciplinaly

More information

Department of Geriatrics

Department of Geriatrics OUTCOMES Division of Medicine Department of Geriatrics About Cleveland Clinic Florida Cleveland Clinic Florida s medical staff are dedicated physicians who have joined the clinic as salaried doctors to

More information

Prevention of Falls and Fall Injuries in the Older Adult: A Pocket Guide

Prevention of Falls and Fall Injuries in the Older Adult: A Pocket Guide INTERNATIONAL AFFAIRS & BEST PRACTICE GUIDELINES Prevention of Falls and Fall Injuries in the Older Adult: A Pocket Guide 2 Introduction to the Pocket Guide This pocket guide resource has been summarized

More information

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References)

Outpatient/Ambulatory Rehab. Dedicated Trans-disciplinary Team (defined within Annotated References) CARDIAC The delivery of Cardiac Rehab is unlike most other rehab populations. The vast majority of patients receive their rehab in outpatient or community settings and only a small subset requires an inpatient

More information

New York State Nursing Home Quality Pool. New York State Department of Health May 2, 2012

New York State Nursing Home Quality Pool. New York State Department of Health May 2, 2012 New York State Nursing Home Quality Pool New York State Department of Health May 2, 2012 1 Overview First meeting in January discussed performance measurement for the Quality Pool Materials were sent to

More information

in the Elderly Thomas Robinson, MD Surgery Grand Rounds March 10 th, 2008

in the Elderly Thomas Robinson, MD Surgery Grand Rounds March 10 th, 2008 Post- Operative Delirium in the Elderly Thomas Robinson, MD Surgery Grand Rounds March 10 th, 2008 What is the most common post-operative complication in elderly patients? What is the most common post-operative

More information

Home versus day rehabilitation: a randomised controlled trial

Home versus day rehabilitation: a randomised controlled trial Age and Ageing 2008; 37: 628 633 doi:10.1093/ageing/afn141 Published electronically 23 August 2008 The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society. The

More information

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD

Bipolar Disorder and Substance Abuse Joseph Goldberg, MD Diabetes and Depression in Older Adults: A Telehealth Intervention Julie E. Malphurs, PhD Asst. Professor of Psychiatry and Behavioral Science Miller School of Medicine, University of Miami Research Coordinator,

More information

Enhanced recovery programme after TKA through multi-disciplinary collaboration

Enhanced recovery programme after TKA through multi-disciplinary collaboration Enhanced recovery programme after TKA through multi-disciplinary collaboration ChanPK(1), ChiuKY(1), FungYK(6), YeungSS(7), NgT(8), ChanMT(5), LamR(4), WongNY(3), ChoiYY(3), ChanCW(2), NgFY(1), YanCH(1)

More information

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes

Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes Guidance for Industry Diabetes Mellitus Evaluating Cardiovascular Risk in New Antidiabetic Therapies to Treat Type 2 Diabetes U.S. Department of Health and Human Services Food and Drug Administration Center

More information

SUMMARY This PhD thesis addresses the long term recovery of hemiplegic gait in severely affected stroke patients. It first reviews current rehabilitation research developments in functional recovery after

More information

Fall 2013. A progress report on improving rehabilitative care in Waterloo Wellington

Fall 2013. A progress report on improving rehabilitative care in Waterloo Wellington Fall 2013 A progress report on improving rehabilitative care in Waterloo Wellington The Waterloo Wellington Rehabilitative Care Council Improving rehabilitative care in Waterloo Wellington, fall 2013,

More information

AGS REHABILITATION/ POST-HOSPITAL CARE OF THE GERIATRIC FRACTURE PATIENT. Egan Allen, MD University of Rochester

AGS REHABILITATION/ POST-HOSPITAL CARE OF THE GERIATRIC FRACTURE PATIENT. Egan Allen, MD University of Rochester AGS REHABILITATION/ POST-HOSPITAL CARE OF THE GERIATRIC FRACTURE PATIENT Egan Allen, MD University of Rochester THE AMERICAN GERIATRICS SOCIETY Geriatrics Health Professionals. Leading change. Improving

More information

Jill Malcolm, Karen Moir

Jill Malcolm, Karen Moir Evaluation of Fife- DICE: Type 2 diabetes insulin conversion Article points 1. Fife-DICE is an insulin conversion group education programme. 2. People with greater than 7.5% on maximum oral therapy are

More information

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA)

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) 10/2012 Coverage for Newborn and Foster Children Coverage Outside the Provider Network Adult Routine Physical Exams Well-Baby and Well-Child

More information

PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium

PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium PREPARING THE PATIENT FOR TRANSFER TO AN INPATIENT REHABILITATON FACILITY (IRF) University Hospitals 8th Annual Neuroscience Nursing Symposium May 31, 2013 2 DEFINITION: INPATIENT REHABILITATION FACILITY

More information

Factors predicting rehabilitation outcomes of elderly patients with hip fracture

Factors predicting rehabilitation outcomes of elderly patients with hip fracture O R I G I N A L A R T I C L E Factors predicting rehabilitation outcomes of elderly patients with hip fracture Raymond PH Chin Bobby HP Ng Lydia PC Cheung Objective To identify predictors of rehabilitation

More information

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula

Prevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Prevention and Recognition of Obstetric Fistula Training Package Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Early detection and treatment If a woman has recently survived a

More information

Title: Outcomes for Older Adults in an Inpatient Rehabilitation Facility Following

Title: Outcomes for Older Adults in an Inpatient Rehabilitation Facility Following Title: Outcomes for Older Adults in an Inpatient Rehabilitation Facility Following Hip Fracture (HF) Surgery Author names and affiliations: Katherine S. McGilton, K. a, RN, PhD.; Nizar Mahomed, N. b, MD;

More information

Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital

Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital Functional Improvement for Heart Failure Patients After Left Ventricular Assistive Device Placement in a Free Standing Rehabilitation Hospital Vittal R. Nagar, M.D, PhDc PGY II Mentor: Robert Nickerson,

More information

NORTH DAKOTA NURSING FACILITY PAYMENT SYSTEM

NORTH DAKOTA NURSING FACILITY PAYMENT SYSTEM NORTH DAKOTA NURSING FACILITY PAYMENT SYSTEM North Dakota Department of Human Services Medical Services 600 E Boulevard Ave Dept 325 Bismarck ND 58505 BACKGROUND State law requires all nursing facilities

More information

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis

Psoriasis Co-morbidities: Changing Clinical Practice. Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology. Psoriatic Arthritis Psoriasis Co-morbidities: Changing Clinical Practice Theresa Schroeder Devere, MD Assistant Professor, OHSU Dermatology Psoriatic Arthritis Psoriatic Arthritis! 11-31% of patients with psoriasis have psoriatic

More information

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT

THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT THE INTERNET STROKE CENTER PRESENTATIONS AND DISCUSSIONS ON STROKE MANAGEMENT Stroke Prevention in Atrial Fibrillation Gregory Albers, M.D. Director Stanford Stroke Center Professor of Neurology and Neurological

More information

INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION

INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION INTERPROFESSIONAL LEARNING OBJECTIVES FOR STROKE CARE INTRODUCTION Supporting Interprofessional Education through Shared Learning Opportunities APRIL 2007 Interprofessional Learning Objectives for Stroke

More information

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention

The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention The Women s Health Initiative: The Role of Hormonal Therapy in Disease Prevention Robert B. Wallace, MD, MSc Departments of Epidemiology and Internal Medicine University of Iowa College of Public Health

More information

The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS)

The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS) RESEARCH Original article... Q The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS) Lathy Prabhakaran*, Wai Yan Chee*, Kia Chong Chua,

More information

2013/2014 Alberta Long-Term Care Resident Profile. June 2015

2013/2014 Alberta Long-Term Care Resident Profile. June 2015 2013/2014 Alberta Long-Term Care Resident Profile June 2015 Table of Contents Introduction 3 Methodology 4 Demographic Profile 7 Health Profile 10 Care and Intervention 23 For Further Information 30 List

More information

REHABILITATION SERVICES

REHABILITATION SERVICES REHABILITATION SERVICES Table of Contents GENERAL... 2 TERMS AND ABBREVIATIONS... 2 PRIOR AUTHORIZATION REQUIREMENTS FOR MEDICAID REIMBURSEMENT OF INPATIENT REHABILITATION SERVICES (Updated 4/1/11)...

More information

for hip fracture in fee-for-service and group/staff HMO delivery systems.

for hip fracture in fee-for-service and group/staff HMO delivery systems. A Comparison of Functional Outcomes after Hip Fracture in Group/Staff HMOs and Fee-for-Service Systems CONTEXT. Previous studies examining differences in the quality of care between capitated and fee-for-service

More information

b. Distinguish between different venues of senior residence c. Advocate the necessity of geriatrics as a true specialty

b. Distinguish between different venues of senior residence c. Advocate the necessity of geriatrics as a true specialty 1. Introduction/ Getting to know our Seniors a. Identify common concepts and key terms used when discussing geriatrics b. Distinguish between different venues of senior residence c. Advocate the necessity

More information

St Vincent s Hospital Sydney Referral to Sacred Heart Rehabilitation Consultation Service Policy Section 1 Policy 32

St Vincent s Hospital Sydney Referral to Sacred Heart Rehabilitation Consultation Service Policy Section 1 Policy 32 Subject: Referral to the Sacred Heart Rehabilitation Consultation Service Area: Hospital wide Classification: Operational Relevant to: All clinical staff Implementation date: October 2003 Review Date:

More information

Depression in Older Persons

Depression in Older Persons Depression in Older Persons How common is depression in later life? Depression affects more than 6.5 million of the 35 million Americans aged 65 or older. Most people in this stage of life with depression

More information

Malnutrition and outcome after acute stroke: using the Malnutrition Universal Screening Tool

Malnutrition and outcome after acute stroke: using the Malnutrition Universal Screening Tool Malnutrition and outcome after acute stroke: using the Malnutrition Universal Screening Tool L Choy, A Bhalla Department of Elderly Care St Helier Hospital, Carshalton, Surrey Prevalence of malnutrition

More information

Chapter 3: Review of Literature Stroke

Chapter 3: Review of Literature Stroke Chapter 3: Review of Literature Stroke INTRODUCTION Cerebrovascular accident (also known as stroke) is a serious health problem in the United States and a leading cause of long-term disability. In this

More information

Clinical pathways in total knee arthroplasty: A New Zealand experience

Clinical pathways in total knee arthroplasty: A New Zealand experience Journal of Orthopaedic Surgery 2003: 11(2): 166 173 Clinical pathways in total knee arthroplasty: A New Zealand experience JM Pennington, DPG Jones, S McIntyre Department of Orthopaedic Surgery, Dunedin

More information

Acute Care to Rehab & Complex Continuing Care (CCC) Referral

Acute Care to Rehab & Complex Continuing Care (CCC) Referral Acute Care to Rehab & Complex Identify Referral Destination: Referral to Rehab Referral to Complex Continuing Care (CCC) If Faxed Include Number of Pages (Including Cover): Pages Estimated Date of Rehab/CCC

More information

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages

More information

Recommended time for assessment:

Recommended time for assessment: Recommended time for assessment: Basic Intermediate Advanced FIMTM: (see attachment 1) - Entry to rehab - Discharge rehab - 1 month post injury - 3 months post injury NSI: (see attachment 2) - Entry to

More information

Long term care coding issues for ICD-10-CM

Long term care coding issues for ICD-10-CM Long term care coding issues for ICD-10-CM Coding Clinic, Fourth Quarter 2012 Pages: 90-98 Effective with discharges: October 1, 2012 Related Information Long Term Care Coding Issues for ICD-10-CM Coding

More information

The Outcome of Stroke at Hospital Discharge in New York City Blacks

The Outcome of Stroke at Hospital Discharge in New York City Blacks The Outcome of Stroke at Hospital Discharge in New York City Blacks BY STEPHEN Q. SHAFER, M.D., BERTEL BRUUN, M.D., AND RALPH W. RICHTER, M.D. Abstract: The Outcome of Stroke at Hospital Discharge in New

More information

Senior Housing: Extension Opportunities Across the Continuum of Care

Senior Housing: Extension Opportunities Across the Continuum of Care Senior Housing: Extension Opportunities Across the Continuum of Care Senior housing includes a broad range of independent living, assisted living and nursing care properties operated as stand-alone, multi-property

More information

Description of the OECD Health Care Quality Indicators as well as indicator-specific information

Description of the OECD Health Care Quality Indicators as well as indicator-specific information Appendix 1. Description of the OECD Health Care Quality Indicators as well as indicator-specific information The numbers after the indicator name refer to the report(s) by OECD and/or THL where the data

More information

An Inpatient Rehabilitation Service for Deconditioned Older Adults. George Raj, MD; Jawad Munir, MD; Linda Ball, PhD; David B.

An Inpatient Rehabilitation Service for Deconditioned Older Adults. George Raj, MD; Jawad Munir, MD; Linda Ball, PhD; David B. Topics in Geriatric Rehabilitation Vol. 23, No. 2, pp. 126 136 Copyright c 2007 Wolters Kluwer Health Lippincott Williams & Wilkins An Inpatient Rehabilitation Service for Deconditioned Older Adults George

More information

Guidelines for Medical Necessity Determination for Occupational Therapy

Guidelines for Medical Necessity Determination for Occupational Therapy Guidelines for Medical Necessity Determination for Occupational Therapy These Guidelines for Medical Necessity Determination (Guidelines) identify the clinical information MassHealth needs to determine

More information

October 2013 Family Choice: Best Practices in Care for Nursing Home Residents

October 2013 Family Choice: Best Practices in Care for Nursing Home Residents SNP Alliance Best Practices October 2013 Family Choice: Best Practices in Care for Nursing Home Residents Overview of Family Choice of New York I-SNP Independent Health s Medicare Advantage Family Choice

More information

Mortality Assessment Technology: A New Tool for Life Insurance Underwriting

Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Mortality Assessment Technology: A New Tool for Life Insurance Underwriting Guizhou Hu, MD, PhD BioSignia, Inc, Durham, North Carolina Abstract The ability to more accurately predict chronic disease morbidity

More information

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013)

TORONTO STROKE FLOW INITIATIVE - Outpatient Rehabilitation Best Practice Recommendations Guide (updated July 26, 2013) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals: Timely access to geographically located acute stroke unit care with a dedicated interprofessional team

More information

Adapting the Fall Prevention Tool Kit (FPTK) for use in NHS Acute Hospital settings in England: Patient and Public Involvement evaluation

Adapting the Fall Prevention Tool Kit (FPTK) for use in NHS Acute Hospital settings in England: Patient and Public Involvement evaluation Adapting the Fall Prevention Tool Kit (FPTK) for use in NHS Acute Hospital settings in England: Patient and Public Involvement evaluation Authors: Dawn Dowding PhD RN Professor of Applied Health Research,

More information

Rehabilitation. Care

Rehabilitation. Care Rehabilitation Care Bruyère Continuing Care is the champion of well-being for aging Canadians and those requiring Continuing Care, helping them to become and remain as healthy and independent as possible

More information

Supplemental Technical Information

Supplemental Technical Information An Introductory Analysis of Potentially Preventable Health Care Events in Minnesota Overview Supplemental Technical Information This document provides additional technical information on the 3M Health

More information

Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease

Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease Frequently Asked Questions about Fee-for-Service Medicare For People with Alzheimer s Disease This brochure answers questions Medicare beneficiaries with Alzheimer s disease, and their families, may have

More information

In-patient Rehabilitation Outcomes Following Lower Extremity Fracture in Patients with Pneumonia

In-patient Rehabilitation Outcomes Following Lower Extremity Fracture in Patients with Pneumonia In-patient Rehabilitation Outcomes Following Lower Extremity Fracture in Patients with Pneumonia Ijaz Ahmed MD RRT, James E Graham PhD, Amol M Karmarkar PhD, Carl V Granger MD, and Kenneth J Ottenbacher

More information

Geriatric Assessment Tools. Dr. Hermes

Geriatric Assessment Tools. Dr. Hermes Geriatric Assessment Tools Dr. Hermes Geriatric Assessment Learning Objectives 1. Identify factors contributing to the need for specialized assessment of the frail older adult 2. Discuss the benefits of

More information

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations

Mar. 31, 2011 (202) 690-6145. Improving Quality of Care for Medicare Patients: Accountable Care Organizations DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services Room 352-G 200 Independence Avenue, SW Washington, DC 20201 Office of Media Affairs MEDICARE FACT SHEET FOR IMMEDIATE RELEASE

More information

Diabetes in the elderly. Chris MacKnight April 2, 2011

Diabetes in the elderly. Chris MacKnight April 2, 2011 Diabetes in the elderly Chris MacKnight April 2, 2011 Disclosure I have no conflict of interest to report Show of Hands 87 yo woman with diabetes and multiple other comorbidities, on multiple medications.

More information

ACUTE INPATIENT REHABILITATION GUIDELINE

ACUTE INPATIENT REHABILITATION GUIDELINE ACUTE INPATIENT REHABILITATION GUIDELINE Inpatient rehabilitation facilities promote rehabilitative health care services rather than general medical and surgical services. Rehabilitation is defined as

More information

Navigating Depression:

Navigating Depression: Navigating Depression: A roadmap for health professionals and patients AH National Conference, 8 th -20 th July, 2007, Hobart, Tasmania Principal investigator: Project Manager: Acknowledgements: Kirsten

More information

UNILATERAL VS. BILATERAL FIRST RAY SURGERY: A PROSPECTIVE STUDY OF 186 CONSECUTIVE CASES COMPLICATIONS, PATIENT SATISFACTION, AND COST TO SOCIETY

UNILATERAL VS. BILATERAL FIRST RAY SURGERY: A PROSPECTIVE STUDY OF 186 CONSECUTIVE CASES COMPLICATIONS, PATIENT SATISFACTION, AND COST TO SOCIETY UNILATERAL VS. BILATERAL FIRST RAY SURGERY: A PROSPECTIVE STUDY OF 186 CONSECUTIVE CASES COMPLICATIONS, PATIENT SATISFACTION, AND COST TO SOCIETY Robert Fridman DPM, Jarrett Cain DPM, Lowell Weil Jr. DPM,

More information

7/29/2014. Optometric Care in the Nursing Home setting- Is it worth it? Disclosure. Objectives of this lecture. James F. Hill III, OD, FAAO

7/29/2014. Optometric Care in the Nursing Home setting- Is it worth it? Disclosure. Objectives of this lecture. James F. Hill III, OD, FAAO A little bit about me Charleston, SC Optometric Care in the Nursing Home setting- Is it worth it? James F. Hill III, OD, FAAO Please silence all mobile devices. Unauthorized recording of this session is

More information

TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Recommendations Guide (updated January 23, 2014)

TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Recommendations Guide (updated January 23, 2014) TORONTO STROKE FLOW INITIATIVE - Inpatient Rehabilitation Best Practice Guide (updated January 23, 2014) Objective: To enhance system-wide performance and outcomes for persons with stroke in Toronto. Goals:

More information

The Independent In-Person Assessment Process

The Independent In-Person Assessment Process The Independent In-Person Assessment Process Jocelyn Gordon, Marc A. Cohen, and Jessica Miller Spring 2011 No. 4 The Community Living Assistance Services and Supports (CLASS) Plan a groundbreaking component

More information

Seniors Health Services

Seniors Health Services Leading the way in care for seniors Seniors Health Services Capital Health offers a variety of services to support seniors in communities across the region. The following list highlights programs and services

More information