IOM Report FY 2008. July 1, 2007 June 30, 2008

IOM Report FY 2008 July 1, 2007 June 30, 2008

FROM THE DIRECTOR HELLO EVERYONE Thank you for taking the time to review this year s Outcomes Report. 2008 was a year of challenges for inpatient rehabilitation facilities across the nation. Medicare legislation governing who is appropriate to be admitted to rehabilitation facilities continues to contribute to the steady decline in rehab admissions. This leads to frustration for families, physicians and providers. Despite these challenges, we continue to be an advocate for rehabilitation in our community and to provide services which are equal to those offered across the country. Our hope is that this report will help you feel confident in the Regional Rehabilitation Institute and will renew your commitment to choosing us as your provider of choice for all your rehabilitation needs. My best wishes for your health and wellness. Sincerely, Mike Latour, PT, MS Director of Rehabilitation Services 2

STROKE Eighty-nine patients were admitted to the during the past fiscal year with the diagnosis of stroke, or CVA. Of those 89 patients, 65 were discharged home or to the community, 8 were transferred back to an acute care hospital, 7 were transferred to another rehab facility and 9 were discharged to a long-term care facility or LTCF. STROKE RRI REGION NATION Stroke Admits 89 (22%) 2473 (20%) 90,491 (22%) LOS 17 17 17 Community 65 (73%) 1,702 (69%) 61,939 (69%) Acute 8 (9%) 213 (9%) 9781 (11%) Other Rehab 7 (8%) 181 (7%) 6860 (8%) LTC Facility 9 (10%) 364 (15%) 11,489 (13%) Other 0 (0%) 5 (0%) 230 (0%) Onset Days 13 12 12 Avg Age 70 69 70 Male 51% 50% 48% Female 49% 50% 52% Admit FIM 56.5 57.7 54.6 Discharge FIM 78.8 84.3 79.2 FIM Change 22.3 26.5 24.6 Follow Up FIM 108 104.6 104.3 for stroke patients was 17 days, the same as other rehab facilities in our region and the nation. The average number of days (onset days) for stroke patients to be admitted to rehab after their stroke was 13 days. On average, a patient admitted to for a stroke diagnosis was 70 years old, with just slightly more men than women being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for stroke diagnoses is 29.2 points higher than at discharge. 3

ORTHOPEDIC One hundred forty patients were admitted to the during the past fiscal year with an orthopedic diagnosis. Of those patients, 121 were discharged home or to the community, 3 were transferred back to an acute care hospital, 12 were transferred to another rehab facility and 4 were discharged to a long-term care facility or LTCF. for orthopedic patients was 11 days, with the Region having a 10 day stay, while the Nation reflected an 11 day stay. The average number of days (onset days) for ortho patients to be admitted to rehab after their injury or surgery was 8 days. On average, a patient admitted to Regional Rehabilitation Institute with an orthopedic diagnosis was 74 years old, with quite a few more women than men being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for orthopedic diagnoses is 17.7 points higher than at discharge. ORTHO RRI REGION NATION Ortho Admits 140 (34%) 4,262 (35%) 139,938 (34%) LOS 11 10 11 Community 121 (86%) 3,597 (85%) 112,272 (80%) Acute 3 (2%) 205 (5%) 8,487 (6%) Other Rehab 12 (9%) 171 (4%) 7,093 (5%) LTC Facility 4 (3%) 272 (6%) 11,726 (8%) Other 0 (0%) 11 (0%) 240 (0%) Onset Days 8 10 7 Avg Age 74 71 72 Male 32% 35% 32% Female 68% 65% 68% Admit FIM 66.1 69.1 66.4 D/C FIM 90.8 97.9 93.7 FIM Change 24.7 28.9 27.3 Follow Up FIM 108.5 115.1 114.9 4

BRAIN Thirty-nine patients were admitted to the during the past fiscal year with a brain diagnosis. These include Traumatic Brain Injuries as well as non-traumatic brain injuries. Of those 39 patients, 30 were discharged back home or to the community (Assisted Living, etc.), 3 were transferred back to an acute care hospital, 5 were transferred to another rehab facility and one was discharged to a skilled nursing center or LTC facility. BRAIN RRI REGION NATION Admits 39 (10%) 1,654 (13%) 37,196 (9%) LOS 14 18 16 Community 30 (77%) 1,259 (76%) 26,649 (72%) Acute 3 (8%) 164 (10%) 4,832 (13%) Other Rehab 5 (13%) 80 (5%) 3,228 (9%) LTC Facility 1 (3%) 141 (9%) 11,726 (8%) Other 0 (0%) 10(1%) 252 (1%) Onset Days 23 20 18 Avg Age 62 56 62 Male 62% 61% 57% Female 38% 39% 43% Admit FIM 62 59.7 55.4 D/C FIM 89.2 89.9 82.2 FIM Change 27.1 30.2 26.8 Follow Up FIM 110.8 109.4 108.4 for brain patients was 14 days, which is 4 days less than both the region and the nation. The average number of days (onset days) for brain patients to be admitted to rehab after their injury was 23 days. On average, a patient admitted to Regional Rehabilitation Institute for a brain diagnosis was 62 years old, with quite a few more men than women being admitted for this diagnosis. from self- care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for brain diagnoses is 21.6 points higher than at discharge. 5

SPINAL CORD Twenty-one patients were admitted to the during the past fiscal year with the diagnosis of spinal cord. These include spinal cord injuries, as well as non-traumatic causes. Of those 21 patients, 18 were discharged home or to the community, one was transferred back to an acute care hospital, one was transferred to another rehab facility and one was discharged to a long-term care facility or LTCF. for spinal cord patients was 17 days, which was considerably less than the region, but about the same as the nation. The average number of days (onset days) for spinal cord patients to be admitted to rehab after their injury or surgery was 19 days. On average, a patient admitted to Regional Rehabilitation Institute for a spinal cord diagnosis was 61 years old, with quite a few more men than women being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for spinal cord diagnoses is 17 points higher than at discharge. SPINAL CORD RRI REGION NATION Admits 21 (5%) 806 (7%) 24,100 (6%) LOS 17 33 18 Community 18 (86%) 621 (77%) 17,754 (74%) Acute 1 (8%) 72 (9%) 1,811 (11%) Other Rehab 1 (8%) 41 (5%) 1,016 (6%) LTC Facility 1 (8%) 71 (9%) 1,457 (9%) Other 0 (0%) 7(1%) 140 (1%) Onset Days 19 23 18 Avg Age 61 54 60 Male 62% 65% 57% Female 38% 34% 43% Admit FIM 66.9 62.5 62.3 D/C FIM 89.4 88.9 86.6 FIM Change 22.6 26.4 24.3 Follow Up FIM 106.4 104.5 105 6

NEUROLOGY Twenty-four patients were admitted to the during the past fiscal year with a neurological diagnosis. Of those 24 patients, 23 were discharged home or to the community, none were transferred back to an acute care hospital, 1 was transferred to another rehab facility and none were discharged to a long-term care facility or LTCF. NEUROLOGY RRI REGION NATION Admits 24 (6%) 702 (6%) 32,412 (8%) LOS 14 15 14 Community 23 (96%) 572 (82%) 24,274 (75%) Acute 0 (0%) 6 (27%) 1,614 (5%) Other Rehab 1 (4%) 27 (4%) 1,614 (5%) LTC Facility 0 (0%) 54 (8%) 2,532 (8%) Other 0 (0%) 3 (0%) 95 (0%) Onset Days 25 18 16 Avg Age 57 60 68 Male 29% 51% 46% Female 71% 49% 54% Admit FIM 66.6 65.8 61 D/C FIM 88.5 90.9 85.4 FIM Change 21.8 25.1 24.4 Follow Up FIM 106.5 105.7 105.5 for neurological patients was 14 days, one day less than rehab facilities in our region and the same as the nation. The average number of days (onset days) for neurological patients to be admitted to rehab after their injury or surgery was 25 days. On average, a patient admitted to Regional Rehabilitation Institute with a neurological diagnosis was 57 years old, with quite a few more women than men being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for neurology diagnoses is 18 points higher than at discharge. 7

AMPUTEE Twenty-three patients were admitted to the during the past fiscal year with the diagnosis of amputation. Of those 23 patients, 18 were discharged home or to the community, 2 were transferred back to an acute care hospital, 2 were transferred to another rehab facility and there were none discharged to a long-term care facility or LTCF. for amputation patients was 11 days, which is less than the region and the nation. The average number of days (onset days) for amputation patients to be admitted to rehab after their surgery was 14 days. On average, a patient admitted to Regional Rehabilitation Institute for an amputation diagnosis was 61 years old, with quite a few more men than women being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for amputation diagnoses is 12.7 points higher than at discharge. AMPUTEE RRI REGION NATION Admits 23 (6%) 340 (3%) 12,592 (3%) LOS 11 13 14 Community 18 (78%) 268 (79%) 9,171 (73%) Acute 2 (9%) 26 (8%) 1,650 (13%) Other Rehab 2 (9%) 15 (4%) 657 (5%) LTC Facility 0 (0%) 26 (8%) 1,650 (13%) Other 1 (4%) 2 (1%) 22 (0%) Onset Days 14 22 21 Avg Age 61 63 64 Male 61% 64% 64% Female 39% 36% 36% Admit FIM 71.7 72.2 67.1 D/C FIM 88.3 94.8 88.3 FIM Change 16.6 22.6 21.2 Follow Up FIM 101 108.5 105.7 8

DEBILITY Thirty-seven patients were admitted to the during the past fiscal year with the diagnosis of debility or decondition. Of those 37 patients, 32 were discharged home or to the community, 2 were transferred back to an acute care hospital, 3 were transferred to another rehab facility and there were none discharged to a long-term care facility or LTCF. DEBILITY RRI REGION NATION Admits 37 (9%) 638 (5%) 29,237 (7%) LOS 12 13 12 Community 32 (86%) 490 (77%) 21,513 (74%) Acute 2 (5%) 78 (12%) 4,100 (14%) Other Rehab 3 (8%) 34 (5%) 1,136 (4%) LTC Facility 0 (0%) 33 (5%) 2,324 (8%) Other 0 (0%) 1 (0%) 80 (0%) Onset Days 14 20 15 Avg Age 73 70 74 Male 38% 49% 44% Female 62% 51% 56% Admit FIM 65.6 62.3 62.7 D/C FIM 86.9 88.8 87.2 FIM Change 21.4 26.5 24.5 Follow Up FIM 108.9 108.1 108.6 for deconditioned patients was 12 days, one day less than the region, and the same as the nation. The average number of days (onset days) for debilitated patients to be admitted to rehab after their diagnoses was 14 days. On average, a patient admitted to for a stroke diagnosis was 73 years old, with more women than men being admitted. from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for debility diagnoses is 22 points higher than at discharge. 9

TOTAL ADMISSIONS Threehundredeightyeightpatientswereadmittedtothe during the past fiscal year. Of those 388 patients, 319 were discharged home or to the community, 20 were transferred back to an acute care hospital, 31 were transferred to another rehab facility and 17 were discharged to a long-term care facility or LTCF. 10 for all patients was 13 days, which is 2 days less than the region and 1 day less than the nation. The average number of days (onset days) for patients to be admitted to rehab after their initial diagnosis was 14 days. On average, a patient admitted to was 69 years old, with more women than men being admitted. Overall age range for patients admitted to Regional Rehabilitation Institute: 0-44..... 40 patients admitted 45-64.... 97 patients admitted 65-74.... 86 patients admitted 75+...... 183 patients admitted from self-care items like dressing and and problem solving. Patients are scored on a scale of 1-7. A score of 7 reflects complete independence, while a score of 1 reflects total dependence. Scoring is based on the burden of care and level of assistance required by the caregiver. attempts to follow-up with all inpatients approximately 3 months after discharge via telephone. At this TOTAL RRI REGION NATION Admits 388 (100%) 12,196 (100%) 411,905 (100%) LOS 13 15 14 Community 319 (82%) 9,578 (79%) 309,228 (75%) Acute 20 (5%) 944 (8%) 41,743 (10%) Other Rehab 31 (8%) 576 (5%) 22,553 (5%) LTC Facility 17 (4%) 1,055 (9%) 37,204 (9%) Other 1 (0%) 43 (0%) 1,177 (0%) Onset Days 14 15 12 Avg Age 69 65 69 Male 43% 48% 44% Female 57% 52% 56% Admit FIM 63.9 64.3 61.7 D/C FIM 87.2 92 87.5 FIM Change 23.3 27.7 25.7 Follow Up FIM 108.5 110.3 109.8 time, another FIM assessment is performed to determine any further increase in function. The average follow-up combined FIM score for all diagnoses is 21.3 points higher than at discharge.

ADMISSIONS & OUTCOMES RRI ADULT ADMISSIONS The total number of admissions to rehab has declined by approximately 54% since 2004. Changes in the Medicare rules governing who can be admitted to rehab, as well as increased competition in the community, have contributed to this trend. Medicare no longer allows single joint replacement patients to be admitted to rehabilitation. Admission trends have leveled off since 2006 and remain steady. Uniform Data Systems for Medical Rehabilitation, A division of UB Foundation Activities RRI PEDIATRIC OUTCOMES FY08 TOTAL RRI Admissions 6 * LOS Avg 22.5 ** Home 89.5 Acute 1 (20%) * LOS Efficiency 1.82 Avg Age 5 YO Admit WeeFIM 45.3 ** D/C WeeFIM 71 WeeFIM Gain 25.7 * LOS = Length of Stay ** D/C = Discharge 11

CUSTOMER SATISFACTION OVERALL SECTION MEAN STD DEV N Overall 87.0 14.3 111 Diet & Meals 71.6 24 103 Nursing Care 89.5 15.3 111 Physical Therapy 92.5 13.6 108 Occupational Therapy 92.8 14.2 101 Recreation Therapy 90.8 15.9 84 Psychology 88.6 20.7 59 Speech Therapy 89.1 14.4 51 Discharge 85.3 21.1 108 Personal Issues 87.2 17.0 106 RRI Inpatient Satisfaction Quarter Survey Received The mean average score for FY08 was 88.5 which puts RRI in the 49th percentile overall. 12

STAFF ACHIEVEMENTS SPEECH THERAPY All staff hold ASHA Certification and are members of the state association (SDSHA). ASHA Fellow, SD Legislative Counselor to American Speech-Language Hearing Association Ruth Samuelsen, MS, CCC-SP Certified in DPNS (Deep Pharyngeal Neuromotor Stimulation) and FMEP (Facial Muscle Exercise Program/e-stim) Jennifer Wright, MA, CCC-SP Certified in LSVT (Lee Silverman Voice Treatment Laura Barbera, MS,CCC-SLP NURSING 53% of registered nursing staff have completed the NIH Stroke Scale from the National Stroke Association. 53% of registered nursing staff have CRRN (Rehabilitation Nursing) certification. CRRN s Veronica Hix, RN, CRRN JoAnn Hofman, RN, CRRN, Member SD Chapter ARN Board of Directors Troy Huber, RN, CRRN Roxanne Reed, RN, CRRN Patty Riley, RN, CRRN Kim Schlecht, RN, CRRN Nancy Snyder, RN, CRRN Certified CPI (Crisis Prevention Intervention) Instructor Sandy Feist, RN NEUROPSYCHOLOGY Dr. Scott Cherry, Ph.D., Diplomat American Board of Psychological Specialties - Neuropsychology Dr. Mark Cook, Ph.D., Diplomat Forensic Rehabilitation Psychology National Register of Health Service Providers in Psychology Patty Bambeck, RN, CNP, Certified Psychiatric Nurse Practitioner OCCUPATIONAL THERAPY Driver Rehabilitation Specialist Alan Schulte, OTR/L-CDRS Neuro-Developmental Treatment-Trained Certified Joy Person, OTR/L Kim York, OTR/L OCCUPATIONAL (continued) Saebo-Flex Trained Kim Anderson, OTR/L Certified CPI (Crisis Prevention Intervention) Instructor Kristin Dorwart-Marsh, MS, OTR/L PHYSICAL THERAPY Neuro-Developmental Treatment-Trained LaRae Blote, PT Certified Hand Therapist Marie Sexe, PT, MS, CHT LANA Certified Manual Lymphedema Drainage Therapist Karine Carpenter, PT, LANA-CLT Cheryl Dornbush, PT, LANA-CLT Heather Weaver, MSPT, LANA-CLT Incontinence/Pelvic Pain Program Marianne Drobny, MSPT Certified Strength Conditioning Specialist Jim Rix, MSPT,CSCS Vestibular/Balance Program Marie Sexe, PT, MS, CHT Certified Functional Capacity Evaluators Nano Johnson, PT PAIN MANAGEMENT Certified in Pain Management Nursing Loretta Gunderson, RN Medical Staff - Pain Management Medical Staff - Rehab Christina Cote, DO, Physiatrist Steven Frost, MD, Anesthesiologist, Medical Director Jane Glanzer, CNP, Certified Nurse Practitioner Craig Mills, MD, Physiatrist, Medical Director Troy Nesbit, MD, Anesthesiologist WOUND CARE/EEG Doug Cragun, REEGT,CNIM Virginia Espeland, RN, COWN Cheryl Hanson, RN, CWS Lavon Herrboldt, RN, CWS Dawn Nye, RN, CWS Dawn Rix, RN, WCC 13

OUTPATIENT SERVICES Occupational Therapy Neurological Disorders Pediatrics Geriatrics Activities of Daily Living Driving Low Vision Home Management and Safety Cognitive Impairments Adaptive Equipment Needs Traumatic Injuries Chronic Pain Speech Language & Audiology Speech Articulation and Fluency Voice - including Laryngectomy Language Disorders Oral - Motor & Swallowing including Video Fluoroscopy Cognition Hearing - including Auditory Processing, Infant Screening and Industrial Screening Pediatric Developmental and Feeding Evaluation and Therapy - including Cleft Palate Physical Therapy General Orthopedics Spinal Disorders Hand and Upper Quarter Dysfunction Incontinence and Pelvic Pain Lymphedema Chronic Pain Vestibular and Balance Dysfunction Neurological Dysfunction (MS, Stroke, Parkinson s, etc.) Pediatrics Functional Capacity Evaluation Work Hardening and Work Conditioning Injury Prevention/Pre-Placement Screening Myofascial and Soft Tissue Dysfunction Physical Therapy (cont.) Pool Therapy Sports Therapy Industrial Rehabilitation Fibromyalgia Amputation Renal Disease Other Services - Massage (Cash Program) Phototherapy Pain Management Medical Evaluation and Supervision Individual Exercise Programs designed to improve strength, flexibility and endurance Medication Management Nerve Blocks Spinal Cord Stimulators Implanted Medication Infusion Pumps Radio Frequency Ablation Neuropsychology/Rehabilitation Psychology Neuropsychological Evaluation Pain Evaluations Rehabilitation Psychology Evaluations Gastric Bypass Evaluations Adjustment to Medical Conditions Sleep Disorders Psychological Pain Management Training and Relaxation Techniques Stress Management and Coping Skills Individual, Group, and Family Counseling Surface EMG/Biofeedback Wound Care Chronic and Acute Problem Wounds Arterial and Venous Statis Ulcers Compromised Skin Grafts and Flaps Non-healing Diabetic Wounds Pressure Ulcers Problem Surgical Wounds Radiation Tissue Damage Burns Trauma Wounds Hyperbaric Medicine HBO Cerebral Arterial Air Embolism Delayed Radiation Injury Carbon Monoxide Poisoning Non-healing Diabetic Wounds Chronic Osteomyelitis Crush Injuries Decompression Sickness Gas Gangrene Necrotizing Infections Compromised Skin Grafts and Flaps Electrodiagnostic Laboratory EEG - Electrical activity of the brain BAER - Hearing ability and auditory brain structures VER - Identifies problems with optic nerves SSEP - Detects spinal cord problems and extremity weakness LTM - Identifies origin, type and frequency of seizures Bariatric Services Surgical and non-surgical approaches for morbid obesity 2908 Fifth Street Rapid City, SD 57701 (605) 719-1100 www.regionalrehabilitationinstitute.org 11354-0609