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Background: This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services., Methods: The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area sometime during school year 2006-2007. A multilevel analysis examined the relative effects of SBMHs on children's absence, suspension, grade promotion, use of acute mental health services, as well as the association of child and school-level factors on the outcomes of interest., Results: Little change in average number of days absent per month and no significant change in the use of acute mental health services were found. The mean number of days suspended per month out-of-school decreased from 0.100 to 0.003 days (p < .001). The percentage of children promoted to the next grade increased almost 13% after program enrollment (p < .01). Program type did not predict outcome changes except grade promotion., Conclusions: Despite the positive effect of school-based mental health programs on some school outcomes, the lack of difference between programs suggests the need to identify active mechanisms associated with outcome to make the delivery of care more efficient., (© 2013, American School Health Association.)

Aim: To examine whether rehabilitation therapy type would be associated with transitions to skilled nursing facilities (SNF) in community-living seniors with acute medical illnesses., Methods: Using administrative and clinical data, multivariate regression analysis examined the relationship between the extent of rehabilitation therapy and transitions to SNF in all participants, as well as participants by physical function at admission., Results: In all participants (n=929), the intensified rehabilitation therapy was associated with a lower probability of transitions to SNF (14% vs 21%; odds ratio [OR] 0.59; 95% confidence intervals [CI] 0.22-0.96; P=0.02). In participants with mild physical limitations (n=270), less frequent transitions to SNF occurred when patients received intensified rehabilitation therapy [16% vs 23%; OR 0.46; 95% CI 0.17-0.94; P=0.01]. In participants with moderate to severe physical limitations (n=265), the decreased frequency of transitions to SNF associated with rehabilitation therapy became more pronounced (18% vs 28%; OR 0.34; 95% CI 0.07-0.89; P=0.004). By contrast, in participants without physical limitation (n=394), the number of transitions to SNF did not change significantly when they received intensified rehabilitation therapy (P=0.53)., Conclusions: We found a significant relationship between intensified rehabilitation therapy and the decrease of transitions to SNF in community-living seniors with acute medical illness. The magnitude of this relationship increased in participants with more physical limitations, but not in participants without physical limitations at admission., (© 2012 Japan Geriatrics Society.)

Background: Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized, and their prognosis after discharge is unclear., Objective: To develop a prognostic index to estimate one-year probabilities of recovery, dependence or death in older hospitalized patients who are discharged with incident ADL dependence., Design: Retrospective cohort study., Participants: 449 adults aged ≥ 70 years hospitalized for acute illness and discharged with incident ADL dependence., Main Measures: Potential predictors included demographics (age, sex, race, education, marital status), functional measures (ADL dependencies, instrumental activities of daily living [IADL] dependencies, walking ability), chronic conditions (e.g., congestive heart failure, dementia, cancer), reason for admission (e.g., neurologic, cardiovascular), and laboratory values (creatinine, albumin, hematocrit). Multinomial logistic regression was used to develop a prognostic index for estimating the probabilities of recovery, disability or death over 1 year. Discrimination of the index was assessed for each outcome based on the c statistic., Key Results: During the year following hospitalization, 36 % of patients recovered, 27 % remained dependent and 37 % died. Key predictors of recovery, dependence or death were age, sex, number of IADL dependencies 2 weeks prior to admission, number of ADL dependencies at discharge, dementia, cancer, number of other chronic conditions, reason for admission, and creatinine levels. The final prognostic index had good to excellent discrimination for all three outcomes based on the c statistic (recovery: 0.81, dependence: 0.72, death: 0.78)., Conclusions: This index accurately estimated the probabilities of recovery, dependence or death in adults aged 70 years or older who were discharged with incident disability following hospitalization. This tool may be useful in clinical settings to guide care discussions and inform decision-making related to post-hospitalization care.

With advances in monitoring and telemedicine, the complexity of care administered in the home to properly selected patients can approach that delivered in the hospital. The challenges include making sure that qualified personnel regularly visit the patient at home, both individually and in teams; information is accurately communicated among the caregiver teams across venues and over time; and patients understand the information communicated to them by providers. Despite these challenges, the benefits of treating chronically or terminally ill patients at home are significant. Among the most important are improved patient satisfaction and reduced cost. Numerous studies have shown that most patients prefer to spend their convalescence or their last days at home. The financial benefits of enabling patients to recover or to die at home are significant.

Given the preferential tax treatment afforded nonprofit firms, policymakers and researchers have been interested in whether the nonprofit sector provides higher nursing home quality relative to its for-profit counterpart. However, differential selection into for-profits and nonprofits can lead to biased estimates of the effect of ownership form. By using "differential distance" to the nearest nonprofit nursing home relative to the nearest for-profit nursing home, we mimic randomization of residents into more or less "exposure" to nonprofit homes when estimating the effects of ownership on quality of care. Using national Minimum Data Set assessments linked with Medicare claims, we use a national cohort of post-acute patients who were newly admitted to nursing homes within an 18-month period spanning January 1, 2004 and June 30, 2005. After instrumenting for ownership status, we found that post-acute patients in nonprofit facilities had fewer 30-day hospitalizations and greater improvement in mobility, pain, and functioning., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objectives: To describe the amount and patterns of ambulatory activity in hospitalized older adults over consecutive hospital days., Design: Observational cohort study., Setting: University teaching hospital Acute Care for Elderly (ACE) unit., Participants: Adults aged 65 and older (N = 239) who wore a step activity monitor during their hospital stay., Measurements: Total number of steps per 24-hour day. Mean daily steps were calculated based on number of days the step activity monitor was worn., Results: Mean age was 76.6 ± 7.6; 55.1% of participants were female. Patients took a mean number of 739.7 (interquartile range 89-1,014) steps per day during their hospital stay. Patients with shorter stays tended to ambulate more on the first complete day of hospitalization and had a markedly greater increase in mobility on the second day than patients with longer lengths of stay. There were no significant differences in mean daily steps according to illness severity or reason for admission., Conclusion: Objective information on patient mobility can be collected for hospitalized older persons. Findings may increase understanding of the level of ambulation required to maintain functional status and promote recovery from acute illness., (© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society.)

Background: Acute care physical therapy is a rapidly evolving practice area, but little is known about the skills, knowledge, and behaviors necessary for a clinician to be most effective in this area., Objective: The objective of this study was to perform the first nationwide survey of acute care physical therapists to validate the knowledge, skill, and behavior sets that reflect practice parameters specific for acute care physical therapy., Design: A survey format was used., Methods: The Acute Care Physical Therapy Practice Analysis Survey was created on the basis of current literature and consensus of a 9-member Subject Matter Expert (SME) Group. The survey sections addressed knowledge areas, professional behaviors, and patient/client management approaches reflecting practice parameters specific for acute care physical therapy. Additionally, respondent demographic information was collected. Pilot testing necessitated minor changes in the survey. After revision, the survey questionnaire was sent to a sample of experienced acute care physical therapists throughout the United States., Results: A convenience sample of 522 physical therapists who identified themselves as having extensive experience in acute care practice was used. Of these, 254 completed the survey, for a response rate of 48.7%. Through the use of predetermined decision rules, 34 items were eliminated on the basis of a descriptive analysis of survey results as well as a failure of the items to meet the threshold of specificity for acute care practice, as determined through SME Group consensus., Limitations: The potential for self-selection bias, a sample weighted heavily with American Physical Therapy Association members and Acute Care Section members, and a small proportion of clinicians (<3%) with less than 1 year of acute care experience may limit generalizability of these results., Conclusions: The results of this practice analysis describe distinct knowledge, skills, and behaviors specific for acute care physical therapy. The outcomes of the survey might assist in the development of professional (entry-level) acute care competencies, a petition for the recognition of specialization in acute care physical therapy, or both. In addition, the findings of this practice analysis could serve as the foundation for the development of residencies or fellowships in acute care practice.

The following five strategies can help health systems meet the increasing requirement under healthcare reform for improved coordination of postacute care: Acknowledge the advantages of care coordination. Conduct an inventory of the organization's existing postacute assets. Determine the optimal portfolio of postacute facilities and services. Assess investment/divestiture alternatives. Build the facility network, supporting protocols, and data systems required to coordinate postacute care effectively.

Objective: To determine the involvement of physiatrists and physical medicine and rehabilitation (PM&R) departments in the acute care of patients admitted to level I trauma centers., Design: An 18-question survey., Setting: Adult, level I trauma center., Participants: Physiatrists, administrative directors, and others involved in rehabilitation in their respective trauma centers. Surveys were mailed to 164 PM&R departments in level I trauma centers. One hundred sixteen responses (70.7%) were received. One hundred five responses (64.0% of total) were used., Main Outcome Measures: The 18-item questionnaire covered topics such as number of staff (based at the trauma center) and consulting physiatrists, number of residents, rehabilitation personnel shortages, participation in multidisciplinary patient care rounds, and relationships between the trauma and rehabilitation services., Results: Eighty-five percent of respondents have at least one full-time or part-time physiatrist based in their PM&R departments. Physiatrists consult in 91% of the responding level I trauma centers. Residents rotate through 52% of responding PM&R departments. Forty-four percent of respondents reported staff shortages, with occupational therapy in greatest demand. Seventy-six percent of PM&R departments participate in multidisciplinary rounds with the trauma service. Eighty-nine percent of PM&R departments stated their relationship with the trauma service was excellent or good., Conclusion: Physiatrists and other allied health personnel are integral members of the trauma care team in most level I trauma centers participating in this study. Further expansion should be encouraged to facilitate early and comprehensive rehabilitative care in all level I centers.