14 results on '"Acute Disease rehabilitation"'
Search Results
2. School-based mental health program evaluation: children's school outcomes and acute mental health service use.
- Author
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Kang-Yi CD, Mandell DS, and Hadley T
- Subjects
- Acute Disease rehabilitation, Adolescent, Child, Female, Humans, Male, Medicaid economics, Philadelphia, Program Evaluation, United States, Child Health Services economics, Child Health Services statistics & numerical data, Mental Health Services economics, Mental Health Services statistics & numerical data, School Health Services economics, School Health Services statistics & numerical data
- Abstract
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.)
- Published
- 2013
- Full Text
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3. Intensified rehabilitation therapy and transitions to skilled nursing facilities in community-living seniors with acute medical illnesses.
- Author
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Yoo JW, Kim S, Choi JH, and Ryu WS
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- Aged, Aged, 80 and over, Female, Follow-Up Studies, Humans, Inpatients, Male, Retrospective Studies, Treatment Outcome, United States, Activities of Daily Living, Acute Disease rehabilitation, Physical Therapy Modalities, Rehabilitation Centers, Skilled Nursing Facilities, Walking physiology
- Abstract
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.)
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- 2013
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4. Prediction of recovery, dependence or death in elders who become disabled during hospitalization.
- Author
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Barnes DE, Mehta KM, Boscardin WJ, Fortinsky RH, Palmer RM, Kirby KA, and Landefeld CS
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- Activities of Daily Living, Acute Disease mortality, Age Factors, Aged, Aged, 80 and over, Female, Humans, Male, Patient Discharge, Patient Readmission, Prognosis, Retrospective Studies, United States, Acute Disease rehabilitation, Geriatric Assessment methods, Hospitalization
- Abstract
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.
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- 2013
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5. Improving outcomes and lowering costs by applying advanced models of in-home care.
- Author
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Boling PA, Chandekar RV, Hungate B, Purvis M, Selby-Penczak R, and Abbey LJ
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- Activities of Daily Living, Acute Disease economics, Chronic Disease rehabilitation, Comorbidity, Cost Control methods, Critical Care economics, Critical Care methods, Critical Care trends, Home Care Services economics, Home Care Services trends, Humans, Medicare economics, Medicare standards, Medicare trends, Models, Organizational, Monitoring, Ambulatory economics, Monitoring, Ambulatory methods, Monitoring, Ambulatory trends, Palliative Care economics, Palliative Care methods, Palliative Care trends, Telemedicine economics, Telemedicine standards, Terminally Ill, United States, Virginia, Acute Disease rehabilitation, Chronic Disease therapy, Home Care Services organization & administration, Patient Satisfaction, Telemedicine trends
- Abstract
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.
- Published
- 2013
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6. Effect of nursing home ownership on the quality of post-acute care: an instrumental variables approach.
- Author
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Grabowski DC, Feng Z, Hirth R, Rahman M, and Mor V
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- Acute Disease rehabilitation, Acute Disease therapy, Aged, 80 and over, Female, Health Facilities, Proprietary economics, Health Facilities, Proprietary standards, Health Facilities, Proprietary statistics & numerical data, Humans, Male, Medicare economics, Medicare statistics & numerical data, Nursing Homes economics, Nursing Homes organization & administration, Organizations, Nonprofit economics, Organizations, Nonprofit standards, Organizations, Nonprofit statistics & numerical data, Ownership economics, Ownership statistics & numerical data, Quality Indicators, Health Care economics, Quality Indicators, Health Care statistics & numerical data, Quality of Health Care statistics & numerical data, United States, Nursing Homes standards, Quality of Health Care economics
- Abstract
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.)
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- 2013
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7. Acute care physical therapist practice: it's come a long way.
- Author
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Craik RL
- Subjects
- Critical Illness rehabilitation, Humans, Professional Role, Specialization, United States, Acute Disease rehabilitation, Physical Therapy Modalities, Physical Therapy Specialty
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- 2012
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8. Hospitals and post-acute care under VBP.
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- Centers for Medicare and Medicaid Services, U.S., Cost Control legislation & jurisprudence, Humans, Patient Protection and Affordable Care Act, Rehabilitation Centers economics, United States, Acute Disease rehabilitation, Legislation, Hospital, Rehabilitation economics
- Published
- 2012
9. Ambulatory activity of older adults hospitalized with acute medical illness.
- Author
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Fisher SR, Goodwin JS, Protas EJ, Kuo YF, Graham JE, Ottenbacher KJ, and Ostir GV
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- Activities of Daily Living, Aged, Aged, 80 and over, Ergometry instrumentation, Female, Geriatrics, Humans, Male, Monitoring, Ambulatory, United States, Acute Disease rehabilitation, Hospitalization, Walking
- Abstract
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.)
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- 2011
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10. Nationwide acute care physical therapist practice analysis identifies knowledge, skills, and behaviors that reflect acute care practice.
- Author
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Gorman SL, Wruble Hakim E, Johnson W, Bose S, Harris KS, Crist MH, Holtgrefe K, Ryan JM, Simpson MS, and Bryan Coe J
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- Adult, Aged, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, United States, Acute Disease rehabilitation, Health Knowledge, Attitudes, Practice, Physical Therapy Modalities statistics & numerical data, Physical Therapy Specialty, Professional Practice statistics & numerical data
- Abstract
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.
- Published
- 2010
- Full Text
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11. 5 strategies for coordinating postacute care.
- Author
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Johnson D and Burik D
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- Acute Disease rehabilitation, Continuity of Patient Care economics, Financial Management, Hospital organization & administration, Home Care Agencies, Hospitals, Humans, Residential Facilities, United States, Continuity of Patient Care organization & administration, Health Care Reform
- Abstract
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.
- Published
- 2010
12. State of the science on postacute rehabilitation: setting a research agenda and developing an evidence base for practice and public policy: an introduction.
- Author
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Heinemann AW
- Subjects
- Clinical Medicine trends, Evidence-Based Medicine, Humans, United States, Acute Disease rehabilitation, Biomedical Research methods, Outcome Assessment, Health Care trends, Public Policy, Rehabilitation trends, Research trends, Science trends
- Abstract
The Rehabilitation Research and Training Center on Measuring Rehabilitation Outcomes and Effectiveness along with academic, professional, provider, accreditor and other organizations, sponsored a 2-day State-of-the-Science of Post-Acute Rehabilitation Symposium in February 2007. The aim of this symposium was to serve as a catalyst for expanded research on postacute care (PAC) rehabilitation so that health policy is founded on a solid evidence base. The goals were to: (1) describe the state of our knowledge regarding utilization, organization and outcomes of postacute rehabilitation settings, (2) identify methodologic and measurement challenges to conducting research, (3) foster the exchange of ideas among researchers, policymakers, industry representatives, funding agency staff, consumers and advocacy groups, and (4) identify critical questions related to setting, delivery, payment and effectiveness of rehabilitation services. Plenary presentation and state-of-the-science summaries were organized around four themes: (1) the need for improved measurement of key rehabilitation variables and methods to collect and analyze this information, (2) factors that influence access to postacute rehabilitation care, (3) similarities and differences in quality and quantity of services across PAC settings, and (4) effectiveness of postacute rehabilitation services. The full set of symposium articles, including recommendations for future research, appear in Archives of Physical Medicine and Rehabilitation.
- Published
- 2007
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13. Keeping hospitalizations in check.
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Armstrong T and Kalenchuk K
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- Acute Disease rehabilitation, Communication, Humans, Respiratory Tract Infections prevention & control, United States, Urinary Tract Infections prevention & control, Hospitalization, Patient Transfer, Skilled Nursing Facilities
- Published
- 2007
14. Status of physiatry and physical medicine and rehabilitation departments in adult level I trauma centers.
- Author
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Melchiorre PJ
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- Acute Disease rehabilitation, Adult, Health Care Surveys, Health Services Research, Humans, Patient Care Team organization & administration, Physician Executives, Referral and Consultation organization & administration, Surveys and Questionnaires, United States, Interdepartmental Relations, Physical Therapy Department, Hospital organization & administration, Physical and Rehabilitation Medicine organization & administration, Physician's Role, Trauma Centers organization & administration
- Abstract
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.
- Published
- 1998
- Full Text
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