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OBJECTIVE: To provide benchmarking information for a large national sample of patients receiving inpatient rehabilitation after a stroke. DESIGN: Analysis of secondary data from 893 medical rehabilitation facilities located in the United States and contributing information to the Uniform Data System for Medical Rehabilitation from 2000 to 2007. RESULTS: Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, and discharge setting), hospitalization information (length of stay, program interruptions, payer, event onset date, rehabilitation impairment group, International Classification of Diseases-9 codes for the admitting diagnosis, and comorbidities), and functional status information (FIM(R) instrument ['FIM'] ratings at admission and discharge, FIM efficiency, and FIM gain). Descriptive statistics revealed that the length of stay decreased from a mean of 19.6 (+/-12.8) days to 16.5 (+/-9.8) days during the 8-yr study period. FIM instrument admission and discharge ratings also decreased. Mean admission ratings decreased from 62.5 (+/-20.1) to 55.1 (+/-19.3), and mean discharge ratings decreased from 86.4 (+/-23.6) to 79.8 (+/-24.0). FIM change remained relatively stable; the mean for the entire sample was 23.9 (+/-14.8). The percent of persons discharged to the community ranged from 75.8% in 2000 to 69.3% in 2007. All results are likely affected by changes in the definition for program interruption and procedures for FIM data collection. CONCLUSION: Uniform Data System for Medical Rehabilitation data from persons with stroke receiving rehabilitation from 2000 to 2007 indicate patients are showing improvement in functional independence during their rehabilitation stay, and a large percentage are discharged to community settings. [ABSTRACT FROM AUTHOR]

Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, 'Medical necessity?! That's what I was taught to know!' [ABSTRACT FROM AUTHOR]

Objective: We sought to assess whether outcomes and reimbursement differ for Medicare beneficiaries with hip fracture when treated in an inpatient rehabilitation facility (IRF) compared with a skilled nursing facility (SNF) subacute rehabilitation program.Participants: Clinical data were linked with Medicare claims for 29,793 Medicare fee-for-service beneficiaries with a recent hip fracture who completed treatment in 1996 or 1997 in rehabilitation facilities that subscribed to the Uniform Data System for Medical Rehabilitation.Outcome Measures: We measured discharge destination, change in motor FIM rating, and Medicare Part A reimbursement.Results: For patients with moderate-to-severe and severe disabilities, case mix groups (CMGs) 704 and 705, the percentage of patients discharged to the community from IRFs was lower than for patients treated in subacute rehabilitation SNFs, after controlling for covariates. Adjusted odds ratios were 0.71 (95% confidence interval 0.55-0.92) for CMG 704 and 0.72 (95% confidence interval 0.63-0.83) for CMG 705. For patients in the 3 other CMGs, no significant differences were detected. Improvement in motor functional status was roughly equivalent for patients treated in IRFs and those treated in the subacute rehabilitation programs across all 5 CMGs, after controlling for covariates. Medicare Part A payments for IRFs were significantly higher than SNF payments across all CMGs.Conclusion: SNF-based subacute rehabilitation was less costly and outcomes were in most, but not all, instances similar or better than IRF-based rehabilitation for Medicare fee-for-service beneficiaries who had a recent hip fracture. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study is a secondary analysis of results from the Multiple Sclerosis Collaborative Research Group multicenter trial. We investigated the effect of interferon beta-1a on disability in patients with relapsing-remitting multiple sclerosis (MS), using the FIM instrument to assess levels of decline in total, motor, and cognitive items. DESIGN: Of the 301 patients enrolled in the trial, 274 subjects with relapsing-remitting multiple sclerosis with baseline FIM and Kurtzke Expanded Disability Status Scale scores were studied in this secondary analysis. Mildly disabled patients were chosen, as indicated by a Kurtzke Expanded Disability Status Scale score of 1.0-3.5. Matched subjects were assigned to receive either interferon beta-1a or placebo. Kurtzke Expanded Disability Status Scale and FIM scores were measured serially every 6 mo. Failure was defined as a 4-point reduction in total FIM score sustained for 6 mo. Analysis was by Kaplan-Meier methodology. The Mann-Whitney test (log rank) compared mean change and Spearman's rank-correlation test determined correlation. RESULT: A significant difference in treatment groups was seen, with a FIM score decline of > or = 4 points, with placebo subjects demonstrating greater loss of function than subjects treated with interferon beta-1a. There was no statistically significant difference in total, cognitive, or motor activities, with a decline of < or = 3 points. CONCLUSION: Disability, as measured by the FIM instrument, was slowed by treatment with interferon beta-1a compared with placebo. The treatment effect determined using the FIM instrument, with its motor and cognitive components, indicates an additional level of response to therapy for mild to moderate multiple sclerosis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine, only for those who improved, the rate per day of improvement expected for outpatients with low back pain and to identify factors influencing pain improvement: pain duration before assessment, pain and physical functioning levels before assessment, age, sex, and affective factors. It was presupposed that affective factors would have an appreciable effect. DESIGN: The LIFEware System database was used. Analysis was performed on 1292 records for the Painfree measure and 1562 records for the LIFEware System Visual Analog Scale. Measures for pain, physical functioning, and affective well-being were analyzed for 0-30 days vs. >30 days of pain duration before assessment using classification and regression trees analysis. RESULTS: In both Painfree and LIFEware System Visual Analog Scale, 73% improved and 27% did not improve. Of those who improved, outpatients with 0-30 days of pain duration before assessment had higher per day rates of improvement than the >30 days group. Factors affecting improvement were, in descending order, more initial pain, younger age, and positive affective well-being; physical functioning did not affect rate of improvement. Factors affecting improvement for outpatients with >30 days since onset were, in descending order, more initial pain and better initial physical functioning; age and affective well-being were not factors. For all, neither sex nor the 'satisfaction with life in general' question affected low back pain rate of improvement. CONCLUSION: Findings may be useful for clinical application because the actual rate of improvement may be compared with the expected rate. There was only a weak relationship shown between affective factors and pain improvement. [ABSTRACT FROM AUTHOR]

Objective: Examine disparity in health services and outcomes for adults with a hip fracture or lower extremity joint replacement.Materials and Methods: This study examined 28,522 patient records including 12,328 (mean age 76.6 years) with hip fracture and 16,194 (mean age 71.8 years) with joint replacement.Results: Non-Hispanic white and black patients were significantly (P < 0.05) more likely to be discharged home alone and responsible for their own care than were Asian or Hispanic patients. Sixty-four percent of Hispanic patients received inpatient rehabilitation after hip fracture and 36% after hip or knee arthroplasty. In contrast, 58% of non-Hispanic white persons, 67% of black persons, and 56% of Asian persons received inpatient medical rehabilitation after hip or knee joint replacement.Conclusion: Disparity in outcomes appeared to be related to family structure and social support. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) constitutes a significant cause of morbidity and mortality in the elderly population. CHID is managed under physician guidance. The management is primarily pharmacological, aimed at alleviating patient suffering and improving the clinical outcome. This approach ignores the functional aspect of CHD. The objective of this study was to explore the relationship between the symptoms experienced by a group of frail elders due to coronary heart disease and the performance of physical activities. A group of 33 frail elders with CHD residing in the region of Western New York were interviewed over a period of 6 months using the LIFEWARE Cardiac Assessment Form (CAF). The results indicate mild to moderate relationships between the symptoms experienced and the performance of physical activities. We suggest the use of occupational therapy intervention aimed at improving the performance of physical activities in frail elders symptomatic with CHD. The intervention could include the use of assistive devices and energy conservation techniques. An improved ability to perform physical activities will ensure a higher functional status and a better quality of daily living. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Length of stay (LOS) and hospital readmission for persons receiving medical rehabilitation were examined. METHODS: A total of 96,473 patient records (1994-1998) were analyzed. Mean age of patients was 68.97 years; 61% were female and 83% were non-Hispanic White. RESULTS: A decrease in LOS of 6.07 days (SD = 3.23) and increase in hospital readmission were found across all impairment groups (P < .001). Readmission increases ranged from 6.7% for amputations to 1.4% for orthopedic conditions. LOS was longer (2.1 days) for readmitted patients (P < .01). Age was not a significant predictor of rehospitalization. CONCLUSIONS: Understanding variables associated with rehospitalization is important as prospective payment systems are introduced for postacute care. [ABSTRACT FROM AUTHOR]