Assessing Clinically Important Differences During Rehabilitation for Stroke: A Pilot Study Evaluating Anchor and Distribution Derived Estimates of Physical Function Change in Classically Summed and Rasch Models of Section GG of the Inpatient Rehabilitation Facility Patient Assessment Instrument.

OBJECTIVE: To determine clinically important differences (CIDs) on Section GG physical functioning scores on the Centers for Medicare and Medicaid Services (CMS) Inpatient Rehabilitation Facility Assessment Instrument (IRF-PAI) for patients with stroke, using anchor and distribution-based approaches. DESIGN: Pilot prospective observational cohort study. SETTING: Inpatient rehabilitation facility. PARTICIPANTS: Patients with stroke (N=208). INTERVENTIONS: Physicians assessed improvements during rehabilitation using the modified Rankin scale (mRS). Improvements (≥1 point) on the mRS were used as the anchor for establishing CIDs. MAIN OUTCOME MEASURES: Classically summed and Rasch transformed Section GG change scores associated with clinically important improvements on the mRS. RESULTS: A total of 166 patients (79.8%) improved ≥1 point on the mRS. Change scores of 27, 9, and 16 on Section GG total physical functioning (self-care + mobility), self-care, and mobility/walk scales, respectively, had high sensitivity (0.82-0.85) but low specificity (0.52-0.69) in identifying patients improving on the mRS. Positive predictive values ranged from 0.87 to 0.91, and negative predictive values ranged from 0.42 to 0.52. Total physical functioning and selfcare anchor-derived change scores were similar to the reliable change index (RCI [2.77 × SEM]), calculated as 28 and 10 points, respectively, whereas anchor-derived mobility/walk scale change scores were equivalent to 1.96 × SEM. Exploratory Rasch modeling identified 3 Section GG subscales (R-Self-Care, R-Mobility, and R-Walking). Improvements on the R-Walking subscale were most correlated with mRS improvements (ρ=-0.47); however, accuracy of CID estimates was not improved. CONCLUSIONS: Cut-off scores obtained using the mRS anchor aligned with more robust estimates of change, as estimated by distribution-based measures. While patients achieving anchor-derived cut-offs have a high probability of mRS improvement, change scores may fail to detect clinically meaningful improvements at these same thresholds. Alternative criteria for determining MCID/CIDs, should be explored. Rasch models require further validation.

Identifying Racial and Ethnic Disparities in Acute Inpatient Rehabilitation.

OBJECTIVE: To investigate whether racial, ethnic, and linguistic disparities exist at discharge from an acute inpatient rehabilitation facility (IRF) by examining change in Functional Independence Measure (FIM) scores and discharge destination. DESIGN: This is a retrospective study using our IRF's data from the Uniform Data System for Medical Rehabilitation from 2013-2019. FIM scores and discharge destination were compared between race, language, and ethnic groups, with adjustment for patient characteristics. SETTING: An urban hospital with a level 1 trauma center, comprehensive stroke center, and IRF with Commission on Accreditation of Rehabilitation Facilities (CARF) certification. PARTICIPANTS: 2518 patients admitted to the IRF from 2013-2019 (N=2518). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in FIM score and discharge destination. RESULTS: After adjusting for covariates, non-White patients and patients with limited English proficiency had significantly lower functional recovery, as measured by smaller changes in FIM scores from IRF admission to discharge. Additionally, both groups were more likely to be discharged home with home health care than to a skilled nursing facility, compared with White and English-speaking patients. Disparities in discharge destination persisted within patients with noncommercial insurance (Medicaid or Medicare) and a stroke diagnosis but not within those who had commercial insurance or a nonstroke diagnosis. CONCLUSIONS: Racial and linguistic disparities were identified within our CARF certified IRF; however, the organization is committed to reducing health care disparities. Next steps will include investigating interventions to reduce disparities.

Trends in the Characteristics and Outcomes of Older Medicare Patients With Traumatic Brain Injury Treated in Inpatient Rehabilitation Facilities: 2013 to 2018.

OBJECTIVE: To describe the characteristics and outcomes of older (65+) Medicare beneficiaries with traumatic brain injury (TBI) treated in inpatient rehabilitation facilities between 2013 and 2018. DESIGN: Descriptive study using IRF Patient Assessment Instrument (IRF-PAI) data reporting trends of the sociodemographic and clinical characteristics and outcomes of inpatient rehabilitation facilities Medicare patients with TBI. SETTING: Inpatient rehabilitation facilities in the United States. PARTICIPANTS: 99,804 older Medicare fee-for-service and Medicare Advantage patients with TBI (N=99,804). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay, self-care, and mobility functional outcomes, discharge destination. RESULTS: The number of older Medicare beneficiaries with TBI treated in inpatient rehabilitation facilities increased from 14,657 in 2013 to 18,791 in 2018, an increase of 28.2%. In addition to this overall increase in patients, we also found the percentage of men increased slightly (52.9% to 54.8%), there was a higher percentage of patients with tier 3 comorbidities, there was a decrease in the variability of length of stay, there was slightly more self-care and mobility improvement and a slightly higher percentage of patients discharged to the community (67.8% in 2013 and 71.6% in 2018). Newer standardized data showed that prior to the injury, more than one-third used a walker and more than three-quarters had a history of recent falls. CONCLUSIONS: Between 2013 and 2018, the number of Medicare beneficiaries with TBI treated in IRFs increased by approximately 28%. The characteristics of IRF older patients with TBI changed between 2013 and 2018 toward a slightly higher proportion of men, more comorbidities, and a higher percentage being discharged home after inpatient rehabilitation.

Inpatient Rehabilitation Facility Ownership Type Yields Mixed Performances on Quality Measures.

OBJECTIVE: To evaluate the effects of inpatient rehabilitation facility (IRF) ownership type on IRF-Quality Reporting Program (IRF-QRP) measures. DESIGN: Cross-sectional, observational design. SETTING: We used 2 Centers for Medicare and Medicare publicly-available, facility-level data sources: (1) IRF compare files and (2) IRF rate setting files - final rule. Data from 2021 were included. PARTICIPANTS: The study sample included 1092 IRFs (N=1092). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We estimated the effects of IRF ownership type, defined as for-profit and nonprofit, on 15 IRF-QRP measures using general linear models. Models were adjusted for the following facility-level characteristics: (1) Centers for Medicare and Medicaid census divisions; (2) number of discharges; (3) teaching status; (4) freestanding vs hospital unit; and (5) estimated average weight per discharge. RESULTS: Ownership type was significantly associated with 9 out of the fifteen IRF-QRP measures. Nonprofit IRFs performed better with having lower readmissions rates within stay and 30-day post discharge. For-profit IRFs performed better for all the functional measures and with higher rates of returning to home and the community. Lastly, for-profit IRFs spent more per Medicare beneficiary. CONCLUSIONS: Ideally, IRF performance would not vary based on ownership type. However, we found that ownership type is associated with IRF-QRP performance scores. We suggest that future studies investigate how ownership type affects patient-level outcomes and the longitudinal effect of ownership type on IRF-QRP measures.

Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID-19 pulmonary disease.

BACKGROUND: Coronavirus disease (COVID-19) has introduced a new subset of patients with acute end-stage lung damage for which lung transplantation has been successfully performed. OBJECTIVE: To describe the inpatient rehabilitation course of patients who underwent bilateral lung transplant due to severe COVID-19 pulmonary disease. DESIGN: Retrospective chart review. SETTING: Free-standing, academic, urban inpatient rehabilitation hospital. PARTICIPANTS: Seventeen patients aged 28-67 years old (mean 53.9 ± 10.7) who developed COVID-19 respiratory failure and underwent bilateral lung transplant. INTERVENTIONS: Patients participated in a comprehensive inpatient rehabilitation program including physical, occupational, and speech therapy tailored to the unique functional needs of each individual. MAIN OUTCOME MEASURES: Primary outcome measures of functional improvements, include mobility and self-care scores on section GG of the Functional Abilities and Goals of the Improving Post-Acute Care Transformation Act, as defined as quality measures by the Centers for Medicare and Medicaid Services. Other functional measures included 6 minute walk test, Berg balance scale, Mann Assessment of Swallowing Ability (MASA), and Cognition and Memory Functional Independence Measure (FIM) scores. Wilcoxon signed rank sum test was used to evaluate statistical significance of change between admission and discharge scores. RESULTS: Fourteen patients completed inpatient rehabilitation. Self-care (GG0130) mean score improved from 20.9 to 36.1. Mobility (GG0170) mean score improved from 30.7 to 70.7. Mean 6-minute walk distance improved from 174.1 to 467.6 feet. Mean Berg balance scores improved from 18.6/56 to 36.3/56. MASA scores improved from 171.3 to 182.3. All functional measures demonstrated statistically significant improvements with p value ≤ .008, except for cognition and memory FIM scores, which did not show a statistically significant difference. A majority (76%) of patients discharged home. CONCLUSION: This new and unique patient population can successfully participate in a comprehensive inpatient rehabilitation program and achieve functional improvements despite medical complications.

Rehabilitation after brain tumor resection: A national study of postacute care service use through insurance claims data.

OBJECTIVE: To assess postacute rehabilitation service use and length of stay among a national sample of patients with brain tumors after surgery. DESIGN: A retrospective review was conducted of health care claims data of a national sample of patients via The Optum Clinformatics DataMart. SETTING AND PARTICIPANTS: This study included adult individuals (≥18 years of age) who were diagnosed with a brain tumor between 2015 and 2019 and underwent a craniotomy or craniectomy within 180 days of diagnosis. METHODS: Descriptive statistics were used to characterize patients by tumor type. Multivariate models assessed factors associated with discharge setting and length of stay. RESULTS: Of the 10,275 individuals identified, 69% had malignant tumors. Over two thirds of patients were discharged directly home (with or without home health care) and 9.3% and 9.5% were discharged to acute rehabilitation facilities (inpatient rehabilitation facilities [IRF]) and skilled nursing facilities (SNF/ICF), respectively. About 13.5% were discharged to other settings. The average length of stay during the episode of care was 8.6 (SD = 9.6) days. After adjusting for confounders, individuals with benign brain tumors were more likely to be discharged to either IRF or SNF/ICF than return home after acute care stay, as were those with greater comorbidities, older age, fee-for-service and health maintenance organization insurance. Wealthier patients were less likely to be discharged to a SNF/ICF than home, although income was not a factor affecting discharge to an IRF. Patients with benign tumors, the oldest old (80+), those with more comorbidities as well as Black and Hispanic patients had a longer length of stay during the acute hospitalization. CONCLUSIONS: Individuals with brain tumors have deficits amenable to rehabilitation; however, this study finds that service use differs by tumor type and demographic and socioeconomic factors. Further study is needed to identify if there are barriers to access and use of rehabilitation services in this population.

A pandemia de Covid-19 e os serviços de reabilitação para pessoas com deficiência no SUS / The Covid-19 pandemic and rehabilitation services for people with disabilities in the SUS

Introdução - A pandemia de Covid-19 trouxe impactos significativos para a rede de serviços de saúde e afetou, sobremaneira, os cuidados em saúde para pessoas com deficiência (PCD). Objetivo - Analisar o impacto da pandemia no funcionamento dos Centros Especializados em Reabilitação (CER) no SUS e os fluxos assistenciais percorridos por usuários com Síndrome Pós-Covid19. Método - O estudo foi composto por duas partes complementares. A primeira, focada nos efeitos da pandemia para cuidados às PCD, utilizou método misto composto pela análise da variação da produção ambulatorial dos CER, entre março/2019 a dezembro/2021, cotejando tais resultados com as percepções de gestores e profissionais de reabilitação de CER aferidas por websurvey. Foram calculadas as médias mensais de 247 procedimentos, para o ano anterior à pandemia, primeiro e segundo anos de pandemia. No websurvey foram investigados: funcionamento e organização dos serviços; reabilitação Pós-Covid-19; ações de apoio aos usuários e profissionais; estratégias e desafios vivenciados. A segunda parte analisou itinerários terapêuticos de residentes no município de São Paulo, com necessidade de reabilitação pós-Covid-19, atendidos por um CER, até a saturação de conteúdo nas narrativas. Os relatos foram transcritos e analisados segundo as dimensões: do adoecimento ao diagnóstico; internação hospitalar; cuidados após alta e reabilitação, com identificação de barreiras, facilitadores e estratégias para a garantia do acesso e da continuidade do cuidado. Resultados - Verificou-se impacto significativo sobre a produção ambulatorial dos CER brasileiros, com redução de 33,3% do total de procedimentos registrados entre o primeiro ano de pandemia e o ano anterior, com maior prejuízo para atividades em grupo, terapias visuais e visitas domiciliares, e com aumento de 104,1% de procedimentos de Fisioterapia Cardiorrespiratória. No websurvey, foram relatadas a descontinuidade da assistência e a necessidade de modificações estruturais e organizacionais como: reorganização de atendimentos; criação de critérios de priorização; introdução de telerreabilitação; e disponibilização de capacitações. Embora metade dos CER já atendessem pessoas com sequelas de Covid-19, nem todos haviam sido instrumentalizados para esta demanda. O estudo dos itinerários pós-covid19 demonstrou que a implantação do protocolo pós-covid19 ocorreu heterogeneamente nos serviços de São Paulo. Observaram-se barreiras para o diagnóstico, estrutura insuficiente para desospitalização e limitações ao acompanhamento após alta na atenção primária e especializada. A existência de diretriz assistencial e o vínculo com UBS figuraram como facilitadores para a obtenção de cuidados no início do quadro clínico de COVID e para reabilitação. O tempo de espera para reabilitação não foi determinado pela gravidade dos casos e se constatou cuidado fragmentado com priorização de terapias físicas em detrimento das demais, além de insuficiente suporte social. Como estratégias individuais se destacaram os contatos pessoais e fluxos informais de acesso. Conclusão - Impuseram-se importantes desafios para a manutenção da assistência para PCD durante a pandemia, assim como para o atendimento de novas demandas dela advindas. Essas questões se somam a limitações prévias da Rede de Cuidados à Pessoa com Deficiência, assim como a negligência de demandas de reabilitação nos planos de contingência, bem como a insuficiência de desenvolvimento de estratégias de enfrentamento específicas e inclusivas.

Introduction - The Covid-19 pandemic has had a significant impact on the health services network and has greatly affected health care for people with disabilities (PWD). Objective - To analyze the impact of the pandemic on the operation of Specialized Rehabilitation Centers (CER) in the SUS and the care flows carried out by users with Post-Covid-19 Syndrome. Method - The study consisted of two complementary parts. The first, focused on the effects of the pandemic on PCD care, used a mixed method consisting of an analysis of the variation in the outpatient production of CERs, between March/2019 and December/2021, comparing these results with CER managers and rehabilitation professionals' perceptions measured by websurvey. The monthly averages of 247 procedures were calculated for the year before the pandemic, the first and second years of the pandemic. The web survey investigated: operation and organization of the services; post-Covid-19 rehabilitation; actions to support users and professionals; strategies and challenges experienced. The second part analyzed the therapeutic itineraries of residents of the city of São Paulo who needed rehabilitation after COVID-19 and were assisted by a CER, until the content saturation of the narratives. The accounts were transcribed and analyzed according to the following dimensions: illness to diagnosis; hospitalization; post-discharge care and rehabilitation, identifying barriers, facilitators and strategies to ensure access and continuity of care. Results - There was a significant impact on the outpatient production of brazilian CER, with a 33.3% reduction in the total number of procedures recorded between the first year of the pandemic and the previous year, with greater damage to group activities, visual therapies and home visits, and a 104.1% increase in cardiorespiratory physiotherapy procedures. In the web survey, the discontinuity of care and the need for structural and organizational changes were reported, such as: reorganizing care, creating prioritization criteria, introducing telerehabilitation, and providing training. Although half of the CERs already cared for people with Covid-19 sequelae, not all had been structured for this demand. The study of post-Covid-19 itineraries showed that implementation of the post-Covid-19 protocol occurred heterogeneously in the São Paulo services. There were barriers to diagnosis insufficient structure for de-hospitalization and limitations to follow-up after discharge in primary and specialized care. Care guidelines and the UBS binding facilitated access to initial Covid-19 care and rehabilitation. Waiting time for rehabilitation was not determined by the severity of the cases and fragmented care was found, with physical therapies being prioritized over others, as well as insufficient social support. Personal contacts and informal access flows stood out as individual strategies. Conclusion - This study demonstrates major challenges in maintaining care for PCD during the pandemic, also meeting the new demands arising from it. Additionally, there are previous limitations on the Care Network for People with Disabilities, besides the neglect of rehabilitation demands in contingency plans and the lack of inclusive coping strategies.

Preliminary assessment of a standardized vision screening guideline in a pediatric inpatient rehabilitation unit.

OBJECTIVE: This study aimed to evaluate the impact of a standardized vision screen guideline on occupational therapy vision screens in a pediatric inpatient rehabilitation unit. METHODS: Charts of patients admitted to a pediatric inpatient rehabilitation before guideline implementation (n = 47) versus charts after implementation (n = 47) were randomly, retrospectively reviewed to explore differences in visual skills screened and use of standardized assessments. RESULTS: Significant improvements (p < = 0.05) were found in the number of visual skills screened (p = 0.034), use of standardized assessments (p = 0.005), and screening of the specific visual skills of accommodative amplitude (p = 0.05), suppression (p = 0.015), and double vision (p < 0.001). CONCLUSION: Implementation of a standardized vision screen guideline improved the frequency of vision screens during occupational therapy evaluations in a pediatric inpatient rehabilitation unit. The use of standardized assessments may also improve the quality of vision screens by encouraging staff to complete more comprehensive vision screens, including screening more visual skills, and by prompting use of standardized assessments, which can improve accuracy of screening procedures.

[Assessment of Long COVID in Medical Rehabilitation]. / Bestandsaufnahme zu Long COVID in der medizinischen Rehabilitation.

PURPOSE: The aim of the study was to provide an insight into the care situation of long COVID patients in inpatient medical rehabilitation facilities in Germany. METHODS: For this purpose, a standardized online survey was conducted among 1,080 inpatient medical rehabilitation facilities in Germany. RESULTS: A total of 338 cases were available for the analysis. Of these, 173 (51%) reported treating long COVID. The cumulative total number of rehabilitants with long COVID treated in the facilities up to the time of the survey was 11,948. The results showed that rehabilitation facilities were mostly prepared for the care of patients with Long COVID. Lack of capacity was reported especially by those rehabilitation facilities that treated rehabilitants with long COVID in pneumology departments. Furthermore, capacity bottlenecks were related to the total number of patients with long COVID in the rehabilitation facility ("proportion of rehabilitants with long COVID to all rehabilitants in the department"). Heterogeneity was found in the treatment concept for long COVID and the allocation of patients to a specific department. CONCLUSION: The results of the long COVID inventory underline the importance of medical rehabilitation in the treatment of the long-term health and participation-related consequences of COVID-19.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact.

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Concurrent Validation of the Inpatient Rehabilitation Facility Patient Assessment Instrument Version 1.4; Sections GG, B, and C.

OBJECTIVE: To validate Sections GG (Self-Care and Mobility Assessment), B (Hearing, Speech, and Vision), and C (Cognitive Patterns) of the Centers for Medicare and Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument (CMS-IRF PAI) Version 1.4 in comparison with Functional Independence Measure (FIM) motor subscale (FIMm) and cognitive subscale (FIMc). DESIGN: Retrospective cohort. SETTING: Single inpatient rehabilitation facility. PARTICIPANTS: Cohort of 1296 patients admitted for rehabilitation after stroke, between October 1, 2016, and October 1, 2019. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sections GG, B, and C scores were compared with FIMm and FIMc using Spearman's and Bland-Altman Analyses. RESULTS: Sections GG and FIMm were highly correlated on admission (ρ=0.919, P<.001) and discharge (ρ=0.929, P<.001). Ceiling effects at discharge were more pronounced for Section GG (8.6%). Bland-Altman analyses revealed a bias toward higher scores on Section GG vs FIMm on admission (Bias=2.3%, P<.001), and discharge (Bias=6.2%, P<.001). Section GG showed bias toward greater gains in function (Bias=3.9%, P<.001), particularly in walking and stairs (bias=3.71%, P<.001). Comparable self-care items accounted for a smaller percentage of the Section GG gains compared with FIMm (bias=-7.5%, P<.001). The internal validity of a scale consisting of Section B and C (B+C scale) was good, (Cronbach's alpha=0.868) and was highly correlated with FIMc (ρ=0.745), but rated patients at a higher level of cognition (bias=20.0%, P<.001) and had a greater ceiling effect (20.4%) on admission compared with the FIMc (0.6%). CONCLUSION: The B+C scale and Section GG were correlated with FIMc and FIMm subscales but biased toward higher ratings of ability. Ceiling effects may limit discrimination at higher level of cognition/functional independence. The clinical acceptability of Section GG total scores as an outcome measure and predictor of long-term outcomes requires further study.

Predicting Falls in Rehabilitation: A Comparison of Three Instruments Including Hester Davis.

PURPOSE: The aim of this study was to evaluate the ability of the Hester Davis Scale (HDS), Section GG, and facility fall risk assessment scores to predict patients who fall during inpatient rehabilitation. DESIGN: This study was an observational quality improvement project. METHODS: Nurses administered the HDS in parallel to the facility's current fall risk assessment and Section GG of the Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility Patient Assessment Instrument. Receiver operating characteristic curves were compared in 1,645 patients. Relationships of individual scale items to falls were also assessed. RESULTS: The HDS (area under the curve [AUC] = .680, 95% CI [.626, .734]), facility fall risk assessment (AUC = .688, 95% CI [.637, .740]), and Section GG scores (AUC = .687, 95% CI [.638, .735]) adequately identified patients who fell. AUCs did not significantly differ between assessments. HDS scores of ≥13, facility scores of ≥14, and Section GG scores of ≤51 resulted in the highest sensitivity/specificity balance. CONCLUSIONS: HDS, facility fall risk assessment, and Section GG scores adequately and similarly identified patients of mixed diagnoses at risk of falling in inpatient rehabilitation. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses have several options including the HDS and Section GG to identify patients at greatest risk of falling.

Characteristics and Outcomes of Medicare Patients Treated in Inpatient Rehabilitation Facilities: 2013-2018.

PURPOSE: The aim of this study was to describe the characteristics and outcomes of Medicare patients treated in inpatient rehabilitation facilities (IRFs) in 2013 through 2018. DESIGN: A descriptive study was conducted. METHODS: A total of 2,907,046 IRF Medicare fee-for-service and Medicare Advantage patient stays that ended in 2013 through 2018 were analyzed. RESULTS: The number of Medicare patients treated in IRFs increased by about 9%, from 466,092 in 2013 to 509,475 in 2018. Although IRF patients' age and racial/ethnic composition remained similar across the years, there was a shift in patients' primary rehabilitation diagnosis, with more patients with stroke, neurological conditions, traumatic and nontraumatic brain injury, fewer patients with orthopedic conditions, and fewer coded as having medically complex conditions. Across the years, the percentage of patients discharged to the community was between 73.0% and 74.4%. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses should have training and expertise in the management of patients with stroke and neurological conditions to provide high-quality IRF care. CONCLUSIONS: Between 2013 and 2018, the number of Medicare patients treated in IRFs increased overall. There were more patients with stroke and neurological conditions and fewer patients with orthopedic conditions. Changes to IRF and other post-acute care policies, Medicaid expansion, and alternative payment programs may partially be driving these changes.

Características demográficas, socioeconômicas e da procura dos usuários em um serviço de reabilitação física de referência estadual, Mato Grosso, 2021 / Demographic, socioeconomic and service demand features of users in a state reference physical rehabilitation service, Mato Grosso, 2021 / Características demográficas, socioeconómicas y de la demanda de los usuarios en un servicio de rehabilitación física de referencia estatal, Mato Grosso, 2021

Introdução: O estudo dos fatores sociodemográficos e socioeconômicos de usuários doSistema Único de Saúde éimportante para o planejamento e a avaliação das ações dos serviços de saúde procurados por esta população. Objetivo:Descrever as características demográficas, socioeconômicas e da procura dos usuários adultos com demanda dereabilitação física ortopédica e neurológica emum Centro Especializado em Reabilitação de referência no Estado de Mato Grosso. Metodologia:Estudo observacional descritivo baseado nos prontuários dosetor de acolhimento de um Centro Especializado em Reabilitação de Mato Grosso,de fevereiro a maio de 2021. Foram analisados dados demográficos e socioeconômicos de usuários adultos de ambos os sexos. Utilizou-se o teste de qui-quadrado de Pearson para as associações entre as variáveis segundo eixo de reabilitação (ortopédica e neurológica). Resultados:Dos196 prontuários analisados,94% dos usuários eram procedentes de Cuiabá, comidade média de 50,3 anos, sendo 52,55% do sexo feminino. Aprocura pelo serviçofoi de 69%pela reabilitação ortopédica (69%) e de 31%reabilitação neurológica. Observaram-se diferenças estatisticamente significantes entre as frequências nos dois eixos dereabilitação física estudados nas variáveis idade (p=0,0005), escolaridade (p=0,0031), principal atividade de trabalho (p=0,0045), doenças concomitantes (p=0,0016), tratamento em outro estabelecimento de saúde (p=0,0041) e motivo da procura pela reabilitação (p<0,0001). Conclusões:Osresultados mostraram que os casos neurológicos possuem maior idade, baixo nível de escolaridadeepequeno percentual de trabalho remuneradoem relação aos casos ortopédicos. Tais resultados sugerem que as necessidades de saúde e de reabilitação dependem da singularidade dos casos e podem subsidiara efetivação depolíticas públicas que favoreçam a reorganização dos serviços e a articulação intersetorial entre saúde, educação emercado de trabalho (AU).

Introduction: Assessing sociodemographic and socioeconomic factors related to Unified Health System's users is essential to plan and evaluate the actions by the health services sought by them.Aim: Describing the demographic and socioeconomic features of adult users, and their search for having their orthopedic and neurological-physical rehabilitation demands fulfilled by a Specialized Center in Orthopedic and Neurological Rehabilitation in Mato Grosso State.Methodology: Observational descriptive study based on medical records collected between February and March 2021, provided by the welcoming sector of a Specialized Center in Rehabilitation in Mato Grosso State. Demographic and socioeconomic records of adult users belonging to both sexes were analyzed. Person's chi-square test was adopted to associate the variables based on the orthopedic and neurological rehabilitation axes.Results: In total, 94% of the 196 analyzed medical records regard patients from Cuiabá, in the mean age group 50.3 years; 52.55% of them belonged to the female sex. The search for orthopedic rehabilitation reached 69% and that for neurological rehabilitation recorded 31%. There were significant statistical differences between frequencies on the two assessed physical rehabilitation axes based on variables such as age (p=0.0005), schooling (p=0.0031), main labor activity (p=0.0045), concomitant diseases (p=0.0016), treatment provided in another health establishment (p=0.0041) and reason for seeking rehabilitation (p<0.0001). Conclusions: Results have shown that neurological cases are linked to older age, low schooling and low rate of paid work in comparison to orthopedic cases. These results have suggested that health and rehabilitation needs depend on cases' particularities; moreover, they can subsidize the process to make public policies to reinforce services'organization, as well as inter-sectoral articulation among health, education and labor market, effective (AU).

Introducción: El estudio de los factores sociodemográficos y socioeconómicos de los usuarios del Sistema Único de Salud es importante para planificar y evaluar las acciones de los servicios de salud buscados por esta población.Objetivo: Describir las características demográficas, socioeconómicas y de demanda de usuarios adultos con demanda de rehabilitación física ortopédica y neurológica en un Centro Especializado de Rehabilitación de Referencia en el Estado de Mato Grosso.Metodología: Estudio observacional descriptivo basado en las historias clínicas del sector de acogimiento de un Centro Especializado de Rehabilitación en Mato Grosso, de febrero a mayo de 2021. Se analizaron datos demográficos y socioeconómicos de usuarios adultos de ambos sexos. Se utilizóla prueba de chi-cuadrado de Pearson para las asociaciones entre las variables según el eje de rehabilitación (ortopédico y neurológico).Resultados: De las 196 historias clínicas analizadas, 94% de los usuarios provenían de Cuiabá, con una edad promedio de 50,3 años, de los cuales 52,55% eran de sexo femenino. La demanda del servicio fue del 69% para la rehabilitación ortopédica (69%) y del 31% para la rehabilitación neurológica. Se observaron diferencias estadísticamente significativas entre las frecuencias en los dos ejes de rehabilitación física estudiados en las variables edad (p=0,0005), escolaridad (p=0,0031), actividad laboral principal (p=0,0045), enfermedades concomitantes (p=0,0016), tratamiento en otro establecimiento de salud (p=0,0041) y motivo de búsqueda de rehabilitación (p <0,0001). Conclusiones:Los resultados mostraron que los casos neurológicos tienen mayor edad, bajo nivel de educación y un pequeño porcentaje de trabajo remunerado en relación con los casos ortopédicos. Estos resultados sugieren que las necesidades de salud y rehabilitación dependen de la singularidad de los casos y pueden apoyar la implementación de políticas públicas que favorezcan la reorganización de los servicios y la articulación intersectorial entre salud, educación y mercado laboral (AU).

Increase in the Initial Outpatient Rehabilitation Utilization for Patients With Total Knee Arthroplasty.

OBJECTIVES: The objective of this study was to examine the patient characteristics and features associated with the initial rehabilitation utilization with a particular emphasis on outpatient rehabilitation after total knee arthroplasty (TKA) among 2016-2018 Texas Medicare enrollees. DESIGN: This is a retrospective cohort study. We used chi-square tests to examine the variability in patient demographic and clinical characteristics across the different post-acute rehabilitation settings after TKA. A Cochran-Armitage trend test was used to investigate the yearly trend of outpatient rehabilitation utilization after TKA. SETTING: Post-acute rehabilitation settings after TKA. PARTICIPANTS: The target population was Medicare beneficiaries aged ≥65 with an initial TKA in 2016-2018 and complete demographic and residential information (N=44,313). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: We identified whether patients first used (1) outpatient rehabilitation, (2) home health, (3) self-care, (4) inpatient rehabilitation, (5) skilled nursing, or (6) other setting within the 3 months after TKA. RESULTS: Our results demonstrated an increasing use of the initial outpatient rehabilitation and home health, while the use of skilled nursing and inpatient rehabilitation facilities decreased from 2016 to 2018. The increase in outpatient utilization was significant in 2018 compared with 2016 controlling for distance to the TKA facilities, comorbid conditions, sex, race/ethnicity groups (White, Black, Hispanic, and Others), lower income (Medicaid eligible), Medicare entitlement types, age groups, and rurality (OR 1.23, 95% CI 1.12-1.34). However, the overall utilization rate of the initial outpatient rehabilitation after TKA remained low, increasing from 7.36% in 2016 to 8.60% in 2018. CONCLUSION: Despite the growing use of the initial outpatient rehabilitation after TKA, the overall rate of outpatient rehabilitation utilization remained low. Our findings raise an important question as to whether certain patient demographics and clinical groups might have limited access to outpatient rehabilitation after TKA.

Reliability and Validity of the Inpatient Rehabilitation Facility Discharge Mobility and Self-Care Quality Measures.

OBJECTIVE: To describe the reliability and validity of the publicly reported facility-level quality measures Inpatient Rehabilitation Facility (IRF) Discharge Mobility Score for Medical Rehabilitation Patients ("Discharge mobility score") and IRF Discharge Self-Care Score for Medical Rehabilitation Patients ("Discharge self-care score"). DESIGN: Observational study using standardized patient assessment data to examine facility-level split-half reliability and construct validity of quality measure scores. SETTING AND PARTICIPANTS: All IRFs (n = 1117) in the United States with at least 20 Medicare stays. Facility-level quality measure scores were calculated from 2017 data on 428,192 Medicare (fee-for-service and Medicare Advantage) IRF patient stays. METHODS: Using clinician-reported assessment data, we calculated facility-level mobility and self-care quality measure scores and examined reliability of these scores using split-half analysis and Pearson product-moment correlations, Spearman rank correlations, and intraclass correlation coefficients (ICC2,1). We examined construct validity of these scores by comparing facility-level quality measure scores by facility stroke disease-specific certification status. RESULTS: Reported as percentages meeting or exceeding expectations, IRF quality measure scores ranged from 8.3% to 90.1% for mobility and 9.0% to 90.3% for self-care. IRF scores, when split in half to examine reliability, showed strong, positive correlations for the mobility (Pearson = 0.898, Spearman = 0.898, ICC = 0.898) and self-care (Pearson = 0.886, Spearman = 0.874, ICC = 0.886) scores. When stratified by provider volume, ICCs remained strong. Construct validity analyses showed IRFs with stroke disease-specific certification had higher mean and median scores than IRFs without certification, and a greater proportion of IRFs that were certified had higher scores. CONCLUSION AND IMPLICATIONS: Our results support the reliability and construct validity of the IRF quality measures Discharge mobility and Discharge self-care scores. Reported as percentages meeting or exceeding expectations, these quality measures are designed to be more consumer-friendly compared to change scores.

Comparison of Functional Outcomes After Acute Inpatient Rehabilitation After Acquired Brain Injury Before and During the COVID-19 Pandemic.

OBJECTIVE: The objective of this study was to characterize and compare functional outcomes of acquired brain injury patients in an inpatient rehabilitation facility in the year before (April 2019-March 2020) and during the first year (April 2020-March 2021) of the COVID-19 pandemic, when the most drastic changes in the delivery of health care occurred. DESIGN: In this retrospective single-center chart review study, functional outcomes, based on the Center for Medicare and Medicaid Services Inpatient Rehabilitation Facility-Patient Assessment Instrument, were obtained and analyzed for patients in acute inpatient rehabilitation with acquired brain injury. RESULTS: Data from 1330 patients were included for analysis. Functional outcomes of average self-care, bed mobility, and transfer scores were statistically, but not clinically, different between groups. More patients in the pandemic group were discharged home (prepandemic n = 454 [65.4%]; pandemic n = 461 [72.6%]; P = 0.011), although they had significantly longer lengths of stay (prepandemic median = 14.0 [interquartile range = 9.0-23.0]; pandemic = 16.0 [10.0-23.0]; P = 0.037). CONCLUSIONS: Despite the impact of hospital policies due to the COVID-19 pandemic, similar functional outcomes were obtained for those with acquired brain injury after inpatient rehabilitation.