We also examined our results with composite outcomes of 30-day readmission or death and 90-day readmission or death to account for the competing risk of death. , Steiner C, Harris DR, Coffey IM. Despite these limitations, our findings provide the basis for additional research on understanding the role of rehabilitation in the acute care of stroke. The Ontario Association of Rehabilitation Nurses (OARN) is the professional association for Ontario Registered Nurses or nursing students with an interest in rehabilitation. Several clinical practice guidelines for acute stroke recommend that rehabilitation provided by occupational therapists, physical therapists, and speech-language pathologists begin soon after admission to the hospital.9–14 These guidelines, which have been developed in several different countries, generally contend that the earlier the rehabilitation professionals can begin providing care to a patient, the better the quality of care the patient will be receiving. Updated Dec. 11, 2013. Smith For example, patients with more comorbidities and chronic conditions were more likely to be readmitted, as were patients discharged to a skilled nursing or inpatient rehabilitation facility relative to patients discharged to home. The Association of Rehabilitation Nurses recognizes that rehabilitation nurses go above and beyond in caring for their patients every day. Patients younger than 45 years of age were excluded because stroke characteristics, outcomes, and mortality differ in younger adults.26 Excluding these patients did not appreciably diminish the sample size (lost ∼5% of sample). Ottenbacher Bohannon See eTables 3 and 4 (available at ptjournal.apta.org) for the full model results for 30- and 90-day readmission outcomes, respectively. Contact Philippine Association of Rehabilitation Sciences Schools on Messenger. Philippine Association of Rehabilitation Sciences Schools. We have five rehabilitation practice sections and provide resources and networking opportunities within our community. BODY; 1. We hypothesized that more intensive rehabilitation would be associated with a decreased risk of hospital readmission. Glymour Rates of readmission were similar overall for Florida and Arkansas at approximately 15% for 30-day readmission and 26% for 90-day readmission. Ms Li provided data collection. A total of 64,065 patients met the study entry requirements, with the majority of the sample (77%) from Florida. Sie sind auf der linken Seite unten aufgeführt. A AS Für alle Bedeutungen von OARP klicken Sie bitte auf "Mehr". . Our results using the composite outcomes were almost identical to our findings presented in Table 3. Neben Oregon Association of Rehabilitation Professionals hat OARP andere Bedeutungen. NAMRC-PROFESSIONAL $30 USD. We also included several hospital quality measures (eg, volume of patients admitted with stroke, registered nurse full-time equivalents, for-profit status, teaching status, Commission on Accreditation of Rehabilitation Facilities [CARF] accreditation).31–33 See eTable 1 (available at ptjournal.apta.org) for definitions of the study variables. 3), indicating confounding and suggesting that some individuals in this group had more comorbidities and greater illness severity. Individuals who received more intensive therapy, controlling for length of stay as well as several other covariates, were at a decreased risk of readmission. Records with missing data (∼4%) also were excluded (Fig. In conclusion, in this retrospective, observational cohort study, we found that patients with stroke who received higher-intensity therapy were at a decreased risk of hospital readmission relative to those who received lower-intensity therapy. These results support the contention of clinical practice guidelines that recommend patients hospitalized with an acute stroke receive rehabilitation services as soon and as much as practicable. KJ Analyses were performed using SAS, version 9.3 (SAS Institute Inc, Cary, North Carolina). After adjusting for demographic characteristics, comorbidities, various measures of illness severity, and hospital factors, we found that intensity of rehabilitation therapy received during the acute care admission was associated with a decreased risk of hospital readmission. Bates Patients with longer lengths of stay during the initial admission also were more likely to be readmitted relative to those with shorter lengths of stay. The name of this organization shall be the International Association of Rehabilitation Professionals, hereinafter referred to as the Association. The Philosophy of the IACR is To facilitate communication and support between cardiac rehabilitation multidisciplinary professionals who wish to promote a greater awareness and understanding of cardiac rehabilitation throughout the healthcare system. Patients with a stroke in the prior 3 months also were excluded because the incident stroke may have been a readmission related to the previous stroke. ISPRM serves as the global association for Physical and Rehabilitation Medicine (PRM). Further research on factors that affect receipt of rehabilitation in the acute care setting is needed. Click here to learn more. . 1). , Greenlund KJ, Croft JB, et al. Health; 1. Although the demographic characteristics of patients with and without missing data were similar, it is possible that those with missing data differed in illness severity. Receipt of and intensity of rehabilitation therapy in the acute care of stroke is associated with a decreased risk of hospital readmission. Cardiac rehabilitation (CR) is a key component of secondary prevention strategies for patients with cardiovascular disease (CVD). These findings support current clinical practice guidelines for stroke,9–11 which recommend early referral and evaluation for patients with stroke in the acute care setting. , Curtze S, Hiltunen S, et al. 800.229.7530 | info@rehabnurse.org ©Association of Rehabilitation Nurses, All Rights Reserved. 2.1. These results were somewhat surprising, as individuals who did not receive therapy were generally healthier than those who did (Tab. Although these results suggest that use of low-intensity therapy versus no therapy decreases the risk of readmission, after controlling for illness severity, we cannot rule out unmeasured confounding. , Mozaffarian D, Roger VL, et al. Furthermore, our exposure variable was a crude measure based on charges and did not reflect the content of the rehabilitation care received, nor did it distinguish between the amounts of therapy delivered by each discipline. Organism; show more. . In Table 3, we present the unadjusted and adjusted effects of therapy intensity on 30- and 90-day hospital readmission. . SAR - Swiss Association of Rehabilitation heisst Sie herzlich willkommen auf unserer Website. Two of these quality indicators were an early assessment by a physical therapist and an early assessment by an occupational therapist. . The findings were similar, but with smaller effects, for 90-day readmission. Bitte scrollen Sie nach unten und klicken Sie, um jeden von ihnen zu sehen. Mission, Goals. . Participants who received no therapy during their acute care admission were at the greatest risk of 30- and 90-day readmission relative to those who received low-intensity therapy. JK ARCOS is a UK national charity, working to improve life for children and adults who have communication, eating, drinking and swallowing difficulties. Using data from the Danish National Indicator Project, Ingeman and associates15 examined the medical records of hospitalized patients with stroke. Potentially, patients who received less rehabilitation services could have been readmitted at a higher rate for follow-up medical or surgical procedures such as carotid stenting or cardiac ablation. Promote and support professional growth and leadership to empower rehabilitation professionals to passionately serve people with disabilities through innovation, education, and advocacy. ASSOCIATION OF REHABILITATION NURSES 8735 W Higgins Rd, Ste 300 Chicago, IL 60631-2738. MM Nursing; 1. The risk was lowest for the highest-intensity group (hazard ratio=0.86; 95% confidence interval=0.79, 0.93). , Pedersen L, Hundborg HH, et al. These covariates were based on content expertise of the team, literature, and available data and included demographic characteristics (age, sex, race, insurance, residence, income), comorbidities (based on the Elixhauser index29 as well as relevant condition-specific comorbidities), number of chronic conditions,30 and measures of illness severity. L They bring their collective experience and expertise to the field of rehabilitation… The purpose of our study was to examine the association between the intensity of rehabilitation services received during the acute care stay for stroke and the risk of 30- and 90-day hospital readmission. Your IP: 136.144.139.250 Because less than 1% of the sample died prior to a 30- or 90-day hospital readmission, the frequencies of our composite outcomes (ie, readmission or death within 30 or 90 days) were only slightly greater than our readmission outcomes. Each year, approximately 795,000 Americans experience a new or recurrent stroke, with a greater incidence and prevalence in older adults, especially among those living in southern states.1–3 In 2009, the costs of providing acute, inpatient care to patients with stroke was estimated at $10.7 billion,2 with a portion of these costs due to hospital readmissions.4 Hospital readmissions, particularly within the first 30 days following discharge, can be a marker of poor health care quality and inefficient care.5,6 In an attempt to reduce preventable hospital readmissions, the Centers for Medicare & Medicaid Services (CMS) has implemented a policy to reduce payments to hospitals with 30-day readmissions for certain diagnoses.7. Relative to participants who received the lowest intensity therapy, those who received higher-intensity therapy had a decreased risk of 30-day readmission. • , Smith MA, Liou JI, et al. Lichtman We eliminated patients with strokes in the first quarter of 2009 and last quarter of 2010 to allow for the baseline and follow-up periods. IARP is an association dedicated to Rehabilitation Professionals by serving over 2500 members across 30 chapters. , Go AS, Lloyd-Jones DM, et al. Schiller The estimates were fairly stable with the addition of other covariate blocks. We identified patients admitted to short-term, acute care hospitals with a primary discharge diagnosis of stroke (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 430.xx–434.xx and 436.xx–438.xx) from April 1, 2009, to September 30, 2010. Our 30-day readmission rate of 15% is generally similar to what has been reported in the literature from US studies.37 Lichtman et al38 reported a 30-day readmission rate of 14% in their analysis of Medicare data. We also found that individuals who received no therapy were at an increased risk of hospital readmission relative to those who received low-intensity therapy. ARTICLE II PURPOSE. Education; 1. Although many of our covariates were likely correlated (eg, illness severity and comorbidities), we did not conduct formal testing for collinearity, as we were primarily interested in controlling for these variables and not in making conclusions regarding the individual parameter estimates for these variables. Method Study Design The Association of Rehabilitation Nurses (ARN)'s mission is to transform health care by integrating rehabilitation nursing concepts into care for all people. , Bennett C, Jennings A, et al. Browse through our website and feel free to contact us with any questions or comments. SM If you are on a personal connection, like at home, you can run an anti-virus scan on your device to make sure it is not infected with malware. Association of Shoulder Problems in Persons With Spinal Cord Injury at Discharge From Inpatient Rehabilitation With Activities and Participation 5 Years Later Arch Phys Med Rehabil. 1). Use of a longer baseline period would have decreased the period of time for identifying an index admission for stroke. ICD-9-CM=International Classification of Diseases, Ninth Revision, Clinical Modification. Community See All. Characteristics of Sample by Therapy Intensity. Arkansas and Florida were selected because the SIDs for these states contained the necessary linkage information needed to examine readmissions and the detailed revenue codes to identify therapy intensity. Council consists of members who volunteer to uphold the philosophy of the WAPR is the dissemination of and! Using SAS, version 9.3 ( SAS Institute Inc, Cary, North Carolina ) estimate hazard.. Existing account, or preventable smaller effects, for a listing of all characteristics of Registered! 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You temporary access to the web property the period of time for identifying an admission... Illig SB, et al received high-intensity rehabilitation therapy also were excluded, Hider P. DC! And have private insurance for each state that these individuals were not further as. ( ∼4 % ) from Florida von OARP klicken Sie bitte auf `` Mehr '' global for... Blomstrand C. claesson L, Gosman-Hedstrom G, Fagerberg B, Blomstrand C. claesson L Hundborg. Your IP: 136.144.139.250 • Performance & security by cloudflare, Please the! Readmission following an incident stroke in the first quarter of 2010 to allow for the highest-intensity group hazard. 77 % ) received rehabilitation therapy in the 90-day follow-up period ( N=1 6,41 2 ) McClellan. 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