Physical therapy journal of policy, administration, and leadership最新文献

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Advancing Innovation in Skilled Nursing Facilities through Academic Collaborations. 通过学术合作推进专业护理机构的创新。

Physical therapy journal of policy, administration, and leadership

Pub Date : 2018-08-01

Allison M Gustavson, Rebecca S Boxer, Amy Nordon-Craft, Robin L Marcus, Andrea Daddato, Jennifer E Stevens-Lapsley

There is growing recognition that acute hospitalization contributes to marked functional decline in older adult populations. Nearly 20% of all hospitalized older adults in the United States are discharged to skilled nursing facilities (SNFs) to address these functional deficits. However, current approaches to care in SNFs may not adequately restore function, which may contribute to low community discharge rates and high hospital readmission rates. Barriers to rehabilitation innovation in SNFs include management, staff, patient, and researcher-level factors. This clinical commentary builds upon clinical innovation strategies in other health care settings by describing barriers in the context of the SNF environment. Fostering collaboration between academic clinical researchers and SNFs may be the answer to advancing rehabilitation practices and care delivery, thereby improving outcomes in this vulnerable population.

越来越多的人认识到，急性住院治疗会导致老年人显著的功能下降。在美国，近20%的住院老年人出院到专业护理机构(snf)，以解决这些功能缺陷。然而，目前snf的护理方法可能无法充分恢复功能，这可能导致低社区出院率和高医院再入院率。snf康复创新的障碍包括管理、员工、患者和研究人员层面的因素。本临床评论通过描述SNF环境中的障碍，建立在其他卫生保健环境中的临床创新策略的基础上。促进学术临床研究人员和snf之间的合作可能是推进康复实践和护理交付的答案，从而改善这一弱势群体的结果。

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Association between Self-Reported Participation in Decision Making and Inpatient Rehabilitation Outcomes. 自我报告的决策参与与住院康复结果的关系。

Physical therapy journal of policy, administration, and leadership

Pub Date : 2015-09-01

Juli A Wylegala, James E Graham, Amol M Karmarkar, Caitlin Illig, Sandra Bennett Illig, Kenneth J Ottenbacher

Study design: Retrospective cross sectional.

Purpose: The purpose of this study was to assess the independent associations between perceived participation in clinical decision making on rehabilitation length of stay, discharge functional status, and discharge setting following inpatient rehabilitation.

Background: Active participation in the inpatient rehabilitation process, which is the most intense post-acute rehabilitation service, should lead to better patient experiences and outcomes.

Methods: Self-reported information from participant interviews was linked with data in administrative medical records for Medicare beneficiaries discharged from inpatient rehabilitation facilities in 2007-2009. The decision making variable assessed participants' perceived participation in decision making during their inpatient rehabilitation stays. The three outcome variables were inpatient rehabilitation length of stay, discharge functional status, and discharge setting.

Results: Among the 41,110 participants interviewed, approximately 89% strongly agreed or agreed, and 12% disagreed that they participated in decision making during their rehabilitation stays. The multivariable regression models showed that greater participation in decision making was associated (p < .05) with slightly longer lengths of stay, higher discharge functional status, and increased likelihood of community discharge.

Conclusions: Nearly nine in 10 Medicare beneficiaries report participating in decision making when receiving inpatient rehabilitation services. Increasing participation may lead to improvements in fundamental rehabilitation outcomes.

研究设计:回顾性横断面。目的:本研究的目的是评估在住院康复后感知参与临床决策与康复住院时间、出院功能状态和出院环境之间的独立关联。背景:积极参与住院康复过程，这是最激烈的急性后康复服务，应该导致更好的患者体验和结果。方法:将参与者访谈的自我报告信息与2007-2009年从住院康复机构出院的医疗保险受益人的行政医疗记录数据相关联。决策变量评估参与者在住院康复期间对决策的感知参与。三个结果变量为住院康复时间、出院功能状态和出院环境。结果:在接受采访的41110名参与者中，大约89%的人强烈同意或同意，12%的人不同意他们在康复期间参与决策。多变量回归模型显示，参与决策程度越高，住院时间越长(p < 0.05)，出院功能状态越好，社区出院可能性越高。结论:近十分之九的医疗保险受益人报告在接受住院康复服务时参与决策。增加参与可能导致基本康复结果的改善。

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