The sickness impact profile: development and final revision of a health status measure. Time Frame Four subjects were recruited and interviewed during this phase. Chest 1995;107(2): 494-9. Post-acute care is the phase of recovery after someone has received treatment for a serious medical condition. Examples of outcome indicators include improvement in global function, decline in pain, and recovery of ambulation/mobility. This national study of stroke patients is intended to address several questions about Medicare beneficiaries who are discharged from hospitals to post-acute care, including: What are the demographic and health-related characteristics of patients admitted to post-acute care, including persons who use multiple post-acute providers (e.g., SNF followed by HHA, or IRF followed by HHA)? What are the similarities and differences between patients admitted to the three settings or multiple settings? This chapter reviews the need to understand post-acute care outcomes in view of the historical trends in post-acute care payment and use, recent changes in post-acute care payment policies and the impact of those changes on quality and access, issues regarding the potential overlap in post-acute care patients and services and the need to understand quality of care across settings if such overlap exists. From the perspective of quality measurement, it is not always clear to what degree use of prescription medications is associated with quality. The instruments designed for satisfaction assessment in nursing homes place more emphasis on living arrangements and autonomy pertinent to a long-term care population rather than time-limited rehabilitation pertinent to post-acute patients. However, the percent of patients receiving IV care (a type of skilled care) is listed separately for all provider types. Finch M, Kane R, Philp I. How could potential subjects be identified in the absence of information derived from the MDS/MDS-PAC/OASIS? Although some may argue that more disease-specific measures should be incorporated, the ratings of the expert panel members indicated that more emphasis should be placed on global measures that are relevant to all patients served in post-acute care settings. In some cases, post-acute care is temporary and continues only until the patient has recovered enough to be discharged. Days of limited activity is a very common, well-regarded quality indicator for PAC. Measuring functioning and well-being: the Medical Outcomes Study approach. Based on the 5-percent file, we identified a total of 157,280 episodes involving the 32 DRGs. Spine 1997;22(10):1123-31. 8 - did not occur, Bladder Continence (#10 Bladder Continence), 0 - continent Journal of Clinical Epidemiology 1998; 51(10):827-835. September 2000 meeting transcript. The types of measures that we included in each domain are listed in Table 2b. The panel members were asked to review the indicators and individually rate them with respect to the importance of each for assessing quality of care for the specified condition. For all eight conditions, it is apparent that the predominant services provided in PAC facilities are therapies, particularly physical and occupational therapy. The relationship between patient satisfaction and quality of care continues to become more accepted and established among leading methodologists.72;73;74 The literature on patient satisfaction has been historically dominated by the inpatient hospital setting, followed by the outpatient setting as a distant second site of care. This section discusses the rationale behind our selection. Finally, the panelists recommended including, if applicable, the date of death. If we assume that the distinction between the two types of patients is definable, then we can use the item as a quality measure. The MMSE is more commonly used as a risk adjuster in qualitative research than the SPMSQ and allows finer delineation between different levels of cognitive dysfunction. Subjects ability to recall the care received 90 days prior may be suspect. Trends in post-acute care from the 1st half of 2023 Medicare expenditures for post-acute care have consumed an increasing share of total Medicare payments. The relationship between hospital readmissions of Medicare beneficiaries with chronic illness and home care nursing interventions. Journal of the American Geriatrics Society 1995; 43(8):877-884. Exercise training frequency in early post-infarction cardiac rehabilitation. Hart RG, Benavente O. Stroke: part I. For the 20 DRGs, we derived summary statistics to examine variations in the patterns of Medicare service utilization, such as hospital readmissions and lengths of stay. Secondly, the first-person nature of the questions was awkward to use in an interview format. Instruction in compensatory breathing techniques. The use of different types of post-acute care providers during an episode was highest among patients with stroke (DRG 214), hip fracture procedures (DRG 209, DRG 210), or back and neck procedures (DRG 214, DRG 215). This orientation also complements, rather than duplicates, our current plans to employ clinically-related criteria to narrow the eight conditions to the four conditions that will be the focus of the eventual outcomes study. Such fragmentation may perpetuate inappropriate financial incentives for the admission, transfer, and discharge of patients in post-acute care. Driving Evaluation Smyer M, Hofland B, Jonas E. Validity study of the short portable mental status questionnaire for the elderly. JAMA 1995; 273(1):59-65. 103(1):42-5. Home health care use is usually seen as a resource outcome, and not a quality measure. Spine 1996;21(5):1777-86. In addition, Commission members questioned the comparability of services across post-acute care settings. Because many hip fractures are treated with a joint replacement (or arthroplasty), we will not define the hip fracture group exclusively by DRG assignment. The purpose of this study will be to compare quality of care across settings. Education: support group, medications, diet, relaxation, stress management, breathing retraining. Health Services Research 1993; 28(3):269-292. Understanding the quality of post-acute care is more important and has become more challenging than ever before. The primary goal of post-acute is to prevent another . discharge from the post-acute care provider?). Role Resumption Provided by the Springer Nature SharedIt content-sharing initiative, Encyclopedia of Gerontology and Population Aging, https://doi.org/10.1007/978-3-030-22009-9_850, https://doi.org/10.1007/978-3-319-71812-5_30, https://doi.org/10.1097/MLR0000000000000359, Reference Module Humanities and Social Sciences. Source Liu et al., (1998). Quality of life as measured by Chronic Respiratory Questionnaire(dyspnea, fatigue, emotion, mastery). Steiner, A. Stroke is also similar, but differs slightly by the high proportion of stroke patients who receive speech therapy as well. Suggested stratifying patients into categories based on a summary measure of severity of risk factors. While these indicators have intuitive appeal, few have been operationalized from the standpoint of quality measurement. For example, chronic care of a stroke victim then involves continued management of the underlying diseases related to stroke, such as hypertension, and long-term management of residual impairment and disability.22. Swinburne A, Fedullo AJ, Bixby K, Lee DK, Wahl GW. First, the reliability and validity of the instruments require further testing. Health Care Financing Review 1999; 20(4):103-126. care ctr. In defining an episode of post-acute care, (the interval between admission and follow-up assessments), the panels objective was to recommend an episode that would allow enough time for most disease-specific outcomes to have occurred, while not encountering any new post-acute care episodes. Visit to physiotherapist 2x/wk. 1 - supervision oversight help only QRB: Quality Review Bulletin 1989; 15(6):185-191. Change in admit to discharge, and discharge to 9mo followup: "Long-term follow-up" - no time specified: 1.5-5 yr. follow-up (at 3 mo. It is most commonly measured with the following item, "During how many of the past 30 days was your activity limited due to your illness?" Comparing activities of daily living assessment instruments: FIM, MDS, OASIS, MDS-PAC. For patients for whom home health care is appropriate, then receiving home health is an indicator of quality. Throughout this report, we frequently make reference to the terms quality indicator and quality measure; we often reference these constructs as they relate to outcomes or processes of care. Respiratory techniques, PT, exercise conditioning, psychosocial rehab, OT, pt/family education. PDF Fact Sheet: Post-acute Care The final criterion refers to the practical aspects of selecting particular conditions for analysis. Journal of Rehabilitation Outcomes Measurement 1997; 1(4):52-65. Long-Term and Post-Acute Care | HealthIT.gov Using Medicare claims data, the eight conditions were ranked based on the percentage of patients with that condition receiving each of the following five services: physical therapy, occupational therapy, speech therapy, respiratory therapy and the use of intravenous medications. The project will focus on four clinical conditions that are found in the post-acute care population. Thus, we are also recommending these for further study. Approximately 25% of Medicare beneficiaries discharged from a hospital receive post-hospital services in HHAs, SNFs, and/or rehabilitation hospitals/units.2 Approximately 17% of those beneficiaries admitted to a post-acute care setting receive post-acute care from more than one post-acute provider. A second wave of feasibility testing was then conducted, and final revisions were made to the instruments. The time to complete the telephone follow-up interview averaged 14 minutes, and the response rate was approximately 63%. Regardless, hospital readmission probably reflects higher patient costs. Davies graduated cum laude from the University of Pittsburgh with a Bachelor of Arts in art history. 2 - occasionally incontinent Trends in elderly hospitalization and readmission rates for a geographically defined population: pre- and post-prospective payment. Denver, CO, Center on Aging, University of Colorado Health Sciences Center. Second, existing data systems do not use the individual patient as the respondent, but are based exclusively on provider reports. He recommended assessing quality through multiple outcome measures. The index of ADL: a standardized measure of biological and psychosocial function. Doris Y. P. Leung . The CMS Data Element Library, an online resource, developed in collaboration with ONC, allows users to search and obtain reports on CMS post-acute care assessment contents, including mapping to nationally recognized health IT standards. In addition, skilled nursing is not discernable for patients in RHs and SNFs, all of whom presumably receive skilled nursing care. 1996. He also suggested controlling for the number of levels on the spine operated on, comorbidity, wound infections, DVT, new neurologic deficits, other organ complications, perioperative myocardial infarction, and new bowel or bladder dysfunction. How such fragmentation will affect the quality and outcomes of post-acute care is difficult to anticipate. The evaluation of the conditions involved applying the above criteria, synthesizing the information, and considering different combinations of conditions. Toll free: 800-876-2632 Report prepared for Office of Research and Demonstrations, Health Care Financing Administration. For example, social function might include such activities as participating in a weekly card game, but this activity would not be considered a "role." Kramer AM, Steiner JF, Schlenker RE, Eilertsen TB, Hrincevich CA, Tropea DA, Ahmad LA, Eckoff DG. This indicator was rated fairly highly as many of the panel members recognized its central role. 8 - activity did not occur, 0 - independent J Neurosurg 1991;74:236-42. Given the decision rules that we employed, there are 17 DRGs that are high volume conditions and 3 DRGs (i.e., DRG 214, DRG 215, DRG 483) that are exceptionally interesting for this study. Payment rates were to be limited to amounts that would have been paid in fiscal year 2000 -- reduced by 15% -- had the PPS not been implemented. Physical Function All conditions were either acute or chronic, with the exception of ventilator, which can be an acute and/or chronic condition. Palliative Care focuses on managing chronic conditions of a patient with the goal of providing comfort and the highest quality of life possible. Chest 1994;195(4):1046-52. There was interest in learning more about this instrument as it contains a number of the domains listed above. Administration time is approximately 30 minutes. 12 week stress management program. Covinsky K, Rosenthal G, Chren M, Justice A, Fortinsky R, Plamer R et al. The conditions targeted in this project were stroke, congestive heart failure (CHF), pneumonia, and back and neck conditions. He noted the disconnect between severity or frequency ratings of pain and how bothered people really are by pain. And finally, although these instruments contain both global and disease-specific components for the four conditions, they are weighted more heavily toward global measures of quality. However, HCFA has since announced that implementation will be delayed and a new date has yet to be established. Further, the differences in patient assessment instruments and processes make it difficult to identify whether similar patients are, in fact, treated across different settings, and if so, what are their relative outcomes of care. Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home. One especially significant outcome of the specialist calls was the decision to narrow the back and neck condition down to the more specific condition of lumbar spinal stenosis. 2 - supervision Initially, the section on physical functioning included measurement of perceived physical function at the time of the interview, in addition to the existing questions about function one month prior to the hospitalization. In current research using 1995 Medicare claims data, we have already constructed episodes of hospital and post-acute care use. Cleary P, McNeil B. These included: (1) hip fracture/replacement, (2) stroke, (3) pneumonia, (4) congestive heart failure, (5) acute myocardial infarction, (6) chronic obstructive pulmonary disease, (7) back and neck procedures, and (8) ventilator-dependent patients. All expert panel members were asked to comment on the relevance and feasibility of the measures, response burden, sampling issues, definitions of an episode of care, and redundancy with other reporting requirements. There may be some difficulty determining exactly when the pneumonia began. 1999. Given these three needs, the MMSE was retained despite the time necessary for completion. Patient education (Process): Documentation of patient education is unlikely to be reliably documented in medical records. The ASHA Functional Communication Measure is new and validity and reliability studies have been conducted. Post-acute care involves helping a patient perform daily routine tasks such as eating, bathing and dressing as well as administering medications and monitoring vital signs. The project will focus on four clinical conditions for which PAC is frequently provided. Mortality Home inotropic therapy in advanced heart failure. 4 - frequently incontinent Springer, Cham. JAMA 1996;274:134-141. However, this may be a difficult indicator to measure because change in social function may or may not be the result of the care that is provided. Second, the instruments rely heavily upon patient-reported information. Journals of Gerontology 1991; 46(6):S345-S357. Days in Bed Journal of Psychiatric Research 1983; 17:37-49. In addition, substantial variation in the utilization of post-acute care across geographic regions creates additional challenges in understanding the relative outcomes associated with different post-acute care options.28;29;30 Our lack of understanding about the relative effectiveness of post-acute care use creates questions regarding the appropriateness of current payment and coverage policies.29;30 Complicating our ability to evaluate the quality of post-acute care, and determine relationships between post-acute care settings and outcomes, is the fact that a large proportion (17% as of 1996) of Medicare beneficiaries receive post-acute care in more than one setting. Meehan TP, Fine MJ, Krumholz HM, Scinto JD, Galushi DH, Mockalis JT, Weber GF, Petullo MK, Hauch PM, Fine JM. Post-acute care: Delivering more value and better patient outcomes. A clinical update on prevention. McLean RF, McIntosh JD, Kung GY, Leung DMW, Byrick RJ. Finally, patient assessment data is collected only as long as a patient is treated in any particular post-acute care setting. Back and Neck Conference Call -- Richard Deyo, M.D. Archives of Physical Medicine and Rehabilitation 1988; 69:583-590. Heinemann A, Bode R, Cichowski K, Kan E. Measuring patient satisfaction with medical rehabilitation. Fine M, Hanusa B, Lave J, Singer D, Stone R, Weissfeld L et al. Post-stroke rehabilitation: clinical practice guideline no. Do you anticipate that these measures will be responsive for detecting clinically important change? The list of panelists is included in Appendix B. This is a disorder which can significantly affect (exaggerate) health care resource utilization. Dennis LI, Blue CL, Stahl SM, Benge ME, Shaw CJ. These classifications were carried over directly from Table 3 to Table 4. Finally, the Appendices include several background and supporting documents, as referenced throughout this report. The effect of comprehensive outpatient pulmonary rehabilitation on dyspnea. What are the health, functional, quality of life, and other outcomes for beneficiaries treated in HHAs, SNFs, IRFs, or in multiple post-acute settings? The key symptoms are cough, SOB, fatigue, and possibly sputum production. Oldridge N, Guyatt G, Jones N, Crowe J, Singer J, Feeney D, McKelvie R, Runions J, Steiner D, Torrance G. Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction. It often involves the use of life support or other intensive care services. ) In that phase, ASPE is funding a study to examine post-acute care outcomes for stroke patients, which will use the patient assessment instrument developed for stroke under the current project. In contrast, the Oswestry Low Back Pain Disability Questionnaire only examines the latter.71. 110. Whether or not there was or continues to be similarities in patients and services across post-acute settings requires further study.
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