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Topics
- Access to Care (2)
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- Racial and Ethnic Minorities (1)
- (-) Rehabilitation (15)
- Respiratory Conditions (1)
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- Sex Factors (1)
- Stroke (2)
- Surgery (2)
- Trauma (2)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedEvans E, Krebill C, Gutman R
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
This retrospective cohort study’s goal was to describe the proportion of older adults with traumatic brain injury (TBI) who exhibited minimal detectable change (MDC) and a minimally clinically important difference (MCID) in motor function from inpatient rehabilitation facility (IRF) admission to discharge; and to identify characteristics associated with clinically meaningful improvement in motor function and better discharge functional status. This study used Medicare administrative data probabilistically linked to the National Trauma Data Bank. The authors found that from IRF admission to discharge 84% of patients achieved the MDC threshold, and 68% of patients achieved the MCID threshold for FIM-M scores. A higher probability of achieving the MCID for IM-M scores included better admission motor and cognitive function, lower comorbidity burden, and a length of stay longer than 10 days but only among individuals with lower admission motor function. Older age was associated with a lower FIM-M discharge score but was not associated with the probability of achieving the MCID in FIM-M score.
AHRQ-funded; HS000011.
Citation: Evans E, Krebill C, Gutman R .
Functional motor improvement during inpatient rehabilitation among older adults with traumatic brain injury.
PM R 2022 Apr; 14(4):417-27. doi: 10.1002/pmrj.12644..
Keywords: Elderly, Rehabilitation, Brain Injury, Inpatient Care
Anderson MC, Evans E, Zonfrillo MR
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
This study compared differences in outcomes for older adults with traumatic brain injury (TBI) in rural and urban settings by 1) comparing the rates of successful community discharge; and 2) reasons for not achieving successful discharge. This retrospective national cohort study looked at skilled nursing facility (SNF) patients aged 66 and older using Medicare inpatient claims with Minimum Data Set assessments. A total of 11,771 SNFs were identified with a total population of 61,021 Medicare beneficiaries discharged to a SNF following hospitalization for TBI between 2011 and 2015. Patients in rural settings had lower rates of successful discharge compared with patients in urban settings (52.1% vs 58.5%). Reasons for unsuccessful discharge differed between rural and urban settings with rural patients less likely to discharged from SNF within 100 days although they were less likely to be rehospitalized within 30 days of SNF discharge.
AHRQ-funded; HS000011.
Citation: Anderson MC, Evans E, Zonfrillo MR .
Rural/urban differences in discharge from rehabilitation in older adults with traumatic brain injury.
J Am Geriatr Soc 2021 Jun;69(6):1601-08. doi: 10.1111/jgs.17065..
Keywords: Elderly, Brain Injury, Trauma, Rural Health, Urban Health, Rehabilitation, Nursing Homes
Reistetter TA, Eschbach K K, Prochaska J
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
This study’s goal was to demonstrate a method for developing rehabilitation service areas for post-acute care. A secondary analysis of 2013-2014 Medicare records for older patients in Texas (n = 469,172) was conducted. The analysis included admission records for inpatient rehabilitation facilities, skilled nursing facilities, and long-term care hospitals. The authors used Ward’s algorithm to cluster patient ZIP code tabulation areas based on which facilities patients were admitted to for rehabilitation. They set the number of rehabilitation clusters to 22 to allow for comparison to the 22 hospital referral regions. Interclass Correlation Coefficient (ICC) and variance in the number of rehabilitation beds across areas were the methods used to evaluate rehabilitation service areas. The service areas had a higher ICC and variance in beds than the hospital referral regions.
AHRQ-funded; HS024711.
Citation: Reistetter TA, Eschbach K K, Prochaska J .
Understanding variation in postacute care: developing rehabilitation service areas through geographic mapping.
Am J Phys Med Rehabil 2021 May;100(5):465-72. doi: 10.1097/phm.0000000000001577..
Keywords: Elderly, Rehabilitation, Medicare, Nursing Homes, Long-Term Care, Home Healthcare, Access to Care
Bush M, Kucharska-Newton A, Simpson RJ
Effect of initiating cardiac rehabilitation after myocardial infarction on subsequent hospitalization in older adults.
Outpatient cardiac rehabilitation (CR) participation after myocardial infarction (MI) reduces all-cause mortality; however, less is known about effects of CR on post-MI hospitalization. The objective of this study was to investigate effects of CR on hospitalization following acute MI among older adults. The investigators concluded that this study provided evidence that CR could reduce the 1-yr risk of cardiovascular and all-cause hospital admissions in Medicare aged MI survivors.
AHRQ-funded; HS000032.
Citation: Bush M, Kucharska-Newton A, Simpson RJ .
Effect of initiating cardiac rehabilitation after myocardial infarction on subsequent hospitalization in older adults.
J Cardiopulm Rehabil Prev 2020 Mar;40(2):87-93. doi: 10.1097/hcr.0000000000000452..
Keywords: Elderly, Rehabilitation, Heart Disease and Health, Cardiovascular Conditions, Hospitalization
Dean JM, Hreha K, Hong I
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
This study examined post-stroke acute care patterns across Hospital Service Areas among a national stroke cohort of Medicare beneficiaries to determine drivers of variation in post-acute care service utilization. Data was extracted from 2013 to 2014 (174,498 total records across 3232 Hospital Service Areas). Patients’ residence ZIP codes were linked to the facility ZIP code where care was received. Patients were considered a “traveler” if they did not live in the Hospital Service Area where they received care. Only 23.5% of all patients received care in skilled nursing-only Hospital Service Areas although 73.4% of all Hospital Service Areas were skilled nursing-only. Thirty-five percent of all patients traveled to a different Hospital Service Area from their residence. Patients living in skilled nursing-only Hospital Service Areas had more than 5 times the odds of traveling compared to those living in Hospital Service Areas with skilled nursing, inpatient rehabilitation, and long-term care hospital services.
AHRQ-funded; HS026133; HS024711.
Citation: Dean JM, Hreha K, Hong I .
Post-acute care use patterns among hospital service areas by older adults in the United States: a cross-sectional study.
BMC Health Serv Res 2021 Feb 25;21(1):176. doi: 10.1186/s12913-021-06159-z..
Keywords: Elderly, Hospitals, Access to Care, Stroke, Cardiovascular Conditions, Healthcare Utilization, Rehabilitation, Nursing Homes
Hay CC, Graham JE, Pappadis MR
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
The goal of this retrospective observational study was to investigate sex differences and the impact of social living situation on individual functional independence measure outcomes after stroke rehabilitation. Subjects were Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities after a stroke. Results showed that when sociodemographic and clinical factors were controlled, females were more likely to discharge from inpatient rehabilitation at a supervision level or better for most functional independence measure items. Individuals who lived alone before their stroke had higher odds of discharging at a supervision level or better.
AHRQ-funded; HS022134.
Citation: Hay CC, Graham JE, Pappadis MR .
The impact of one's sex and social living situation on rehabilitation outcomes after a stroke.
Am J Phys Med Rehabil 2020 Jan;99(1):48-55. doi: 10.1097/phm.0000000000001276..
Keywords: Stroke, Rehabilitation, Elderly, Patient-Centered Outcomes Research, Sex Factors, Cardiovascular Conditions, Outcomes
Patel DK, Duncan MS, Shah AS
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
Investigators sought to characterize cardiac rehabilitation (CR) enrollment after cardiac valve surgery and its association with outcomes, including hospitalizations and mortality. Subjects were all fee-for-service Medicare beneficiaries undergoing open cardiac valve surgery in 2014, identified by inpatient diagnosis codes for open aortic, mitral, tricuspid, and pulmonary valve surgery. They found that fewer than half of Medicare beneficiaries undergoing cardiac valve surgery enrolled in CR programs, and there were marked racial/ethnic disparities among those who do. They recommend further study on barriers to CR enrollment in this population.
AHRQ-funded; HS022990.
Citation: Patel DK, Duncan MS, Shah AS .
Association of cardiac rehabilitation with decreased hospitalization and mortality risk after cardiac valve surgery.
JAMA Cardiol 2019 Dec;4(12):11887-1301. doi: 10.1001/jamacardio.2019.4032..
Keywords: Cardiovascular Conditions, Heart Disease and Health, Rehabilitation, Hospitalization, Surgery, Mortality, Risk, Elderly
Vadlamani A, Perry JA, McCunn M
Racial differences in discharge location after a traumatic brain injury among older adults.
The purpose of this retrospective cohort study was to determine if there were racial differences in discharge location among older adults treated for traumatic brain injury (TBI) at a level 1 trauma center. The authors concluded that in this group of Medicare-eligible older adults, blacks were more likely to be discharged to inpatient rehabilitation compared to whites.
AHRQ-funded; HS024560.
Citation: Vadlamani A, Perry JA, McCunn M .
Racial differences in discharge location after a traumatic brain injury among older adults.
Arch Phys Med Rehabil 2019 Sep;100(9):1622-28. doi: 10.1016/j.apmr.2019.03.008.
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Keywords: Racial and Ethnic Minorities, Brain Injury, Trauma, Elderly, Hospital Discharge, Rehabilitation, Medicare
Cary MP, Prvu Bettger J, Jarvis JM
Successful community discharge following postacute rehabilitation for Medicare beneficiaries: analysis of a patient-centered quality measure.
The purpose of this study was to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge. The investigators retrospectively examined 167,664 Medicare beneficiaries discharged from inpatient rehabilitation facilities (IRFs) in 2013 to determine the sociodemographic and clinical characteristics as well as health services use associated with successful community discharge.
AHRQ-funded; HS022134.
Citation: Cary MP, Prvu Bettger J, Jarvis JM .
Successful community discharge following postacute rehabilitation for Medicare beneficiaries: analysis of a patient-centered quality measure.
Health Serv Res 2018 Aug;53(4):2470-82. doi: 10.1111/1475-6773.12796..
Keywords: Elderly, Medicare, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Rehabilitation, Quality Indicators (QIs), Quality Measures
Welsh RL, Graham JE, Karmarkar AM
Effects of postacute settings on readmission rates and reasons for readmission following total knee arthroplasty.
This study examined the effects of postacute discharge setting on unplanned hospital readmissions following total knee arthroplasty (TKA) in older adults. Inpatient rehabilitation facility (IRF), skilled nursing facility (SNF) concluded that patients discharged to either inpatient rehabilitation facility (IRF) or skilled nursing facility (SNF), in comparison with those discharged to the community, had greater likelihood of readmission within 30 and 90 days.
AHRQ-funded; HS022907.
Citation: Welsh RL, Graham JE, Karmarkar AM .
Effects of postacute settings on readmission rates and reasons for readmission following total knee arthroplasty.
J Am Med Dir Assoc 2017 Apr;18(4):367.e1-67.e10. doi: 10.1016/j.jamda.2016.12.068.
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Keywords: Elderly, Nursing Homes, Hospital Readmissions, Rehabilitation, Surgery
Nishi SP, Zhang W, Kuo YF
Pulmonary rehabilitation utilization in older adults with chronic obstructive pulmonary disease, 2003 to 2012.
The authors assessed the trends in pulmonary rehabilitation (PR) utilization and factors associated with its use in older adults with chronic obstructive pulmonary disease (COPD). They concluded that utilization of PR during the study period increased only 1.1% in these Medicare beneficiaries with COPD and remained low.
AHRQ-funded; HS020642; HS022134.
Citation: Nishi SP, Zhang W, Kuo YF .
Pulmonary rehabilitation utilization in older adults with chronic obstructive pulmonary disease, 2003 to 2012.
J Cardiopulm Rehabil Prev 2016 Sep-Oct;36(5):375-82. doi: 10.1097/hcr.0000000000000194.
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Keywords: Respiratory Conditions, Elderly, Patient-Centered Outcomes Research, Rehabilitation
Kelly JP, Hammill BG, Doll JA
The potential impact of expanding cardiac rehabilitation in heart failure.
The authors sought to characterize the patient population newly eligible for cardiac rehabilitation (CR) based on the 2014 CMS expanded coverage criteria. Their findings suggested that expansion of coverage for the newly eligible group is an important systems process to undertake to rapidly increase the participating eligible patients and that extension of CR coverage to the ineligible group should be considered.
AHRQ-funded; HS021092.
Citation: Kelly JP, Hammill BG, Doll JA .
The potential impact of expanding cardiac rehabilitation in heart failure.
J Am Coll Cardiol 2016 Aug 30;68(9):977-8. doi: 10.1016/j.jacc.2016.05.081.
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Keywords: Cardiovascular Conditions, Elderly, Healthcare Utilization, Heart Disease and Health, Rehabilitation
McDonough CM, Ni P, Coster WJ
Development of an IRT-based short form to assess applied cognitive function in outpatient rehabilitation.
The authors developed a 15-item outpatient rehabilitation self-report short form for the Activity Measure for Post-Acute Care Applied Cognition item bank. They concluded that their Applied Cognition outpatient short form demonstrated acceptable psychometric properties and provides a bridge to item response theory-based measurement when point-of-care computing is not available.
AHRQ-funded; HS021368.
Citation: McDonough CM, Ni P, Coster WJ .
Development of an IRT-based short form to assess applied cognitive function in outpatient rehabilitation.
Am J Phys Med Rehabil 2016 Jan;95(1):62-71. doi: 10.1097/phm.0000000000000340.
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Keywords: Elderly, Neurological Disorders, Ambulatory Care and Surgery, Rehabilitation
Fisher SR, Graham JE, Krishnan S
Predictors of 30-day readmission following inpatient rehabilitation for patients at high risk for hospital readmission.
The purpose of this study was to identify variables in the full administrative medical record, particularly in regard to physical function, that could help clinicians further discriminate between patients who are and are not likely to be readmitted to an acute care hospital within 30 days of rehabilitation discharge. It found that functional outcomes and rehabilitation length of stay were the best predictors of 30-day rehospitalization.
AHRQ-funded; HS022134.
Citation: Fisher SR, Graham JE, Krishnan S .
Predictors of 30-day readmission following inpatient rehabilitation for patients at high risk for hospital readmission.
Phys Ther 2016 Jan;96(1):62-70. doi: 10.2522/ptj.20150034..
Keywords: Hospital Readmissions, Rehabilitation, Outcomes, Risk, Elderly
Ottenbacher KJ, Karmarkar A, Graham JE
Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
This study sought to determine 30-day readmission rates and factors related to readmission for patients receiving postacute inpatient rehabilitation. It found that among postacute rehabilitation facilities providing services to Medicare fee-for-service beneficiaries, 30-day readmission rates ranged from 5.8 percent to 18.8 percent for selected impairment groups.
AHRQ-funded; HS022134.
Citation: Ottenbacher KJ, Karmarkar A, Graham JE .
Thirty-day hospital readmission following discharge from postacute rehabilitation in fee-for-service Medicare patients.
JAMA 2014 Feb 12;311(6):604-14. doi: 10.1001/jama.2014.8..
Keywords: Hospital Readmissions, Medicare, Rehabilitation, Elderly, Quality Indicators (QIs)