Richard V. Riggs

Joint Replacement and Hip Fracture Readmission Rates: Impact of Discharge Destination

To determine if discharge destination after hospitalization for hip replacement or repair influences the hospital readmission rate.

Visual deficit interventions in adult stroke and brain injury: a systematic review.

Riggs RV, Andrews K, Roberts P, Gilewski: Visual deficit interventions in adult stroke and brain injury: a systematic review. Am J Phys Med Rehabil 2007;86:853–860. Visual deficits after cerebral injury are common. The variability in the types of injury sustained as well as their impact on function in the environment have produced multiple approaches at corrective intervention. To assess the effectiveness of these vision interventions, an extensive literature search was completed. The analysis of this review revealed some success with visual neglect disorders, but not enough evidence to comment definitively on interventions for hemianopsia, quadrantonopsia, diplopia, or convergence insufficiency. A lack of follow-up also limited efforts to assess the durability of documented gains. Additional research is necessary to clarify, quantify, and measure treatment outcomes for acquired visual dysfunction as well as to link laboratory testing to improvement in actual functioning for individuals in their environment.

The Impact of Inpatient Rehabilitation on Function and Survival of Newly Diagnosed Patients With Glioblastoma

To examine the impact of an inpatient rehabilitation program on functional improvement and survival among patients with newly diagnosed glioblastoma multiforme (GBM) who underwent surgical resection of the brain tumor.

Discriminating high fall risk on an inpatient rehabilitation unit.

&NA; The objective of this study was to identify on admission the most discriminating fall predictors for patients to an inpatient rehabilitation unit. Medical information from 34 patients who fell over a consecutive 7‐month period and 102 controls (1:3 ratio) matched for diagnosis, age, and gender was analyzed to identify a set of best predictors. Admission mobility and problem solving FIM™ scores accounted for 17% of variance in whether a fall occurred during the admission. After statistically deriving optimal cutoff thresholds for decision making, high fall risk was retroactively assigned to patients. Logistic regression revealed increased odds of having fallen by 5.1 times for poorer mobility and 2.4 times for poorer problem solving. The practical benefits of the evidence‐based risk assessment were discussed.

Transferring Inpatient Rehabilitation Facility Cancer Patients Back to Acute Care (TRIPBAC)

To determine predictive factors for TRansferring Inpatient rehabilitation facility (IRF) cancer Patients Back to Acute Care (TRIPBAC).

Risk Factors for Discharge to an Acute Care Hospital From Inpatient Rehabilitation Among Stroke Patients

OBJECTIVE To identify medical and functional health risk factors for being discharged directly to an acute-care hospital from an inpatient rehabilitation facility among patients who have had a stroke. DESIGN Retrospective cohort study. SETTING Academic medical center. PARTICIPANTS A total of 783 patients with a primary diagnosis of stroke seen from 2008 to 2012; 60 were discharged directly to an acute-care hospital and 723 were discharged to other settings, including community and other institutional settings. METHODS OR INTERVENTIONS Logistic regression analysis. MAIN OUTCOME MEASUREMENTS Direct discharge to an acute care hospital compared with other discharge settings from the inpatient rehabilitation unit. RESULTS No significant differences in demographic characteristics were found between the 2 groups. The adjusted logistic regression model revealed 2 significant risk factors for being discharged to an acute care hospital: admission motor Functional Independence Measure total score (odds ratio 0.97, 95% confidence interval 0.95-0.99) and enteral feeding at admission (odds ratio 2.87, 95% confidence interval 1.34-6.13). The presence of a Centers for Medicare and Medicaid-tiered comorbidity trended toward significance. CONCLUSION Based on this research, we identified specific medical and functional health risk factors in the stroke population that affect the rate of discharge to an acute-care hospital. With active medical and functional management, early identification of these critical components may lead to the prevention of stroke patients from being discharged to an acute-care hospital from the inpatient rehabilitation setting.

Using Functional Status in the Acute Hospital to Predict Discharge Destination for Stroke Patients.

ObjectiveThe aim of this study was to determine whether functional status, as measured by the AcuteFIM instrument, can be used to predict discharge destination of stroke patients from the acute hospital setting. DesignA retrospective cohort study was carried out in an urban academic medical center. Data were collected on 481 new-onset stroke patients 18 yrs or older in an acute hospital between January 1 and September 30, 2013. Functional Independence Measure (FIM) instrument data were linked to a subset of 54 patients who received additional services at an inpatient rehabilitation facility. A receiver operator characteristic curve was constructed to validate the predictive ability of the AcuteFIM instrument and to determine the optimal cutoff score associated with discharge to a community setting. ResultsAll AcuteFIM items in stroke patients at admission demonstrated strong interitem correlation coefficients (all above 0.6) and high internal consistency (Cronbach &agr; = 0.94). The AcuteFIM total score was positively associated with discharge to the community from the acute hospital (odds ratio, 1.06; 95% confidence interval, 1.05–1.07). Receiver operator characteristic curve analysis generated a c statistic of 0.89 (95% confidence interval, 0.87–0.92), indicating that the AcuteFIM instrument is predictive of patient discharge to the community setting. ConclusionThis study suggests that the AcuteFIM instrument is a reliable tool that can be used to predict discharge destination from the acute hospital among stroke patients.

Medicare's recovery audit contractor program: inpatient rehabilitation facilities are taking back takebacks, but enough?

A perfect storm had been brewing in the last decade: Medicare payment mistakes; Medicare waste, fraud, and abuse; fuzzy medical necessity definitions; erroneous coding; and a strained national budget. The United States Congress responded by inserting Section 306 into the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Section 306 called for the correction of Medicare payment problems by establishing the Recovery Audit Contractor program as the vehicle for the Centers for Medicare & Medicaid Services to recoup Medicare overpayments as far back as 3 yrs from its healthcare providers and to return underpayments to them. The legislation allowed for Medicare to contract with private firms to follow the money and earn a cut. Caught in the eye of the storm, Medicare providers combined are giving back more than they get back. Inpatient Rehabilitation Facilities are taking back takebacks-but enough to remain viable?

Frailty in a Post-Acute Care Population: A Scoping Review

Frailty is a complex and growing phenomenon facing health care providers throughout the continuum of care. Frailty is not well understood in post‐acute care (PAC) settings. The purpose of this scoping review was to summarize current evidence of frailty impact on outcomes and frailty mitigation initiatives in PAC. Three major publication databases were searched from January 2000 to June 2017 that identified 18 articles specifically addressing frailty in PAC. Three themes were identified: scales used to measure frailty, factors that led to an adverse outcome or diagnosis of frailty, and interventions to address frailty in PAC. Scales used to measure frailty were dominated by physical factors and scarce on nutrition and social support. Functional decline, grip strength, gait speed, polypharmacy, and nutrition were identified in the studies as factors that identify frailty and are associated with poor outcomes. All these frailty characteristics compromise patients’ ability to benefit from rehabilitation, which further establishes the importance of PAC providers to identify, prevent, and treat frailty. Intervention studies had mixed outcomes, suggesting a need for further development in this area. The findings of this scoping review highlight the need for a comprehensive multidimensional assessment of frailty risks in PAC.

A conceptual model for vision rehabilitation.

Vision impairments are highly prevalent after acquired brain injury (ABI). Conceptual models that focus on constructing intellectual frameworks greatly facilitate comprehension and implementation of practice guidelines in an interprofessional setting. The purpose of this article is to provide a review of the vision literature in ABI, describe a conceptual model for vision rehabilitation, explain its potential clinical inferences, and discuss its translation into rehabilitation across multiple practice settings and disciplines.