We used a database from one health system containing '6-Clicks' scores from first and last physical and occupational therapist visits for 84,446 patients. Descriptive statistics were derived to describe the patients for whom data were collected at the first or last physical therapist or occupational therapist visit. Empirical weights were derived in the New Jersey population and the performance of scores with new weights was validated in the Pennsylvania population. The association of each Charlson comorbidity measure and Elixhauser comorbidity measure with mortality was assessed in bivariate analysis. Although reports of the application of various tools have suggested that they might address some of these concerns, their usefulness in doing so has not been consistently documented. Therefore, they may not include the type of data necessary to address research questions, nor the form of data useful for analysis. Specific comorbidities and patient demographic factors showed less significance.
Intentional differences in payments attributable to such factors as geography or illness severity explained much of this variation. The fact that the patients for whom the discharge destination field was coded as missing data were younger and more likely to be living at home than the patients for whom we identified the actual discharge destination suggests some misclassification. Recent findings: Current literature supports decreased length of hospital stay and increased discharge to home with cost savings and stable readmission rates. Studies have shown that the percentage of patients scheduled for physical therapy, yet not receiving these services, may be quite high and that the time spent by therapists when patients cannot be treated may be substantial. Background: Readmissions following total hip arthroplasty are a focus given the forthcoming financial penalties that hospitals in the United States may incur starting in 2015. Lower scores equate to a greater degree of limitation. It may be that issues other than patients' activity limitations, such as patients' or families' needs for education concerning safety, self-care, or home modifications, drive additional visits.
Observational cohort study with clinical patient data obtained from the Nationwide Inpatient Sample. The purpose of this study was to identify the incidence, causes, and risk factors for readmission following total joint arthroplasty. In our study, we identified 46,395 gastric resections, 18,234 hepatic resections, and 15,443 pancreatic resections. However, the lower mortality rates at teaching hospitals can be explained by higher procedural volume. We evaluated instruments proposed to predict a patient's discharge disposition and summarize reports investigating the safety in sending more patients home by reviewing complications and readmission rates. Finally, further investigation to define cutoff scores for making decisions about need for intervention and the appropriate extent of intervention should be undertaken.
We also performed trend analyses. Mr Ranganathan and Dr Frost provided institutional liaisons. Proximal humerus fractures are very common in infirm elderly patients, and are associated with appreciable inpatient mortality. Lower scores equate to a greater degree of limitation. Recently, physical therapists and occupational therapists at Cleveland Clinic Health System hospitals pilot tested the use in an acute care setting of new standardized functional assessment instruments that may meet these requirements. It is critical to determine a common underlying structure before employing current methods of item equating across outcome instruments for future item banking and computer-adaptive testing applications. In terms of relative improvement in predictive ability, the Elixhauser score performed 46% better than the Charlson score.
Complex operations performed in teaching hospitals have similar outcomes as those performed in nonteaching hospitals. By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. All remaining analyses were conducted separately for basic mobility and daily activities scores. Objective: To assess the extent to which a comprehensive set of patient characteristics accounts for differences in hospital readmission rates. Learning objectives describe how the am pac was developed understand the difference between short forms and computerized adaptive tests cats list the different types of short forms available and identify which forms is are most appropriate for a given diagnosis or patient population. Setting and Procedures The Cleveland Clinic Health System is a nonprofit system that includes 3,700 beds in the main campus hospital and 8 regional hospitals. However, the plotted frequencies of predicted and observed discharge to home did not reveal large differences.
See the Instructions for Authors for a complete description of levels of evidence. Limitations One limitation of the present study is the fact that discharge destination likely is influenced by many factors. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. This phenomenon would not be inconsistent with the experience of therapists in other acute care settings. It may be used for assessment in adults with a wide range of diagnoses and levels of performance in the 3 domains. Validity of both forms was supported by evidence for ceiling and floor effects below 20% at first and last visits.
Studies have shown that early planning of discharge is essential in reducing length of stay and achieving financial benefit; tools that can help predict discharge disposition would therefore be of use. This sample could be biased in ways that we cannot determine. Patient characteristics explained approximately 15% of the variance in hospital payments, hospital characteristics teaching status, geographic region explained 30% of variance, and approximately 55% of variance was not explained by either factor. The implementation was part of a broad institutional push for providing uniform, high-quality services. To determine possible ceiling and floor effects, we examined the distribution of scores derived from the first and final visits. To develop and validate a single numerical comorbidity score for predicting short- and long-term mortality, by combining conditions in the Charlson and Elixhauser measures.
Another limitation is use of a clinical database to provide data for analyses. Jette, Mary Stilphen, Vinoth K. Although some visits that result in nontreatment are due to patients being medically unstable, some may be the result of patients being referred who are sufficiently mobile and have sufficient capacity for functional activity as to not require services. Patients need adequate counseling and education regarding advantages and limitations of the two discharge destinations. This study provides evidence for the validity of the measures' scores and their potential ability to address some of the concerns about instruments previously designed and proposed for this purpose.