42 results on '"Erik H. Hoyer"'
Search Results
2. The Johns Hopkins Activity and Mobility Promotion Program
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Kevin H. McLaughlin, Michael Friedman, Erik H. Hoyer, Sapna Kudchadkar, Eleni Flanagan, Lisa Klein, Kelly Daley, Annette Lavezza, Nicole Schechter, and Daniel Young
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General Nursing - Published
- 2022
3. Improving hospital outcomes using an acute hospital rehabilitation intensive service (ARISE) for patients with COVID‐19
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Erik H. Hoyer, Sowmya Kumble, April Pruski, Kelly N. Daley, Nicole Langton‐Frost, Bhavesh Patel, Yisi Liu, Dhananjay Vaidya, Annette Lavezza, and Pablo A. Celnik
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Internal Medicine - Published
- 2023
4. Comparing three wearable accelerometers to measure early activity after cardiac surgery
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Charles H. Brown, Lisa Yanek, Ryan Healy, Tiffany Tsay, Junrui Di, Lee Goeddel, Daniel Young, Vadim Zipunnikov, Jennifer Schrack, Glenn Whitman, Kaushik Mandal, Tim Madeira, Michael C. Grant, and Erik H. Hoyer
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Abstract
Wearable activity monitors can provide detailed data on activity after cardiac surgery and discriminate a patient's risk for hospital-based outcomes. However, comparative data for different monitoring approaches, as well as predictive ability over clinical characteristics, are lacking. In addition, data on specific thresholds of activity are needed. The objective of this study was to compare 3 wearable activity monitors and 1 observational mobility scale in discriminating risk for 3 hospital-based outcomes, and to establish clinically relevant step thresholds.Cardiac surgery patients were enrolled between June 2016 and August 2017 in a cohort study. Postoperative activity was measured by 3 accelerometry monitors (StepWatch Ambulation Monitor, Fitbit Charge HR, and ActiGraph GT9X) and 1 nurse-based observation scale. Monitors represent a spectrum of characteristics, including wear location (ankle/wrist), output (activity counts/steps), consumer accessibility, and cost. Primary outcomes were duration of hospitalization7 days, discharge to a nonhome location, and 30-day readmission.Data were available from 193 patients (median age 67 years [interquartile range, 58-72]). All postoperative day 2 activity metrics (ie, from StepWatch, Fitbit, ActiGraph, and the observation scale) were independently associated with prolonged hospitalization and discharge to a nonhome location. Only steps as measured by StepWatch was independently associated with 30-day readmission. Overall, StepWatch provided the greatest discrimination (C-statistics 0.71-0.76 for all outcomes). Step thresholds between 250 and 500 steps/day identified between 74% and 96% of patients with any primary outcome.Data from wearable accelerometers provide additive value in early postoperative risk-stratification for hospital-based outcomes. These results both support and provide guidance for activity-monitoring programs after cardiac surgery.
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- 2022
5. Using Nursing Assessments of Mobility and Activity to Prioritize Patients Most Likely to Need Rehabilitation Services
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Carmen E. Capo-Lugo, Kevin H. McLaughlin, Bingqing Ye, Kelly Daley, Daniel Young, Annette Lavezza, Michael Friedman, and Erik H. Hoyer
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Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation - Published
- 2023
6. Identifying Cognitive Impairment in the Acute Care Hospital Setting: Finding an Appropriate Screening Tool
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Kelly Casey, Erin Sim, Annette Lavezza, Kristen Iannuzzi, Lisa Aronson Friedman, Erik H. Hoyer, and Daniel L. Young
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Occupational Therapy - Abstract
Importance: Identifying cognitive impairment in adults in acute care is essential so that providers can address functional deficits and plan for safe discharge. Occupational therapy practitioners play an essential role in screening for, evaluating, and treating cognitive impairment. Objective: To test and compare the psychometrics and feasibility of three cognitive screens and select the ideal screen for use in acute care. Design: Prospective mixed methods. Setting: Acute care hospital. Participants: Fifty adults. Outcomes and Measures: We examined the interrater reliability, administration time, and usability of the Brief Cognitive Assessment Tool Short Form (BCAT–SF), the Activity Measure for Post-Acute Care “6-Clicks” Applied Cognitive Inpatient Short Form (AM-PAC ACISF), and the Montreal Cognitive Assessment (MoCA). We compared the construct validity, sensitivity, and specificity of the BCAT–SF and AM-PAC ACISF with those of the MoCA. Results: Interrater reliability was good to excellent; ICCs were .98 for the MoCA, .97 for the BCAT–SF, and .86 for the AM-PAC ACISF. The BCAT–SF and the AM-PAC ACISF both had 100% sensitivity, and specificity was 74% for the BCAT–SF and 98% for the AM-PAC ACISF. The optimal cutoff score for cognitive impairment on the AM-PAC ACISF was Conclusions and Relevance: Each screen demonstrated acceptable reliability and construct validity. The AM-PAC ACISF had the optimum mix of performance and feasibility for the fast-paced acute care setting. What This Article Adds: Early identification of cognitive impairment using the AM-PAC ACISF can allow for timely occupational therapy intervention in acute care settings.
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- 2023
7. The Paradox of Readmission Prevention Interventions: Missing Those Most in Need
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Daniel J. Brotman, Amy Deutschendorf, Rosalyn W. Stewart, Diane Lepley, Curtis Leung, Blair Golden, Erik H. Hoyer, Melissa Richardson, and Geoff B. Dougherty
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Male ,Patient Transfer ,medicine.medical_specialty ,Psychological intervention ,Aftercare ,030204 cardiovascular system & hematology ,Logistic regression ,Patient Readmission ,Risk Assessment ,Odds ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Intervention (counseling) ,Preventive Health Services ,medicine ,Humans ,030212 general & internal medicine ,Generalized estimating equation ,Socioeconomic status ,Aged ,Maryland ,business.industry ,General Medicine ,Continuity of Patient Care ,Patient Acceptance of Health Care ,Readmission rate ,Patient Discharge ,Socioeconomic Factors ,Emergency medicine ,Female ,business ,Medicaid - Abstract
Background Post-hospitalization transition interventions remain a priority in preventing rehospitalization. However, not all patients referred for readmission prevention interventions receive them. We sought to 1) define patient characteristics associated with non-receipt of readmission prevention interventions (among those eligible for them), and 2) determine whether these same patient characteristics are associated with hospital readmission at the state level. Methods We used state-wide data from the Maryland Health Services Cost Review Commission to determine patient-level factors associated with state-wide readmissions. Concurrently, we conducted a retrospective analysis of discharged patients referred to receive 1 of 3 post-discharge interventions between January 2013 and July 2019—a nurse transition guide, post-discharge phone call, or follow-up appointment in our post-discharge clinic—to determine patient-level factors associated with not receiving the intervention. Multivariable generalized estimating equation logistic regression models were used to calculate the odds of not accepting or not receiving the interventions. Results Older age, male gender, black race, higher expected readmission rate, and lower socioeconomic status were significantly associated with 30-day readmission in hospitalized Maryland patients. Most of these variables (age, sex, race, payer type [Medicaid or non-Medicaid], and socioeconomic status) were also associated with non-receipt of intervention. Conclusions We found that many of the same patient-level characteristics associated with the highest readmission risk are also associated with non-receipt of readmission reduction interventions. This highlights the paradox that patients at high risk of readmission are least likely to accept or receive interventions for preventing readmission. Identifying strategies to engage hard-to-reach high-risk patients continues to be an unmet challenge in readmission prevention.
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- 2021
8. A unit-based, multi-center evaluation of adopting mobility measures and daily mobility goals in the hospital setting
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Erik H. Hoyer, Michael Friedman, Annette Lavezza, Eleni Flanagan, Sowmya Kumble, Michelle D'Alessandro, Morning Gutierrez, Elizabeth Colantuoni, Daniel J. Brotman, and Daniel L. Young
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General Nursing - Published
- 2023
9. Machine learning prediction of hospital patient need for post-acute care using an admission mobility measure is robust across patient diagnoses
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Daniel L. Young, Rebecca Engels, Elizabeth Colantuoni, Lisa Aronson Friedman, and Erik H. Hoyer
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Health Policy ,Biomedical Engineering - Published
- 2023
10. Psychometric Testing of the Activity Measure for Post-Acute Care (AM-PAC) in the Pediatric Acute Care Setting
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Daniel L. Young, Meghan Beier, Katherine Denlinger, Sapna R. Kudchadkar, Julie Quinn, Erik H. Hoyer, and Michael Friedman
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030506 rehabilitation ,medicine.medical_specialty ,Psychometrics ,Physical Therapy, Sports Therapy and Rehabilitation ,Post acute care ,03 medical and health sciences ,0302 clinical medicine ,Acute care ,Activities of Daily Living ,medicine ,Humans ,Psychometric testing ,Child ,Hand Strength ,business.industry ,Reproducibility of Results ,Construct validity ,Weak correlation ,Inter-rater reliability ,Walk test ,Pediatrics, Perinatology and Child Health ,Physical therapy ,0305 other medical science ,business ,Subacute Care ,030217 neurology & neurosurgery - Abstract
PURPOSE To determine interrater reliability and construct validity of the Activity Measure for Post-Acute Care (AM-PAC) Inpatient "6-clicks" Short Forms for children in acute care. METHODS Eight physical therapists (PTs) scored the AM-PAC Basic Mobility, 30-second walk test (30SWT), and Timed Up and Go (TUG) for 54 patients (4-17 years); 6 occupational therapists (OTs) scored the AM-PAC Daily Activity and handgrip dynamometry for 50 patients (5-17 years). Correlations between the AM-PAC Basic Mobility, 30SWT, and TUG and between the Daily Activity AM-PAC and handgrip dynamometry were calculated for evidence of construct validity. RESULTS Interrater reliability for the AM-PAC was excellent for PTs and OTs. Validity was strong to moderate for Basic Mobility when compared with the 30SWT and TUG. Daily Activity had weak correlation with mean left handgrip strength and no correlation with mean right handgrip strength. CONCLUSIONS AM-PAC Short Forms have acceptable psychometrics for use among children in acute care.
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- 2021
11. An interprofessional examination of the Johns Hopkins Mobility Goal Calculator among hospitalized postsurgical patients
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Kevin H. McLaughlin, Daniel Young, Lisa A. Friedman, Jessica Peters, Gina Vickery, and Erik H. Hoyer
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Patients ,Surveys and Questionnaires ,Humans ,Pain ,General Medicine ,Goals ,General Nursing - Abstract
Individualized mobility goals created using a goal calculator have been shown to increase patient mobility on medical nursing units, but have not been studied among postoperative populations. This study aimed to examine the feasibility of an automated mobility goal calculator on a postoperative nursing unit. To examine this, we used the goal calculator to create goals for patients (N = 128) following surgery and mobilized each patient with either a nurse or physical therapist. Each patient's highest level of mobility was recorded and providers completed surveys on the appropriateness of calculated goals. Overall, 94% of patients achieved calculated goals. Patients with more pain achieved goals significantly less often than those with less pain. Those with higher mobility achieved their goals similarly with either provider. Providers reported 47% of goals were appropriate, with goals being set too low as the primary reason for goals being inappropriate. We conclude that the automated goal calculator can be used on postoperative nursing units to set realistic goals for patients after surgery.
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- 2022
12. Machine-learning-based hospital discharge predictions can support multidisciplinary rounds and decrease hospital length-of-stay
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Arnaud Debraine, Matthew F. Toerper, Jeremiah S. Hinson, Anthony DeAngelo, Erik H. Hoyer, Scott Levin, Eric E Howell, Trushar Dungarani, Sean Barnes, and Eric Hamrock
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Patient discharge ,medicine.medical_specialty ,Financial performance ,Receiver operating characteristic ,business.industry ,010102 general mathematics ,Length of hospitalization ,General Medicine ,01 natural sciences ,Patient flow ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Emergency medicine ,Hospital discharge ,medicine ,030212 general & internal medicine ,0101 mathematics ,business ,Predictive modelling - Abstract
BackgroundPatient flow directly affects quality of care, access and financial performance for hospitals. Multidisciplinary discharge-focused rounds have proven to minimise avoidable delays experienced by patients near discharge. The study objective was to support discharge-focused rounds by implementing a machine-learning-based discharge prediction model using real-time electronic health record (EHR) data. We aimed to evaluate model predictive performance and impact on hospital length-of-stay.MethodsDischarge prediction models were developed from hospitalised patients on four inpatient units between April 2016 and September 2018. Unit-specific models were implemented to make individual patient predictions viewable with the EHR patient track board. Predictive performance was measured prospectively for 12 470 patients (120 780 patient-predictions) across all units. A pre/poststudy design applying interrupted time series methods was used to assess the impact of the discharge prediction model on hospital length-of-stay.ResultsProspective discharge prediction performance ranged in area under the receiver operating characteristic curve from 0.70 to 0.80 for same-day and next-day predictions; sensitivity was between 0.63 and 0.83 and specificity between 0.48 and 0.80. Elapsed length-of-stay, counts of labs and medications, mobility assessments and measures of acute kidney injury were model features providing the most predictive value. Implementing the discharge predictions resulted in a reduction in hospital length-of-stay of over 12 hours on a medicine unit (pConclusionsIncorporating automated patient discharge predictions into multidisciplinary rounds can support decreases in hospital length-of-stay. Variation in execution and impact across inpatient units existed.
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- 2020
13. Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 Survivors
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Kenneth Silver, Anisa L. Tatini, Mary S. Keszler, April D. Pruski, Bhavesh Patel, Annette Lavezza, Pablo Celnik, Soo Yeon Kim, Margaret Kott, Tracy Friedlander, Erik H. Hoyer, Michael Friedman, Marlís González-Fernández, Laryssa Richards, Alba Azola, Sowmya Kumble, and Kavita Nadendla
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030506 rehabilitation ,medicine.medical_treatment ,Psychological intervention ,Disease ,RASS, Richmond Agitation Sedation Scale ,e-ACIR, Extended Acute Comprehensive Inpatient Rehabilitation ,law.invention ,Disability Evaluation ,0302 clinical medicine ,law ,Telerehabilitation ,Activities of Daily Living ,Pandemic ,Medicine ,Survivors ,Rehabilitation ,ARDS, Acute Respiratory Distress Syndrome ,rehabilitation services ,Measurable, Achievable ,Continuity of Patient Care ,Physiatrists ,Intensive care unit ,PICS, Post-Intensive Care Syndrome ,IRF ,CMS, Center for Medicare & Medicaid Services ,Intensive Care Units ,ERAC, Enhanced Recovery After COVID-19 ,COVID rehabilitation ,Medical emergency ,0305 other medical science ,COVID-19, COronaVIrus Disease 2019 ,ACIR, Acute Comprehensive Inpatient Rehabilitation ,CARES, Coronavirus Aid, Relief, and Economic Security ,RPM, Remote Patient Monitoring ,Physical Therapy, Sports Therapy and Rehabilitation ,Medicare ,Article ,WHO, World Health Organization ,RISC, Rehabilitation Intervention Severity Categories ,Realistic, Time sensitive ,03 medical and health sciences ,Inpatient rehabilitation ,AM-PAC, Activity Measure for Post-Acute Care ,ICU, Intensive Care Unit ,Humans ,Glasgow Coma Scale ,MICU, Medical Intensive Care Unit ,Pandemics ,Personal protective equipment ,SMART, Specific ,ARISE, Acute Hospital Rehabilitation Intensive Service ,SARS-CoV-2 ,business.industry ,PM&R, Physical Medicine and Rehabilitation ,COVID-19 ,SOC, Standard Of Care ,ICF, International Classification of Functioning, Disability and Health ,Physical and Rehabilitation Medicine ,medicine.disease ,United States ,SLP, Speech-Language Pathologist ,acute care rehabilitation ,ICU rehabilitation ,AMP, Activity and Mobility Promotion ,ERAS®, Enhanced recovery after surgery ,business ,030217 neurology & neurosurgery - Abstract
The COVID-19 pandemic is having a profound impact on the provision of medical care. As the curve progresses and patients are discharged the rehabilitation wave brings a high number of post-acute COVID-19 patients suffering from physical, mental, and cognitive impairments threatening their return to normal life. The complexity and severity of disease in patients recovering from severe COVID-19 infection require an approach that is implemented as early in the recovery phase as possible, in a concerted and systematic way. To address the rehabilitation wave, we describe a spectrum of interventions that start in the ICU and continue through all the appropriate levels of care. This approach requires organized rehabilitation teams including physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists/neuropsychologists, and physiatrists collaborating with acute medical teams. Here, we also discuss administrative factors that influence the provision of care during the COVID-19 pandemic. The services that can be provided are described in detail to allow the reader to understand what services may be appropriate locally. We have been learning and adapting real-time during this crisis and hope that sharing our experience facilitates the work of others as the pandemic evolves. It is our goal to help reduce the potentially long-lasting challenges faced by COVID-19 survivors., Highlights • Rehabilitation care of COVID-19 recovering patient can be safely provided starting in the ICU. • Redeployment of outpatient therapy workforce was useful to provide rehabilitation to patients recovering from COVID-19 in the acute medical care. • Objective functional assessments allowed for a tailored rehabilitation approach based on the individual patient’s needs. • Changes in Medicare regulation allowed for the provision of Acute Inpatient Rehabilitation Services outside of the rehabilitation unit. COVID-19 patients were able to receive ACIR level of care while still recovering from the acute infection.
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- 2020
14. Key Data Elements for Longitudinal Tracking of Physical Function: A Modified Delphi Consensus Study
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Daniel L Young, Julie M Fritz, Jacob Kean, Anne Thackeray, Joshua K Johnson, Danica Dummer, Sandra Passek, Mary Stilphen, Donna Beck, Suzanne Havrilla, Erik H Hoyer, Michael Friedman, Kelly Daley, and Robin L Marcus
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Consensus ,Delphi Technique ,Health Personnel ,Humans ,Physical Therapy, Sports Therapy and Rehabilitation ,Health Services Research ,Home Care Services - Abstract
Objective Physical function is associated with important outcomes, yet there is often a lack of continuity in routine assessment. The purpose of this study was to determine data elements and instruments for longitudinal measurement of physical function in routine care among patients transitioning from acute care hospital setting to home with home health care. Methods A 4-round modified Delphi process was conducted with 13 participants with expertise in physical therapy, health care administration, health services research, physiatry/medicine, and health informatics. Three anonymous rounds identified important and feasible data elements. A fourth in-person round finalized the recommended list of individual data elements. Next, 2 focus groups independently provided additional perspectives from other stakeholders. Results Response rates were 100% for online rounds 1, 3, and 4 and 92% for round 2. In round 1, 9 domains were identified: physical function, participation, adverse events, behavioral/emotional health, social support, cognition, complexity of illness/disease burden, health care utilization, and demographics. Following the fourth round, 27 individual data elements were recommended. Of these, 20 (74%) are “administrative” and available from most hospital electronic medical records. Additional focus groups confirmed these selections and provided input on standardizing collection methods. A website has been developed to share these results and invite other health care systems to participate in future data sharing of these identified data elements. Conclusion A modified Delphi consensus process was used to identify critical data elements to track changes in patient physical function in routine care as they transition from acute hospital to home with home health. Impact Expert consensus on comprehensive and feasible measurement of physical function in routine care provides health care professionals and institutions with guidance in establishing discrete medical records data that can improve patient care, discharge decisions, and future research.
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- 2022
15. Association between ambulatory status and call bell use in hospitalized patients—A retrospective cohort study
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Elys Bhatia, Carmen E. Capo-Lugo, Erik H. Hoyer, Andre Cassell, Annette Lavezza, Lisa M. Klein, Daniel L. Young, Michael Friedman, Kara Shumock, Daniel J. Brotman, and Maria Cvach
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Adult ,Male ,medicine.medical_specialty ,Leadership and Management ,Hospitalized patients ,Nurses ,Walking ,Workload ,03 medical and health sciences ,Help-Seeking Behavior ,Mobility status ,Humans ,Medicine ,Association (psychology) ,Nursing management ,Aged ,Retrospective Studies ,030504 nursing ,business.industry ,030503 health policy & services ,Ambulatory Status ,Retrospective cohort study ,Length of Stay ,Middle Aged ,stomatognathic diseases ,Ambulatory ,Emergency medicine ,Female ,Nurse-Patient Relations ,0305 other medical science ,business - Abstract
Aim Characterize the relationship between patient ambulatory status and in-hospital call bell use. Background Although call bells are frequently used by patients to request help, the relationship between physical functioning and call bell use has not been evaluated. Methods Retrospective cohort study of 944 neuroscience patients hospitalized in a large academic urban medical centre between April 1, 2014 and August 1, 2014. We conducted multiple linear regression analyses with number of daily call bells from each patient as the primary outcome and patients' average ambulation status as the primary exposure variable. Results The mean number of daily call bell requests for all patients was 6.9 (6.1), for ambulatory patients 5.6 (4.8), and for non-ambulatory patients, it was 7.7 (6.6). Compared with non-ambulatory patients, ambulatory patients had a mean reduction in call bell use by 1.7 (95% CI 2.5 to -0.93, p 250 feet had 5 fewer daily call bells than patients who were able to perform in-bed mobility. Conclusion Ambulatory patients use their call bells less frequently than non-ambulatory patients. Implications for nursing management Frequent use of call bells by non-ambulatory patients can place additional demands on nursing staff; patient mobility status should be considered in nurse workload/patient assignment.
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- 2019
16. Implementing an Opioid Risk Reduction Program in the Acute Comprehensive Inpatient Rehabilitation Setting
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Teresa Tang, Amira A. Noles, Ada Lyn Yao, Erik H. Hoyer, Nicholas Dabai, Margaret Kott, Stephanie P. Van, Alexis Coslick, Lee Ann Sprankle, and Solomon Rojhani
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Male ,030506 rehabilitation ,medicine.medical_specialty ,Inservice Training ,Narcotic Antagonists ,medicine.medical_treatment ,Psychological intervention ,Physical Therapy, Sports Therapy and Rehabilitation ,Rehabilitation Centers ,Gee ,03 medical and health sciences ,0302 clinical medicine ,Patient Education as Topic ,Naloxone ,Humans ,Medicine ,Prospective Studies ,Practice Patterns, Physicians' ,Medical prescription ,Prospective cohort study ,Inpatients ,Rehabilitation ,business.industry ,Middle Aged ,Opioid-Related Disorders ,Quality Improvement ,Confidence interval ,Analgesics, Opioid ,Models, Organizational ,Emergency medicine ,Female ,Drug Overdose ,0305 other medical science ,business ,Risk Reduction Behavior ,030217 neurology & neurosurgery ,Patient education ,medicine.drug - Abstract
To describe the implementation and evaluation of an interdisciplinary quality improvement (QI) project to increase prescription of take-home naloxone (THN) to reduce risks associated with opioids for patients admitted to an acute inpatient rehabilitation unit.Prospective cohort quality improvement project.Eighteen-bed acute comprehensive inpatient rehabilitation (ACIR) unit at a large academic institution.Patients admitted to ACIR between December 2015-November 2016 (N=788).An interdisciplinary QI model comprised of planning, education, implementation, and maintenance was used to implement a THN and opioid risk-reduction program involving provider and patient education. Analyses consisted of comparisons between baseline, early, and late phases of the project.(1) The proportion of eligible patients who received a prescription for naloxone upon discharge from ACIR; (2) the proportion of patients originally admitted to ACIR on opioids that were weaned off upon discharge.The adjusted odds of eligible patients being discharged from ACIR with a naloxone prescription during the late QI period were 7 (95% confidence interval [CI]: 3-21) times higher than during the early QI period (late QI period: 43%, 95% CI: 25%-63%; early QI period: 10%, 95% CI: 3%-28%; P.001). For patients admitted on opioids, the adjusted odds of being weaned off opioids during the late QI period were 10 (95% CI: 4-25) times higher than during baseline (late QI period: 29%, 95% CI: 17%-45%; baseline: 4%, 95% CI: 1%-10%; P.001).Implementation of a THN and opioid risk reduction QI project in an inpatient rehabilitation setting led to significantly more eligible patients receiving naloxone and more patients weaned off schedule II opioids.
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- 2019
17. Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU
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Carrie M. Goodson, Sarah Coggins, Michael Velaetis, Antionette Jones, Annette Lavezza, Jason Seltzer, Amy L. Toonstra, Kitty S. Chan, Caroline Outten, Ann M. Parker, Kit Schwartz, Erik H. Hoyer, Dale M. Needham, Lisa Aronson Friedman, Kevin Heckle, Earl Mantheiy, and Mary Glover
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Adult ,Male ,Quality management ,Critical Care ,Attitude of Health Personnel ,medicine.medical_treatment ,Critical Care and Intensive Care Medicine ,Attitudes beliefs ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,law ,Medical Staff, Hospital ,medicine ,Humans ,Early Ambulation ,Mobilization ,Rehabilitation ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,Quality Improvement ,Intensive care unit ,Intensive Care Units ,030228 respiratory system ,Medical icu ,Health Care Surveys ,Early mobilization ,Female ,business - Abstract
Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (−0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.
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- 2018
18. Assessment of Patient Ambulation Profiles to Predict Hospital Readmission, Discharge Location, and Length of Stay in a Cardiac Surgery Progressive Care Unit
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Nicole Zahradka, Marc S. Sussman, Benjamin Bao, Ryan Healy, William Xie, Glenn J. Whitman, Tim Madeira, In Cheol Jeong, Peter C. Searson, Charles H. Brown, Erik H. Hoyer, and Jennifer A. Schrack
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Walking ,Progressive care unit ,Patient Readmission ,Risk Assessment ,Sensitivity and Specificity ,Predictive Value of Tests ,medicine ,Physical Medicine and Rehabilitation ,Humans ,Cardiac Surgical Procedures ,Statistic ,Aged ,Original Investigation ,Hospital readmission ,Rehabilitation ,Cardiac Rehabilitation ,business.industry ,Research ,General Medicine ,Length of Stay ,Middle Aged ,Prognosis ,Patient Discharge ,Cardiac surgery ,Hospitalization ,Online Only ,Predictive value of tests ,Physical therapy ,Female ,Discharge location ,business ,Gait Analysis ,Cohort study - Abstract
Key Points Question Are patient ambulation profiles predictive of hospital readmission, discharge location, and length of stay? Findings In this prognostic cohort study of 100 adults in a cardiac surgery progressive care unit, patient ambulation profiles were predictive of 30-day readmission (C statistic, 0.925), discharge location (C statistic, 0.930), and length of stay (correlation coefficient, 0.927). Meaning Patient ambulation profiles from a real-time location system enable prediction of clinically relevant outcomes., This prognostic cohort study evaluates novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients., Importance Promoting patient mobility during hospitalization is associated with improved outcomes and reduced risk of hospitalization-associated functional decline. Therefore, accurate measurement of mobility with high–information content data may be key to improved risk prediction models, identification of at-risk patients, and the development of interventions to improve outcomes. Remote monitoring enables measurement of multiple ambulation metrics incorporating both distance and speed. Objective To evaluate novel ambulation metrics in predicting 30-day readmission rates, discharge location, and length of stay using a real-time location system to continuously monitor the voluntary ambulations of postoperative cardiac surgery patients. Design, Setting, and Participants This prognostic cohort study of the mobility of 100 patients after cardiac surgery in a progressive care unit at Johns Hopkins Hospital was performed using a real-time location system. Enrollment occurred between August 29, 2016, and April 4, 2018. Data analysis was performed from June 2018 to December 2019. Main Outcomes and Measures Outcome measures included 30-day readmission, discharge location, and length of stay. Digital records of all voluntary ambulations were created where each ambulation consisted of multiple segments defined by distance and speed. Ambulation profiles consisted of 19 parameters derived from the digital ambulation records. Results A total of 100 patients (81 men [81%]; mean [SD] age, 63.1 [11.6] years) were evaluated. Distance and speed were recorded for more than 14 000 segments in 840 voluntary ambulations, corresponding to a total of 127.8 km (79.4 miles) using a real-time location system. Patient ambulation profiles were predictive of 30-day readmission (sensitivity, 86.7%; specificity, 88.2%; C statistic, 0.925 [95% CI, 0.836-1.000]), discharge to acute rehabilitation (sensitivity, 84.6%; specificity, 86.4%; C statistic, 0.930 [95% CI, 0.855-1.000]), and length of stay (correlation coefficient, 0.927). Conclusions and Relevance Remote monitoring provides a high–information content description of mobility, incorporating elements of step count (ambulation distance and related parameters), gait speed (ambulation speed and related parameters), frequency of ambulation, and changes in parameters on successive ambulations. Ambulation profiles incorporating multiple aspects of mobility enables accurate prediction of clinically relevant outcomes.
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- 2020
19. Towards improving hospital workflows: An evaluation of resources to mobilize patients
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Erik H. Hoyer, Julie Kreif, Brent C. Pottenger, Deborah B. Hobson, Lisa M. Klein, Peter J. Pronovost, and Daniel L. Young
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Adult ,Male ,Time Factors ,Leadership and Management ,Session (web analytics) ,Workflow ,InformationSystems_GENERAL ,03 medical and health sciences ,Resource (project management) ,Humans ,Medicine ,Medical diagnosis ,Assistive device ,Nursing management ,Aged ,Venous Thrombosis ,Moving and Lifting Patients ,Maryland ,030504 nursing ,business.industry ,030503 health policy & services ,Middle Aged ,medicine.disease ,Stroke ,Mobility Limitation ,Background current ,Health Resources ,Female ,Medical emergency ,0305 other medical science ,business - Abstract
Aim To characterize resources to safely mobilize different types of hospitalized patients. Background Current approaches to determine nurse-patient ratios do not always include information regarding the specific demands of patients who require extra resources to mobilize. Workflows must be designed with knowledge of resource requirements to integrate patient mobility into the daily nursing team care plan. Methods Nurse-led mobility sessions were evaluated on two adult hospital units, which consisted of nurse-patient encounters focused on patient mobility only. The resources assessed for each session were time-to-mobilize patient, time-to-document, need for additional staff support, and the need for assistive devices. Mobility sessions were also categorized by patient ambulation status, level of mobility limitations (low, medium and high) and diagnosis. Results In 212 total mobility sessions, the median time-to-mobilize and time-to-document were 7.75 and 1.27 min, respectively. Additional staff support was required for 87% and 92% of patients with medium and high mobility limitations, respectively. All patients with low mobility limitations ambulated, and only 14% required additional staff. Ambulating patients with high mobility limitations was the most time-intensive (median 12.55 min). Ambulating stroke patients required one additional staff and an assistive device in 92% and 69% of the sessions, respectively. Conclusion This study describes the resources associated with mobilizing inpatients with different levels of mobility impairments and diagnoses. Implications for nursing management These results could assist nursing management with facilitating appropriate daily nurse-patient ratios and justify the need for assistive devices and staff support to safely mobilize patients.
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- 2018
20. Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals
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Diane Lepley, Romsai T. Boonyasai, Amy Deutschendorf, Curtis Leung, Erik H. Hoyer, Melissa Richardson, Daniel J. Brotman, and Ariella Apfel
- Subjects
Adult ,Male ,medicine.medical_specialty ,Psychological intervention ,030204 cardiovascular system & hematology ,Patient Readmission ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Outcome Assessment, Health Care ,Health care ,Internal Medicine ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Aged ,Quality Indicators, Health Care ,Maryland ,business.industry ,Case-control study ,Odds ratio ,Middle Aged ,Patient Discharge ,Confidence interval ,Editorial ,Case-Control Studies ,Emergency medicine ,Female ,Observational study ,business ,Risk assessment - Abstract
Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. To evaluate the effects of two care coordination interventions on 30-day readmission rates. Prospective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models. A total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units. Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse. Two large academic hospitals in Baltimore, MD. Thirty-day all-cause readmission to any Maryland hospital. Among all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12–1.44, p
- Published
- 2017
21. Inter-rater reliability of the Johns Hopkins Highest Level of Mobility Scale (JH-HLM) in the intensive care unit
- Author
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Lisa Aronson Friedman, Stephanie Hiser, Dale M. Needham, Erik H. Hoyer, Elizabeth Colantuoni, Chi Ryang Chung, and Amy Toonstra
- Subjects
Adult ,medicine.medical_specialty ,Intraclass correlation ,medicine.medical_treatment ,Short Communication ,Ordinal Scale ,Physical Therapy, Sports Therapy and Rehabilitation ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Medicine ,Humans ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Reliability (statistics) ,Rehabilitation ,business.industry ,Reproducibility of Results ,030208 emergency & critical care medicine ,Intensive care unit ,Confidence interval ,Physical Therapists ,Inter-rater reliability ,Intensive Care Units ,Scale (social sciences) ,Physical therapy ,business ,human activities - Abstract
Background The Johns Hopkins Highest Level of Mobility (JH-HLM) scale is used to document the observed mobility of hospitalized patients, including those patients in the intensive care unit (ICU) setting. Objective To evaluate the inter-rater reliability of the JH-HLM, completed by physical therapists, across medical, surgical, and neurological adult ICUs at a single large academic hospital. Methods The JH-HLM is an ordinal scale for documenting a patient’s highest observed level of activity, ranging from lying in bed (score = 1) to ambulating > 250 feet (score = 8). Eighty-one rehabilitation sessions were conducted by eight physical therapists, with 1 of 2 reference physical therapist rater simultaneously observing the session and independently scoring the JH-HLM. The intraclass correlation coefficient was used to determine the inter-rater reliability. Results A total of 77 (95%) of 81 assessments had perfect agreement. The overall intraclass correlation coefficient for inter-rater reliability was 0.98 (95% confidence interval: 0.96, 0.99), with similar scores in the medical, surgical, and neurological ICUs. A Bland–Altman plot revealed a mean difference in JH-HLM scoring of 0 (limits of agreement: −0.54 to 0.61). Conclusion The JH-HLM has excellent inter-rater reliability as part of routine physical therapy practice, across different types of adult ICUs.
- Published
- 2019
22. Measuring Mobility in Low Functioning Hospital Patients: An AM-PAC Replenishment Project
- Author
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Michael Friedman, Debra J. Rogers, Susan C. Martin, Erik H. Hoyer, Heather Littier, Tracey Euloth, Daniel L. Young, Carmen E. Capo-Lugo, Tami Minnier, Annette Lavezza, Pengsheng Ni, Dale M. Needham, Sowmya Kumble, Alan M. Jette, and Beth Matcho
- Subjects
Male ,030506 rehabilitation ,medicine.medical_specialty ,Patient-Reported Outcomes Measurement Information System ,Physical Therapy, Sports Therapy and Rehabilitation ,Pilot Projects ,Risk Assessment ,Structural equation modeling ,Tertiary Care Centers ,03 medical and health sciences ,Disability Evaluation ,0302 clinical medicine ,Floor effect ,Acute care ,Item response theory ,Activities of Daily Living ,Outcome Assessment, Health Care ,medicine ,Raw score ,Humans ,Longitudinal Studies ,Mobility Limitation ,Aged ,Academic Medical Centers ,Inpatients ,business.industry ,Rehabilitation ,Middle Aged ,Differential item functioning ,Confirmatory factor analysis ,United States ,Physical therapy ,Female ,0305 other medical science ,business ,030217 neurology & neurosurgery ,Subacute Care - Abstract
Objective To expand an existing validated measure of basic mobility (Activity Measure for Post-Acute Care [AM-PAC]) for patients at the lowest levels of function. Design Item replenishment for existing item response theory (IRT) derived measure via (1) idea generation and creation of potential new items, (2) item calibration and field testing, and (3) longitudinal pilot test. Setting Two tertiary acute care hospitals. Participants Consecutive inpatients (N=502) ≥18 years old, with an AM-PAC Inpatient Mobility Short Form (IMSF) raw score ≤15. For the longitudinal pilot test, 8 inpatients were evaluated. Results Fifteen new AM-PAC items were developed, 2 of which improved mobility measurement at the lower levels of functioning. Specifically, with the 2 new items, the floor effect of the AM-PAC IMSF was reduced by 19%, statistical power and measurement breadth were greater, and there was greater measurement sensitivity in longitudinal pilot testing. Conclusion Adding 2 new items to the AM-PAC IMSF lowered the floor and increased statistical power, measurement breadth, and sensitivity.
- Published
- 2019
23. Prediction of Disposition Within 48 Hours of Hospital Admission Using Patient Mobility Scores
- Author
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Erik H. Hoyer, Jason Seltzer, Elizabeth Colantuoni, Lisa Aronson Friedman, Daniel J. Brotman, Bingqing Ye, Kelly N. Daley, and Daniel L. Young
- Subjects
medicine.medical_specialty ,Leadership and Management ,Hospitalized patients ,medicine.medical_treatment ,Assessment and Diagnosis ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,Mobility Limitation ,Care Planning ,Early discharge ,Retrospective Studies ,Rehabilitation ,business.industry ,Health Policy ,General Medicine ,Disposition ,Middle Aged ,Functional recovery ,Hospitals ,Patient Discharge ,Hospitalization ,Systematic measurement ,Hospital admission ,Emergency medicine ,Fundamentals and skills ,Discharge location ,business ,030217 neurology & neurosurgery ,Subacute Care - Abstract
Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 805) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95%CI:67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.
- Published
- 2019
24. Letter to the Editor: Selecting the best measure for hospital-acquired deconditioning
- Author
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Daniel L. Young, Erik H. Hoyer, and Carmen E. Capo-Lugo
- Subjects
medicine.medical_specialty ,Physical medicine and rehabilitation ,Deconditioning ,business.industry ,Rehabilitation ,medicine ,Measure (physics) ,Physical Therapy, Sports Therapy and Rehabilitation ,General Medicine ,business - Published
- 2019
25. Inpatient Mobility Technicians: One Step Forward?
- Author
-
Daniel J. Brotman, Erik H. Hoyer, and Daniel L. Young
- Subjects
Inpatients ,Leadership and Management ,business.industry ,Health Policy ,MEDLINE ,General Medicine ,Walking ,Assessment and Diagnosis ,medicine.disease ,Text mining ,Physical Therapist Assistants ,Early ambulation ,medicine ,Humans ,Fundamentals and skills ,Medical emergency ,business ,Care Planning ,Early Ambulation - Published
- 2018
26. Does Patient Experience Predict 30-Day Readmission? A Patient-Level Analysis of HCAHPS Data
- Author
-
Rehan Qayyum, Amanda Bertram, Nowella Durkin, Daniel J. Brotman, Peter J. Pronovost, Stephen A. Berry, Elizabeth C. Wick, Erik H. Hoyer, Zishan K. Siddiqui, and Lisa Allen
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Leadership and Management ,MEDLINE ,Assessment and Diagnosis ,01 natural sciences ,Tertiary care ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Exposure group ,Risk Factors ,Patient experience ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Care Planning ,Aged ,Retrospective Studies ,Academic Medical Centers ,business.industry ,Health Policy ,010102 general mathematics ,Retrospective cohort study ,General Medicine ,Middle Aged ,Logistic Models ,Patient Satisfaction ,Health Care Surveys ,Emergency medicine ,Fundamentals and skills ,Observational study ,Female ,Index hospitalization ,business ,Healthcare providers - Abstract
BACKGROUND Hospital-level studies have found an inverse relationship between patient experience and readmissions. However, based on typical survey response time, it is unclear if patients are able to respond to surveys before they get readmitted and whether being readmitted might be a driver of poor experience scores (reverse causation). OBJECTIVE Using patient-level Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) and Press Ganey data to examine the relationship between readmissions and experience scores and to distinguish between patients who responded before or after a subsequent readmission. DESIGN Retrospective analysis of 10-year HCAHPS data. SETTING Single tertiary care academic hospital. PARTICIPANTS Patients readmitted within 30 days of an index hospitalization who received an HCAHPS survey linked to index admission comprised the exposure group. This group was divided into those who responded prior to readmission and those who responded after readmission. Nonreadmitted patients comprised the control group. ANALYSIS Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors. RESULTS Only 15.8% of the readmitted patients responded to the survey prior to readmission, and their scores were not significantly different from the nonreadmitted patients. The patients who responded after readmission were significantly more dissatisfied with physicians (doctors listened 73.0% vs 79.2%, aOR 0.75, P < .0001), staff responsiveness, (call button 50.0% vs 59.1%, aOR 0.71, P < .0001) pain control, discharge plan, noise, and cleanliness of the hospital. CONCLUSIONS Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.
- Published
- 2018
27. Choosing Wisely Together: Physical and Occupational Therapy Consultation for Acute Neurology Inpatients
- Author
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Holly Russell, Angie Feurer, Margie Burnett, Michael Friedman, Chepkorir Maritim, John C. Probasco, Andre Cassell, Annette Lavezza, H. Adrian Puttgen, Victor C. Urrutia, Hilary Sporney, Tenise Shakes, and Erik H. Hoyer
- Subjects
Occupational therapy ,medicine.medical_specialty ,Neurology ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Original Articles ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Physical therapy ,030212 general & internal medicine ,Neurology (clinical) ,business ,Stroke ,030217 neurology & neurosurgery - Abstract
Background: Although many hospitalized neuroscience patients have physical and occupational therapy (rehabilitation) needs, patients with none or minimal physical impairments frequently receive rehabilitation consultation, diverting from patients with greatest need. Methods: A multidisciplinary team on the general and cerebrovascular neurology acute inpatient services mapped the rehabilitation consultation process, resulting in multiple implemented interventions including physician education on appropriate acute rehabilitation consultations, modification of multidisciplinary rounds, and discussion of patient rehabilitation needs throughout hospitalization. Nurses used the same functional impairment measurement tool used by physical and occupational therapists, the Activity Measure for Post-Acute Care Inpatient Short Forms (Basic Mobility and Activity domains). Results: The rate for initial rehabilitation consults for patients with no limitations in mobility or activity during the 6-month baseline period was 12%, which was decreased to 7% and 10% during the 6-month intervention and sustain periods, respectively ( P < .001). The baseline rate for patients with no limitations receiving both physical therapy and occupational therapy consultations was 62% and was decreased to 21% and 39% in the intervention and sustain periods, respectively ( P < .001). Rehabilitation sessions per hospital day increased for patients with high functional impairments, from 0.52 at baseline to 0.64 in the intervention and 0.66 in the sustain periods ( P = .02), which equated to 1 more rehabilitation visit per patient hospitalization. Conclusions: A multifaceted intervention led to improved utilization of acute inpatient rehabilitation consultation while increasing the frequency of rehabilitation treatment for patients with highest functional impairment.
- Published
- 2018
28. Reconsidering Hospital Readmission Measures
- Author
-
Peter J. Pronovost, Amy Deutschendorf, Erik H. Hoyer, and Daniel J. Brotman
- Subjects
medicine.medical_specialty ,Leadership and Management ,Hospital quality ,MEDLINE ,Assessment and Diagnosis ,Patient Readmission ,Centers for Medicare and Medicaid Services, U.S ,03 medical and health sciences ,0302 clinical medicine ,Bias ,030225 pediatrics ,medicine ,Humans ,Hospital Mortality ,Quality of care ,Care Planning ,Quality Indicators, Health Care ,Hospital readmission ,business.industry ,Health Policy ,General Medicine ,Hospitals ,United States ,Harm ,SOCIOECONOMICALLY DISADVANTAGED ,Quality rating ,030220 oncology & carcinogenesis ,Emergency medicine ,Fundamentals and skills ,business ,Medicaid - Abstract
Current hospital readmission measures are part of the Centers for Medicare & Medicaid Services Five-Star Quality Rating System but are inadequate for reporting hospital quality. We review potential biases in the readmission measures and offer policy recommendations to address these biases. Hospital readmission rates are influenced by multiple sources of variation (eg, mix of patients served, bias in the performance measure); true differences in quality of care are often a much smaller source of this variation. Thus, variation from caring for large proportions of socioeconomically disadvantaged or tertiary-care patients will bias a hospital's ratings. Ratings aside, readmission measures may indirectly harm patients because low readmission rates do not correlate with reduced mortality, yet the Five-Star Quality Rating System weighs readmission equally with mortality. We propose that hospital quality rankings not use readmission measures as currently constructed.
- Published
- 2017
29. Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project
- Author
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Erik H. Hoyer, Lisa M. Klein, Du Feng, Annette Lavezza, Kelly N. Daley, Stephanie Hiser, and Daniel L. Young
- Subjects
medicine.medical_specialty ,Quality management ,Health Status ,Decreased mobility ,Patient Care Planning ,law.invention ,Unit (housing) ,InformationSystems_GENERAL ,03 medical and health sciences ,0302 clinical medicine ,law ,Medicine ,Humans ,030212 general & internal medicine ,General Nursing ,Moving and Lifting Patients ,business.industry ,Standardized approach ,Quality Improvement ,Goal attainment ,Mobility Limitation ,Calculator ,Usual care ,Baltimore ,Physical therapy ,business ,030217 neurology & neurosurgery - Abstract
Background Hospital-acquired functional decline due to decreased mobility has negative impacts on patient outcomes. Current nurse-directed mobility programs lack a standardized approach to set achievable mobility goals. Purpose We aimed to describe implementation and outcomes from a nurse-directed patient mobility program. Method The quality improvement mobility program on the project unit was compared to a similar control unit providing usual care. The Johns Hopkins Mobility Goal Calculator was created to guide a daily patient mobility goal based on the level of mobility impairment. Findings On the project unit, patient mobility increased from 5.2 to 5.8 on the Johns Hopkins Highest Level of Mobility score, mobility goal attainment went from 54.2% to 64.2%, and patients exceeding the goal went from 23.3% to 33.5%. All results were significantly higher than the control unit. Discussion An individualized, nurse-directed, patient mobility program using daily mobility goals is a successful strategy to improve daily patient mobility in the hospital.
- Published
- 2017
30. Toward a Common Language for Measuring Patient Mobility in the Hospital: Reliability and Construct Validity of Interprofessional Mobility Measures
- Author
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Erik H. Hoyer, Stephanie Hiser, Julie Kreif, Kara Shumock, Annette Lavezza, Lisa M. Klein, Daniel L. Young, Dale M. Needham, Michael Friedman, Kitty S. Chan, and Alan M. Jette
- Subjects
Adult ,Male ,medicine.medical_specialty ,Activities of daily living ,Intraclass correlation ,Nurses ,Physical Therapy, Sports Therapy and Rehabilitation ,Walk Test ,03 medical and health sciences ,Disability Evaluation ,0302 clinical medicine ,Terminology as Topic ,Activities of Daily Living ,medicine ,Humans ,030212 general & internal medicine ,Mobility Limitation ,Reliability (statistics) ,Aged ,Observer Variation ,Patient Care Team ,Hand Strength ,Communication ,Construct validity ,Reproducibility of Results ,Middle Aged ,humanities ,Hospitals ,Test (assessment) ,Physical Therapists ,Inter-rater reliability ,Convergent validity ,Scale (social sciences) ,Physical therapy ,Female ,Psychology ,human activities ,030217 neurology & neurosurgery ,Subacute Care - Abstract
Background The lack of common language among interprofessional inpatient clinical teams is an important barrier to achieving inpatient mobilization. In The Johns Hopkins Hospital, the Activity Measure for Post-Acute Care (AM-PAC) Inpatient Mobility Short Form (IMSF), also called “6-Clicks,” and the Johns Hopkins Highest Level of Mobility (JH-HLM) are part of routine clinical practice. The measurement characteristics of these tools when used by both nurses and physical therapists for interprofessional communication or assessment are unknown. Objective The purposes of this study were to evaluate the reliability and minimal detectable change of AM-PAC IMSF and JH-HLM when completed by nurses and physical therapists and to evaluate the construct validity of both measures when used by nurses. Design A prospective evaluation of a convenience sample was used. Methods The test-retest reliability and the interrater reliability of AM-PAC IMSF and JH-HLM for inpatients in the neuroscience department (n = 118) of an academic medical center were evaluated. Each participant was independently scored twice by a team of 2 nurses and 1 physical therapist; a total of 4 physical therapists and 8 nurses participated in reliability testing. In a separate inpatient study protocol (n = 69), construct validity was evaluated via an assessment of convergent validity with other measures of function (grip strength, Katz Activities of Daily Living Scale, 2-minute walk test, 5-times sit-to-stand test) used by 5 nurses. Results The test-retest reliability values (intraclass correlation coefficients) for physical therapists and nurses were 0.91 and 0.97, respectively, for AM-PAC IMSF and 0.94 and 0.95, respectively, for JH-HLM. The interrater reliability values (intraclass correlation coefficients) between physical therapists and nurses were 0.96 for AM-PAC IMSF and 0.99 for JH-HLM. Construct validity (Spearman correlations) ranged from 0.25 between JH-HLM and right-hand grip strength to 0.80 between AM-PAC IMSF and the Katz Activities of Daily Living Scale. Limitations The results were obtained from inpatients in the neuroscience department of a single hospital. Conclusions The AM-PAC IMSF and JH-HLM had excellent interrater reliability and test-retest reliability for both physical therapists and nurses. The evaluation of convergent validity suggested that AM-PAC IMSF and JH-HLM measured constructs of patient mobility and physical functioning.
- Published
- 2017
31. Association of impaired functional status at hospital discharge and subsequent rehospitalization
- Author
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Erik H. Hoyer, Levan Atanelov, Brenda Knox, Daniel J. Brotman, Dale M. Needham, and Michael Friedman
- Subjects
medicine.medical_specialty ,Activities of daily living ,Leadership and Management ,business.industry ,Health Policy ,Retrospective cohort study ,General Medicine ,Assessment and Diagnosis ,medicine.disease ,3. Good health ,Acute care ,Severity of illness ,Health care ,medicine ,Fundamentals and skills ,Risk factor ,Intensive care medicine ,business ,Care Planning ,Chi-squared distribution ,Stroke - Abstract
Federally mandated pay-for-performance initiatives promote minimizing 30-day hospital readmissions to improve healthcare quality and reduce costs. Although the reasons for readmissions are multifactorial, many patients are readmitted for a condition other than their initial hospital admitting diagnosis.1 Impairments in functional status experienced during acute care hospitalization contribute to patients being discharged in a debilitated state and being vulnerable to postdischarge complications and potentially hospital read-mission.2 As such, decreased functional status may be an important and potentially modifiable risk factor for acute care hospital readmission.3 Previous studies have suggested that impaired functional status may be an important predictor of rehospitalization.4–7 However, inferences from existing studies are limited because they did not consider functional status as their primary focus, they only considered specific patient populations (eg, stroke) or readmissions occurring well beyond the 30-day period defined by federal pay-for-performance standards.4–6,8–10 Our objective was to evaluate the association between functional status near the time of discharge from acute care hospital and 30-day readmission for patients admitted to an acute inpatient rehabilitation facility. As a secondary objective, we sought to investigate the relationship between functional status and readmission by diagnostic category (medical, neurologic, or orthopedic).
- Published
- 2014
32. Poster 457-C Towards Reducing Harms: Designing a Quality Improvement Project to Improve Pain Management and Outcomes Among Chronic Pain and Opioid Users in an Acute Rehabilitation Program
- Author
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Charles A. Odonkor, Erik H. Hoyer, Ada Yao, Solomon Rojhani, Teresa Tang, and Lee Ann Sprankle
- Subjects
medicine.medical_specialty ,Rehabilitation ,Quality management ,business.industry ,medicine.medical_treatment ,Chronic pain ,Physical Therapy, Sports Therapy and Rehabilitation ,Pain management ,medicine.disease ,Neurology ,Opioid ,medicine ,Physical therapy ,Neurology (clinical) ,business ,medicine.drug - Published
- 2016
33. Promoting Early Mobility for Hospitalized Patients: A Quality Improvement (QI) Project
- Author
-
Erik H. Hoyer and Levi Levan Atanelov
- Subjects
medicine.medical_specialty ,Quality management ,Process management ,SMART criteria ,business.industry ,Hospitalized patients ,DMAIC ,Six Sigma ,Context (language use) ,Sample (statistics) ,Scientific evidence ,Physical therapy ,Medicine ,business - Abstract
This chapter provides a sample case of developing a quality improvement project to encourage mobility in hospitalized patients. This chapter is unique in that it provides a perspective from both a resident and an attending in order to help delineate differences in commitment between these two roles. This chapter also explains the basic structure utilized in the book for other sample projects. SBAR template (see below) will be used to provide the motivation for the project and DMAIC template (see below) will be used to communicate the project implementation. SBAR will provide the context for the quality improvement opportunity, which often can be identified as a gap between current scientific evidence and present-day clinical practice. Each of the subsections below will be subdivided into What and How sections. What section describes goals and conclusions. How section illustrates how these were reached/accomplished.
- Published
- 2016
34. Poster 135: Implementing an Opioid Risk Reduction Program in a Comprehensive Inpatient Rehabilitation Unit
- Author
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Stephanie P. Van, Nicholas Dabai, Ada Lyn Yao, Alexis M. Coslick, Amira A. Noles, Erik H. Hoyer, Margaret Kott, and Teresa Tang
- Subjects
medicine.medical_specialty ,business.industry ,Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Unit (housing) ,Reduction (complexity) ,Neurology ,Opioid ,Emergency medicine ,medicine ,Neurology (clinical) ,business ,Inpatient rehabilitation ,medicine.drug - Published
- 2018
35. Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland
- Author
-
Erik H. Hoyer, Charles A. Odonkor, Sumit N. Bhatia, Curtis Leung, Amy Deutschendorf, and Daniel J. Brotman
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Leadership and Management ,Assessment and Diagnosis ,Logistic regression ,01 natural sciences ,Patient Readmission ,Odds ,03 medical and health sciences ,0302 clinical medicine ,Acute care ,Health care ,Medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Care Planning ,Retrospective Studies ,Maryland ,business.industry ,Health Policy ,010102 general mathematics ,Retrospective cohort study ,General Medicine ,Odds ratio ,Length of Stay ,Middle Aged ,Confidence interval ,Patient Discharge ,Hospital medicine ,Emergency medicine ,Fundamentals and skills ,Female ,business - Abstract
OBJECTIVE Hospital discharge summaries can provide valuable information to future providers and may help to prevent hospital readmissions. We sought to examine whether the number of days to complete hospital discharge summaries is associated with 30-day readmission rate. PATIENTS AND METHODS This was a retrospective cohort study conducted on 87,994 consecutive discharges between January 1, 2013 and December 31, 2014, in a large urban academic hospital. We used multivariable logistic regression models to examine the association between days to complete the discharge summary and hospital readmissions while controlling for age, gender, race, payer, hospital service (gynecology–obstetrics, medicine, neurosciences, oncology, pediatrics, and surgical sciences), discharge location, length of stay, expected readmission rate in Maryland based on diagnosis and illness severity, and the Agency for Healthcare Research and Quality Comorbidity Index. Days to complete the hospital discharge summary—the primary exposure variable—was assessed using the 20th percentile (>3 vs ≤3 days) and as a continuous variable (odds ratio expressed per 3-day increase). The main outcome was all-cause readmission to any acute care hospital in Maryland within 30 days. RESULTS Among the 87,994 patients, there were 14,248 (16.2%) total readmissions. Discharge summary completion >3 days was significantly associated with readmission, with adjusted odds ratio (OR) (95% confidence interval [CI]) of 1.09 (1.04 to 1.13, P = 0.001). We also found that every additional 3 days to complete the discharge summary was associated with an increased adjusted odds of readmission by 1% (OR: 1.01, 95% CI: 1.00 to 1.01, P < 0.001). CONCLUSION Longer days to complete discharge summaries were associated with higher rates of all-cause hospital readmissions. Timely discharge summary completion time may be a quality indicator to evaluate current practice and as a potential strategy to improve patient outcomes. Journal of Hospital Medicine 2016;11:393–400. 2016 Society of Hospital Medicine
- Published
- 2015
36. Promoting mobility and reducing length of stay in hospitalized general medicine patients: A quality-improvement project
- Author
-
Judy L. Skolnik, Robin Lewis-Cherry, Sherrie P. Byers, Levan Atanelov, Michael Friedman, Daniel J. Brotman, Annette Lavezza, Dale M. Needham, Elizabeth Colantuoni, Kathleen Wagner‐Kosmakos, and Erik H. Hoyer
- Subjects
Gerontology ,Male ,medicine.medical_specialty ,Quality management ,Leadership and Management ,medicine.medical_treatment ,Population ,MEDLINE ,Length of hospitalization ,Walking ,Assessment and Diagnosis ,Physical function ,Bed rest ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,030212 general & internal medicine ,education ,Care Planning ,Generalized estimating equation ,education.field_of_study ,business.industry ,Health Policy ,General Medicine ,Length of Stay ,Middle Aged ,Quality Improvement ,Patient Discharge ,Hospital medicine ,Hospitalization ,Physical therapy ,Fundamentals and skills ,Female ,business ,030217 neurology & neurosurgery - Abstract
To determine whether a multidisciplinary mobility promotion quality-improvement (QI) project would increase patient mobility and reduce hospital length of stay (LOS).Implemented using a structured QI model, the project took place between March 1, 2013 and March 1, 2014 on 2 general medicine units in a large academic medical center. There were 3352 patients admitted during the QI project period. The Johns Hopkins Highest Level of Mobility (JH-HLM) scale, an 8-point ordinal scale ranging from bed rest (score = 1) to ambulating ≥250 feet (score = 8), was used to quantify mobility. Changes in JH-HLM scores were compared for the first 4 months of the project (ramp-up phase) versus 4 months after project completion (post-QI phase) using generalized estimating equations. We compared the relative change in median LOS for the project months versus 12 months prior among the QI units, using multivariable linear regression analysis adjusting for 7 demographic and clinically relevant variables.Comparing the ramp-up versus post-QI phases, patients reaching JH-HLM's ambulation status increased from 43% to 70% (P0.001), and patients with improved JH-HLM mobility scores between admission and discharge increased from 32% to 45% (P0.001). For all patients, the QI project was associated with an adjusted median LOS reduction of 0.40 (95% confidence interval [CI]: -0.57 to -0.21, P 0.001) days compared to 12 months prior. A subgroup of patients expected to have a longer LOS (expected LOS7 days), were associated with a significantly greater adjusted median reduction in LOS of 1.11 (95% CI: -1.53 to -0.65, P0.001) days. Increased mobility was not associated with an increase in injurious falls compared to 12 months prior on the QI units (P = 0.73).Active prevention of a decline in physical function that commonly occurs during hospitalization may be achieved with a structured QI approach. In an adult medicine population, our QI project was associated with improved mobility, and this may have contributed to a reduction in LOS, particularly for more complex patients with longer expected hospital stay. Journal of Hospital Medicine 2016. © 2016 Society of Hospital Medicine.
- Published
- 2015
37. Associations between hospital‐wide readmission rates and mortality measures at the hospital level: Are hospital‐wide readmissions a measure of quality?
- Author
-
Daniel J. Brotman, Curtis Leung, Erik H. Hoyer, Diane Lepley, and Amy Deutschendorf
- Subjects
medicine.medical_specialty ,Leadership and Management ,media_common.quotation_subject ,030204 cardiovascular system & hematology ,Assessment and Diagnosis ,Patient Readmission ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Quality (business) ,Hospital Mortality ,030212 general & internal medicine ,Care Planning ,Quality Indicators, Health Care ,media_common ,Measure (data warehouse) ,business.industry ,Health Policy ,Hospital level ,General Medicine ,medicine.disease ,Hospitals ,Emergency medicine ,Fundamentals and skills ,Medical emergency ,business - Published
- 2016
38. Using a Real-Time Location System for Assessment of Patient Ambulation in a Hospital Setting
- Author
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Erik H. Hoyer, Julie Kreif, David Bychkov, Stephanie Hiser, In Cheol Jeong, Peter C. Searson, and Lisa M. Klein
- Subjects
Adult ,Male ,medicine.medical_specialty ,Validation study ,Hospital setting ,medicine.medical_treatment ,Physical Therapy, Sports Therapy and Rehabilitation ,Walking ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Physical medicine and rehabilitation ,Computer Systems ,Humans ,Medicine ,030212 general & internal medicine ,Physical Therapy Modalities ,Aged ,Inpatients ,Rehabilitation ,business.industry ,Location systems ,Middle Aged ,University hospital ,Actigraphy ,Real-time locating system ,Walk test ,Physical therapy ,Female ,Nervous System Diseases ,CRITERION STANDARD ,business ,030217 neurology & neurosurgery - Abstract
To assess the feasibility of using an infrared-based Real-Time Location System (RTLS) for measuring patient ambulation in a 2-minute walk test (2MWT) by comparing the distance walked and the Johns Hopkins Highest Level of Mobility (JH-HLM) score to clinician observation as a criterion standard.Criterion standard validation study.Inpatient, university hospital.Patients (N=25) in an adult neuroscience/brain rescue unit.Not applicable.RTLS and clinician-reported ambulation distance in feet, and JH-HLM score on an 8-point ordinal scale.The RTLS ambulation distance for the 25 patients in the 2MWT was between 68 and 516ft. The mean difference between clinician-reported and RTLS ambulation distance was 8.4±11.7ft (2.7%±4.6%). The correlation between clinician-reported and RTLS ambulation distance was 97.9% (P.01). The clinician-reported ambulation distance for 2 patients was +100ft and -99ft compared with the RTLS distance, implying clinician error in counting the number of laps (98ft). The correlation between the RTLS distance and clinician-reported distance excluding these 2 patients is 99.8% (P.01). The accuracy of the RTLS for assessment of JH-HLM score for all 25 patients was 96%. The average patient speed obtained from RTLS data varied between 0.4 and 3.0mph.The RTLS is able to accurately measure patient ambulation and calculate JH-HLM for a 2MWT when compared with clinician observation as the criterion standard.
- Published
- 2017
39. Barriers to early mobility of hospitalized general medicine patients: survey development and results
- Author
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Erik H. Hoyer, Kitty S. Chan, Daniel J. Brotman, and Dale M. Needham
- Subjects
medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,Quality management ,Multivariate analysis ,Cross-sectional study ,Attitude of Health Personnel ,medicine.medical_treatment ,MEDLINE ,Physical Therapy, Sports Therapy and Rehabilitation ,Health knowledge ,Nursing Staff, Hospital ,Article ,InformationSystems_GENERAL ,medicine ,Humans ,Early Ambulation ,Rehabilitation ,business.industry ,Evidence-based medicine ,Quality Improvement ,Physical Therapists ,Cross-Sectional Studies ,Family medicine ,Health Care Surveys ,Multivariate Analysis ,Functional status ,business - Abstract
Functional status decline commonly accompanies hospitalization making patients vulnerable to complications. Such decline can be mitigated through hospital-based early mobility programs. Success in implementing patient mobility quality improvement processes requires evaluating providers' knowledge, attitudes, and behaviors.A cross-sectional, self-administered survey in two different hospital settings was completed by 120 nurses and physical and occupational therapists (rehabilitation therapists, 38; nurses, 82) from six general medicine units. The survey was developed using published guidelines, literature review, and provider meetings and refined through pilot testing. Psychometric properties were assessed, and regression analyses were conducted to examine barriers to early mobility by hospital site, provider discipline, and years of experience.Internal consistency reliability, item consistency, and discriminant validity psychometric characteristics were acceptable. In multivariable regression analysis, overall perceived barriers were similar between the two hospitals (P = 0.25) and significantly higher for staff with less experience (P = 0.02) and for nurses vs. rehabilitation therapists (P0.001).The survey identified specific barriers common to both nurses and rehabilitation therapists and other barriers that were discipline specific.This novel survey identified important barriers to mobilizing medical inpatients that were similar across two hospital settings. These results can assist with the implementation of quality improvement projects for increasing early hospital-based patient mobility.
- Published
- 2014
40. Functional status impairment is associated with unplanned readmissions
- Author
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Erik H. Hoyer, Dale M. Needham, Amy Deutschendorf, Michael Friedman, Jason Miller, and Daniel J. Brotman
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Adult ,Male ,medicine.medical_specialty ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,Patient Readmission ,Article ,Disability Evaluation ,Acute care ,Internal medicine ,Severity of illness ,Medicine ,Humans ,Risk factor ,Aged ,Retrospective Studies ,business.industry ,Rehabilitation ,Retrospective cohort study ,Odds ratio ,Length of Stay ,Middle Aged ,Confidence interval ,Patient Discharge ,Propensity score matching ,Physical therapy ,Female ,business - Abstract
Objective To determine whether functional status on admission to a Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP) is associated with unplanned readmission to acute care. Design Retrospective cohort study. Setting Academic hospital-based CIIRP. Participants Consecutive patients (N=1515) admitted to a CIIRP between January 2009 and June 2012. Interventions Patients' functional status, the primary exposure variable, was assessed using tertiles of the total FIM score at CIIRP admission, with secondary analyses using the FIM motor and cognitive domains. A propensity score, consisting of 25 relevant clinical and demographic variables, was used to adjust for confounding in the analysis. Main Outcome Measures Readmission to acute care was categorized as (1) readmission before planned discharge from the CIIRP, (2) readmission within 30 days of discharge from the CIIRP, and (3) total readmissions from both groups, with total readmissions being the a priori primary outcome. Results Among the 1515 patients, there were 347 total readmissions. Total readmissions were significantly associated with FIM scores, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the lowest and middle FIM tertiles versus the highest tertile (AOR=2.6; 95% CI, 1.9–3.7; P P =.002, respectively). There were similar findings for secondary analyses of readmission before planned discharge from the CIIRP (AOR=3.5; 95% CI, 2.2–5.8; P P =.002, respectively), and a weaker association for readmissions after discharge from the CIIRP (AOR=1.6; 95% CI, 1.0–2.4; P =.047 and AOR=1.3; 95% CI, 0.8–1.9; P =.28, respectively). The FIM motor domain score was more strongly associated with readmissions than the FIM cognitive score. Conclusions Functional status on admission to the CIIRP is strongly associated with readmission to acute care, particularly for motor aspects of functional status and readmission before planned discharge from the CIIRP. Efforts to reduce hospital readmissions should consider patient functional status as an important and potentially modifiable risk factor.
- Published
- 2013
41. A Lean Six Sigma quality improvement project to increase discharge paperwork completeness for admission to a comprehensive integrated inpatient rehabilitation program
- Author
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Richard L. Powers, Nathan J. Neufeld, Philippines Cabahug, Erik H. Hoyer, Megha Mehta, N. Colbey Walker, R. Samuel Mayer, and Marlís González-Fernández
- Subjects
Medical Audit ,Total quality management ,Quality management ,Rehabilitation ,business.industry ,Health Policy ,medicine.medical_treatment ,Six Sigma ,Patient Handoff ,Efficiency, Organizational ,Lean manufacturing ,Quality Improvement ,Patient Discharge ,Tertiary Care Centers ,Workflow ,Patient Admission ,Health care ,medicine ,Humans ,Operations management ,Lean Six Sigma ,business ,Total Quality Management - Abstract
Lean Six Sigma (LSS) process analysis can be used to increase completeness of discharge summary reports used as a critical communication tool when a patient transitions between levels of care. The authors used the LSS methodology as an intervention to improve systems process. Over the course of the project, 8 required elements were analyzed in the discharge paperwork. The authors analyzed the discharge paperwork of patients (42 patients preintervention and 143 patients postintervention) of a comprehensive integrated inpatient rehabilitation program (CIIRP). Prior to this LSS project, 61.8% of required discharge elements were present. The intervention improved the completeness to 94.2% of the required elements. The percentage of charts that were 100% complete increased from 11.9% to 67.8%. LSS is a well-established process improvement methodology that can be used to make significant improvements in complex health care workflow issues. Specifically, the completeness of discharge documentation required for transition of care to CIIRP can be improved.
- Published
- 2013
42. Reducing Post-Hospital Syndrome: A Quality Improvement (QI) Project
- Author
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Erik H. Hoyer, R. Samuel Mayer, Levan Atanelov, and Michael Friedman
- Subjects
medicine.medical_specialty ,Quality management ,Neurology ,business.industry ,Rehabilitation ,Medicine ,Physical Therapy, Sports Therapy and Rehabilitation ,Neurology (clinical) ,business ,Intensive care medicine - Published
- 2013
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