Search

Objective. The objective was to use the Activity Measure for Post-Acute Care '6-Clicks' scores at initial physical therapist and/or occupational therapist evaluation to assess (1) predictive ability for community versus institutional discharge, and (2) association with discharge destination (home/self-care [HOME], home health [HHA], skilled nursing facility [SNF], and inpatient rehabilitation facility [IRF]). Methods. In this retrospective cohort study, initial '6-Clicks' Basic Mobility and/or Daily Activity t scores and discharge destination were obtained from electronic health records of 17,546 inpatient admissions receiving physical therapy/occupational therapy at an academic hospital between October 1, 2015 and August 31, 2018. For objective (1), postacute discharge destination was dichotomized to community (HOME and HHA) and institution (SNF and IRF). Receiver operator characteristic curves determined the most predictive Basic Mobility and Daily Activity scores for discharge destination. For objective (2), adjusted odds ratios (OR) from multinomial logistic regression assessed association between discharge destination (HOME, HHA, SNF, IRF) and cut-point scores for Basic Mobility ([less than or equal to]40.78 vs >40.78) and Daily Activity ([less than or equal to]40.22 vs >40.22), accounting for patient and clinical characteristics. Results. Area under the curve for Basic Mobility was 0.80 (95% CI = 0.80-0.81) and Daily Activity was 0.81 (95% CI = 0.80-0.82). The best cut-point for Basic Mobility was 40.78 (raw score = 16; sensitivity = 0.71 and specificity = 0.74) and for Daily Activity was 40.22 (raw score = 19; sensitivity = 0.68 and specificity = 0.79). Basic Mobility and Daily Activity were significantly associated with discharge destination, with those above the cut-point resulting in increased odds of discharge HOME. The Basic Mobility scores [less than or equal to]40.78 had higher odds of discharge to HHA (OR = 1.7 [95% CI = 1.5-1.9]), SNF (OR = 7.8 [95% CI = 6.8-8.9]), and IRF (OR = 7.5 [95% CI = 6.3-9.1]), and the Daily Activity scores [less than or equal to]40.22 had higher odds of discharge to HHA (OR = 1.8 [95% CI = 1.7-2.0]), SNF (OR = 8.9 [95% CI = 7.9-10.0]), and IRF (OR = 11.4 [95% CI = 9.7-13.5]). Conclusion. 6-Clicks at physical therapist/occupational therapist initial evaluation demonstrated good prediction for discharge decisions. Higher scores were associated with discharge to HOME; lower scores reflected discharge to settings with increased support levels. Impact. Initial Basic Mobility and Daily Activity scores are valuable clinical tools in the determination of discharge destination. Keywords: Activities of Daily Living, Acute Care, Case Management, Outcome Assessment (Health Care), Patient Discharge, Introduction Implementation of health care cost containment measures, such as the Inpatient Prospective Payment System (1) and Hospital Readmissions Reduction Program, (2) has forced inpatient facilities to optimize care and [...]

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty., This clinical practice guideline (CPG) is based on a systematic review of published studies with regard to the physical therapist management of patients undergoing total knee arthroplasty. In addition to [...]

Supply chain managers are overwhelmed with choices and information. Too often the result isn't decisiveness, but gridlock. The answer: Put in place strong leadership that gets to the choices that [...]

Background and Purpose. Early physical functional changes after gastric bypass surgery (GBS) are unclear, and the relationship between these changes and health-related quality of life (HR-QOL) has not been reported. We measured distances from a 6-minute walk test (6MWT) and scores on the 36-Item Short-Form Health Survey (SF-36) before and after GBS. Subjects and Methods. Twenty-five people undergoing GBS completed the SF-36 and 6MWT presurgically and at the 3-month and 6-month follow-up visits. Ratings of perceived exertion (RPE) were measured during 6MWTs. Results. Presurgical walking distance ([bar.X] ± SD; 414.1 ± 103.7 m) was 55% ± 14% of normative values. Distances increased significantly at 3 months (505.2 ± 98.0 m) and at 6 months (551.5 ± 101.2 m). Final RPEs decreased significantly, and HR-QOL improved significantly. Both physical and mental health components of the SF-36 improved significantly. Distance was inversely correlated with body mass throughout the study and positively correlated with the SF-36 Physical Component Summary change from 3 to 6 months. Discussion and Conclusions. Improved functional capacity was associated with enhanced HR-QOL. At 6 months, walking distances remained 75% of those for age-matched peers who had normal weight., Obesity prevalence is rapidly rising to epidemic proportions in the United States, resulting in a corresponding increase in health care costs. (1-3) Estimates from the World Health Organization indicate that [...]

Successful outsourcing of supply chain activities has as much to do with the kind of relationship developed as it does with the details of the operational execution. When the provider [...]

Once you have selected the best provider for your outsourcing initiative, you will be eager to move forward. You will have plans, deadlines, and products, and your company will be [...]

There is a lot of hype and emotion surrounding the topic of outsourcing. Every day, I see an article or column strongly in favor of outsourcing and almost as often [...]

EDITOR'S NOTE: This column is the third in a series of columns based on the book, Future Capable Company: What Manufacturing Leaders Need To Do Today To Succeed Tomorrow, by [...]

I have a problem with people who tout the benefits of supply chain management (SCM). They say it can help you reduce inventory by up to 60 percent. The problem [...]

Setting and sharing goals can be a very valuable activity within the family environment. Each member of the family can set personal goals for the year ahead, while the family as a whole can choose a word of the year around which to focus its goals. Sharing goals with other members of the family ensures that individuals gain support for their personal growth, with the family working as a single unit for the success of each of its members. The goals approach also serves as a communications tool among members of the family.

The Genesis Enterprise is a new management model which allows units to retain optimum performance by reacting positively to change and its demands. The Genesis Enterprise relies on the quality of leadership supplied by managers, as leaders rather than managers. This means that the direction, commitment and ability to react to change emanates from the leader and filters down effectively to unit members. The system also relies heavily on team-based organizations to respond effectively to changes.

Three corporate leaders talk about their experiences in drawing from academia to add to the board mix. The success of a board is highly dependent on its composition - who [...]

Companies should consider several factors when making purchasing decisions regarding material handling systems. Systems should be capable of adjusting to changing market demands and produce a competitive advantage. Purchasing agents should interview project managers and programmers and consider maintenance issues to determine whether a particular system meets the needs of the company., You can't afford to buy material handling equipment any more. You should be investing in solutions. The idea of buying a technology goes out the window once you dedicate yourself [...]

Significant advancements in the area of material handling have resulted in major improvements in total facility efficiency, effectiveness, flexibility and modularity. However, it seems that the material handling function has become too dependent on fads as facilitators of growth. Professionals who are involved in planning, designing, implementing and operating material handling systems should veer away from this orientation and focus on longer-term trends. These can serve as guides in the pursuit of long-term success of material handling operations. The trends that are expected to have an impact on material handling systems in the future are reliability, total integration, automated identification, flexibility and modularity, ease of use, upgradeability, and maintainability., The last several decades have been a time of explosive growth for the field of material handling. This growth has undoubtedly helped fuel the gains in total facility efficiency, effectiveness, [...]