Background: In the current policy environment hospital readmissions are receiving considerable attention due to a provision in the Affordable Care Act (2010), that penalize hospitals through reduced payments for excess readmissions (the hospital readmissions reduction program (HRRP)). This program primarily holds hospitals accountable, although a multitude of factors not directly in control of hospitals can be contributory to readmissions. Of these, whether or not patients are discharged to an appropriate post-discharge care setting can be one contributory factor, and, this study evaluated the association between post-discharge care setting and hospital revisits. Methods: A retrospective analysis of the 2008 Medicare Current Beneficiary Survey (MCBS) was conducted. Three post-discharge care settings were evaluated: 1) routine discharge to home; 2) home with home healthcare; and 3) skilled nursing facility. Two outcomes were assessed: 1) 30-day all-cause hospital readmissions; and 2) 30-day all-cause hospital revisits (combination of inpatient admissions and emergency department visits). Analyses were carried out among patients with hospitalizations for any reason, as well as among a subgroup that were hospitalized for one of seven priority conditions identified in the HRRP. Weighted logistic regression analyses that incorporated information on the complex survey design were conducted. Results: Of the MCBS sample representing 46,048,125 Medicare beneficiaries (unweighted N=11,723), 4.9 percent (N= 2,293,629; unweighted N=670) contributed at least one index hospitalization to the analysis. Among hospitalization for any reason, 30-day all-cause hospital readmissions and revisits was 12.3 percent and 17.8 percent, respectively. The subgroup consisted of 31.8 percent of hospitalizations for any reason (N=730,174; unweighted N=216). Readmissions and revisits in the subgroup were 17.8 percent, and 24.5 percent, respectively. Post-discharge care setting was not significantly associated with either readmissions (P=0.966) or revisits (P=0.728) for hospitalizations for any reason. Findings for the subgroup were similar with no significant association between post-discharge care setting with either readmissions (P=0.850) or revisits (P=0.483). Conclusion: Absence of a difference in readmissions and revisits by post-discharge care setting suggests that the choice of discharge status might be appropriate following an inpatient admission. However, further research with larger sample sizes for conditions in the subgroup both together and separately is recommended.

No description available.

Traumatic brain injury (TBI), also referred to as an acquired brain injury, is caused by damage to the brain as a result of trauma to the head. The following report serves as a resource for patients and families wanting to gain information regarding community integration outcomes after participation in post-acute rehabilitation programs. The goal of the post-acute level of medical care is to increase functionality and serve as a transition for the patient from the rehabilitation facility to life within the community. A thorough examination of community integration after participation in a post-acute rehabilitative program with the use of the Community Integration Questionnaire (CIQ) is provided. After investigation of the available literature, four articles were found to meet inclusion criteria and were included within the review. All studies included met the following criteria. Participants were ages 17 to 65 years old, had a diagnosis of moderate to severe TBI, were enrolled in post-acute rehabilitation, and were assessed with the Community Integration Questionnaire (CIQ). Overall, the available literature suggests that completion of a program within a post-acute facility does create positive outcomes for the individual with TBI; however, the outcomes are dependent on various factors regarding TBI severity, the administration of intervention, the type of intervention, time post-onset and age of participants at the time of onset. Future research is necessary to provide a more comprehensive view of post-acute rehabilitation and the outcomes that these patients may expect as they begin their road to recovery. / text

Brain injury affects nearly 1.5 million people in the United States every year and estimated that 124,000 of those affected will have some form of long-term disability. Impaired Self Awareness (ISA) has been identified as one of the largest obstacles to successful brain injury rehabilitation and adaption to living with a brain injury. Research on the relationship between the awareness of individuals with acquired brain injury (IwABI) and their significant others has been inconsistent. This study examined the role IwABI and their significant others perception concordance&mdashagreement concerning functioning&mdashhas on maintenance of rehabilitation gains at a follow-up date after completion of adolescent brain injury rehabilitation services. Contrary to the hypotheses, the data showed a strong correlation (.872, p&le.01) and significant relationship (t=35, p&le.001) between IwABI and their significant others Functional Area Outcomes Menu (FAOM) scores at follow-up. There was no relationship between functioning at discharge and perception concordance at follow-up or time post-discharge and perception concordance at follow-up. Several explanations for the findings are provided along with suggestions for future investigation of the research subject.

Brain injury has a tremendous effect on the United States. The medical system has a continuum of care available but many of these services are extremely expensive. Despite the effectiveness of residential post-acute brain injury rehabilitation (PABIR) resistance to provide adequate funding remains because of a dearth of randomized controlled trial (RCT) studies demonstrating effectiveness. Some research suggests observational trials are typically more representative of community samples and yield conclusions similar to RCT studies. This study uses a large multi-state naturalistic community-based sample of individuals who received residential PABIR. The purposes of this study were to (1) use logistic regression to identify a model that considered the relationships among the predictor variables to explain treatment outcome for individuals receiving residential PABIR and (2) better understand how self-awareness influences treatment outcome. The final model contained five independent variables (substance use at time of admit, functioning level at time of admit, change in awareness between discharge and admit, admit before or after 6 months post-injury (TPI), and length of stay (LOS) in the program less than or greater than 2 months). The model was statistically significant, ÷2 (5, N=434) = 194.751, p < .001, accounting for 36.2% (Cox & Snell R square) to 61.3% (Nagelkerke R square) of the variance in success rate, and correctly classified 89.4% of cases. Four of the five predictor variables (current substance use, change in awareness, LOS 2 months and TPI 6 months) made statistically significant contributions to the model. The strongest predictor of successful treatment outcome was change in awareness recording an odds ratio of 29.9 indicating that individuals who improved in self-awareness by at least one level were nearly 30 times more likely to be in the successful outcome group, controlling for other factors in the model. Participants were also more likely to be in the successful outcome group if they admitted within 6-months post-injury (5.5x) and stayed longer than 2-months (4.4x). Findings also suggest that active substance use at time of admission did not prevent people from being successful. Importance and implications of these findings are discussed.

No description available.

No / OBJECTIVES: To compare the effects of community hospital care on independence for older people needing rehabilitation with that of general hospital care. DESIGN: Randomized, controlled trial. SETTING: Seven community hospitals and five general hospitals in the midlands and north of England. PARTICIPANTS: Four hundred ninety patients needing rehabilitation after hospital admission with an acute illness. INTERVENTION: Multidisciplinary team care for older people in community hospitals. MEASUREMENTS: The primary outcome was the Nottingham extended activities of daily living scale (NEADL); secondary outcomes were the Barthel Index, Nottingham Health Profile, Hospital Anxiety and Depression Scale, mortality, discharge destination, 6-month residence status, and satisfaction with services. RESULTS: Loss of independence at 6 months was significantly less likely in the community hospital group (mean adjusted NEADL change score group difference 3.27; 95% confidence interval 0.26–6.28; P=.03). The results for the secondary outcome measures were similar for the two groups. CONCLUSION: Postacute community hospital rehabilitation care for older people is associated with greater independence.

No / Purpose. This article contrasts community hospital and general hospital philosophies of care and examines how they relate to patients' and caregivers' experiences. Methods. Semi-structured interviews with 42 staff were used to produce care setting vignettes in six community hospitals and four general hospitals in the midlands and north of England. The vignettes were used with 26 patients and 10 caregivers in semi-structured interviews. Results. Community hospital and general hospital staff identified shared understandings of requirements for post-acute rehabilitation care for older people. Distinctive features were: general hospital – medical efficiency, helping patients get better, high standard of care, need for stimulation; community hospital – homelike setting, quiet, calm ambience, good views, orientated to elderly people, encouragement of social interaction, involvement of relatives in care. In the main there was symmetry between staff aspirations and patients' experience. However some concepts used and assumptions made by staff were not recognised by patients. These were characteristically reframed in patients' answers as if they were discussing subjective dimensions of care. Conclusions. There was patient and caregiver preference for the homelike environment of community hospitals. In care of older people, where the focus is rehabilitation, patient preferences are particularly pertinent and should be considered alongside clinical outcomes and cost-effectiveness.

Background: COVID-19 is a disease caused by the virus SARS-CoV-2. The disease was classified as a pandemic by World Health Organization in March 2020. COVID-19 can cause Post-Acute COVID-19 Syndrome, which is long-term symptoms after the infection itself. Post-COVID can affect health in the long term. Purpose/aim: The aim of this study was to illustrate the patients ́ experiences of living with Post-Acute COVID-19 Syndrome. Method: The method used was a general literature study. Eight articles were used for the study. Results: The result identified the four categories. Experiences of symptoms, experiences of changes in physical health, experiences of changes in social life and experiences of health care. Many patients experienced that they did not have the same energy to do things they had previously been able to do and needed help from close relatives. Conclusion: Due to both Post-COVID and COVID-19 being new diseases, patients experienced a lack of knowledge in the healthcare systems. Patients felt invisible and forgotten as healthcare professionals did not know how to address or care for them. Therefore, there’s a need for further research and increased knowledge regarding the subject in order to improve the quality of healthcare. / Bakgrund: COVID-19 är en sjukdom som orsakas av viruset SARS-CoV- 2. Sjukdomen klassades som en pandemi av World Health Organization i mars 2020. COVID-19 kan orsaka Post-COVID, vilket utgörs av långvariga symtom efter infektionen är utläkt. Post-COVID kan påverka hälsan på lång sikt. Syfte: Syftet var att belysa patienters upplevelser av att leva med Post- COVID. Metod: Metoden som användes var allmän litteraturstudie. Litteraturstudien baserades på åtta resultatartiklar som analyserades. Resultat: Analysen resulterade i fyra olika kategorier: Upplevelser av symtom, upplevelser av förändringar i den psykiska hälsan, upplevelser av förändringar i sociala relationer, samt upplevelser av mötet med vården. I resultatet framkom att vissa patienter orkade inte längre genomföra dagliga sysslor och fick ta hjälp från närstående. Konklusion: Till följd av att både Post-COVID och COVID-19 är nya sjukdomar upplevde patienterna brist på kunskap inom vården. Patienterna kände sig osynliga och bortglömda då vårdpersonal inte visste hur de skulle bemöta eller vårda dem. Det finns därför ett behov av vidare forskning och ökad kunskap kring ämnet för att öka vårdkvaliteten.

The purpose of this study was to explore what makes the interorganizational referral process effective and efficient from the perspectives of acute care referral senders and post acute care referral receivers. The referral process was conceptualized as the classic communication model involving a sender, receiver, information, a communication channel and contextual factors such as formalization and relationships. The hypotheses proposed that the relationships between each of the variables information usefulness, communication channel richness, and degree of formalization affected each of perceived referral process effectiveness and efficiency through the variable ‘relational coordination’. Key informants who either sent referrals from acute care settings or who received them in post acute care inpatient settings were asked to discuss each variable. These results were combined with those of a literature review to develop questionnaires containing a scale with acceptable Chronbach alpha for each. Surveys were disseminated through networks and associations involved in acute and post acute stroke and hip fracture care and in discharge planning and Long Term Care. Useable responses included 114 surveys from referral senders and 171 from referral recipients. Baron and Kenny’s four step test for mediation was used to test the hypotheses. For senders, each of channel richness (adjR2 = 10% p= 0.001), information usefulness (adjR2 = 16% p= 0.000), and formalization (adjR2 = 10% p= 0.000) were significantly related to perceived effectiveness. For channel richness, the relationship with perceived effectiveness was partially mediated by relational coordination (adjR2 = 19% p= 0.001). This was also the case for the relationship between information usefulness and perceived effectiveness (adjR2 = 0.20; p=000). For receivers, channel richness is related to perceived effectiveness through relational coordination (adjR2 = 12% p= 0.003). This was also the case for information usefulness (adjR2 = 13% p= 0.000). In neither group were any of the variables significantly related to efficiency. We may conclude that in the referral process, channel richness and information usefulness are related to perceived effectiveness for both senders and receivers. These may provide an important return on investment if chosen as an areas for referral process improvement, if accompanied by concurrent investments in relational coordination.