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Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population.

ABSTRACT: (1) To examine clinician adherence to a standardized assessment battery across settings (acute hospital, inpatient rehabilitation facilities [IRFs], outpatient facility), professional disciplines (physical therapy [PT], occupational therapy, speech-language pathology), and time of assessment (admission, discharge/monthly), and (2) to evaluate how specific implementation events affected adherence.Retrospective cohort study.Acute hospital, IRF, and outpatient facility with approximately 118 clinicians (physical therapists, occupational therapists, speech-language pathologists).Participants (N=2194) with stroke who were admitted to at least 1 of the above settings. All persons with stroke underwent standardized clinical assessments.Not applicable.Adherence to Brain Recovery Core assessment battery across settings, professional disciplines, and time. Visual inspections of 17 months of time-series data were conducted to see if the events (eg, staff meetings) increased adherence ?5% and if so, how long the increase lasted.Median adherence ranged from .52 to .88 across all settings and professional disciplines. Both the acute hospital and the IRF had higher adherence than the outpatient setting (P?.001), with PT having the highest adherence across all 3 disciplines (P<.004). Of the 25 events conducted across the 17-month period to improve adherence, 10 (40%) resulted in a ?5% increase in adherence the following month, with 6 services (60%) maintaining their increased level of adherence for at least 1 additional month.Actual adherence to a standardized assessment battery in clinical practice varied across settings, disciplines, and time. Specific events increased adherence 40% of the time with those gains maintained for >1 month 60% of the time.

SUBMITTER: Bland MD

PROVIDER: S-EPMC4151176 | biostudies-other | 2013 Jun

REPOSITORIES: biostudies-other

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Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population.

Bland Marghuretta D MD Sturmoski Audra A Whitson Michelle M Harris Hilary H Connor Lisa Tabor LT Fucetola Robert R Edmiaston Jeff J Huskey Thy T Carter Alexandre A Kramper Marian M Corbetta Maurizio M Lang Catherine E CE

Archives of physical medicine and rehabilitation 20130213 6

<h4>Objectives</h4>(1) To examine clinician adherence to a standardized assessment battery across settings (acute hospital, inpatient rehabilitation facilities [IRFs], outpatient facility), professional disciplines (physical therapy [PT], occupational therapy, speech-language pathology), and time of assessment (admission, discharge/monthly), and (2) to evaluate how specific implementation events affected adherence.<h4>Design</h4>Retrospective cohort study.<h4>Setting</h4>Acute hospital, IRF, and ...[more]

PMID: 23415809

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Project description:Background and Purpose- We assessed ethnic differences in medication adherence 3 months poststroke in a population-based study as an initial step in investigating the increased stroke recurrence risk in Mexican Americans compared with non-Hispanic whites. Methods- Ischemic stroke cases from 2008 to 2015 from the Brain Attack Surveillance in Corpus Christi project in Texas were followed prospectively for 3 months poststroke to assess medication adherence. Medications in 5 drug classes were analyzed: statins, antiplatelets, anticoagulants, antihypertensives, and antidepressants. For each drug class, patients were considered adherent if they reported never missing a dose in a typical week. The χ2 tests or Kruskal-Wallis nonparametric tests were used for ethnic comparisons of demographics, risk factors, and medication adherence. A multivariable logistic regression model was constructed for the association of ethnicity and medication nonadherence. Results- Mexican Americans (n=692) were younger (median 65 years versus 68 years, P<0.001), had more diabetes mellitus ( P<0.001) and hypertension ( P<0.001) and less atrial fibrillation ( P=0.003), smoking ( P=0.003), and education ( P<0.001) than non-Hispanic whites (n=422). Sex, insurance status, high cholesterol, previous stroke/transient ischemic attack history, excessive alcohol use, tPA (tissue-type plasminogen activator) treatment, National Institutes of Health Stroke Scale score, and comorbidity index did not significantly differ by ethnicity. There was no significant difference in medication adherence for any of the 5 drug classes between Mexican Americans and non-Hispanic whites. Conclusions- This study did not find ethnic differences in medication adherence, thus challenging this patient-level factor as an explanation for stroke recurrence disparities. Other reasons for the excessive stroke recurrence burden in Mexican Americans, including provider and health system factors, should be explored.

Project description:ObjectiveInpatient rehabilitation represents a critical setting for stroke treatment, providing intensive, targeted therapy and task-specific practice to minimize a patient's functional deficits and facilitate their reintegration into the community. However, impairment and recovery vary greatly after stroke, making it difficult to predict a patient's future outcomes or response to treatment. In this study, the authors examined the value of early-stage wearable sensor data to predict 3 functional outcomes (ambulation, independence, and risk of falling) at rehabilitation discharge.MethodsFifty-five individuals undergoing inpatient stroke rehabilitation participated in this study. Supervised machine learning classifiers were retrospectively trained to predict discharge outcomes using data collected at hospital admission, including patient information, functional assessment scores, and inertial sensor data from the lower limbs during gait and/or balance tasks. Model performance was compared across different data combinations and was benchmarked against a traditional model trained without sensor data.ResultsFor patients who were ambulatory at admission, sensor data improved the predictions of ambulation and risk of falling (with weighted F1 scores increasing by 19.6% and 23.4%, respectively) and maintained similar performance for predictions of independence, compared to a benchmark model without sensor data. The best-performing sensor-based models predicted discharge ambulation (community vs household), independence (high vs low), and risk of falling (normal vs high) with accuracies of 84.4%, 68.8%, and 65.9%, respectively. Most misclassifications occurred with admission or discharge scores near the classification boundary. For patients who were nonambulatory at admission, sensor data recorded during simple balance tasks did not offer predictive value over the benchmark models.ConclusionThese findings support the continued investigation of wearable sensors as an accessible, easy-to-use tool to predict the functional recovery after stroke.ImpactAccurate, early prediction of poststroke rehabilitation outcomes from wearable sensors would improve our ability to deliver personalized, effective care and discharge planning in the inpatient setting and beyond.

Project description:BackgroundThe use of measurement instruments has become a major issue in physical therapy, but their use in daily practice is rare. The aim of this paper is to describe adherence to standardized assessments by physical therapists using a complexity-based model for categorizing rehabilitation (CMCR) at the Clínica Alemana of Santiago, an acute hospital in Chile.MethodsThis retrospective cohort study used 145,968 participant records that were stored in the inpatient database between July 2011 and December 2015. Adherence to the CMCR by 31 physical therapists working with intensive care unit (ICU) and non-ICU inpatients was assessed every quarter using the electronic patient records (EPR). This instrument (CMCR) linked clinical functional assessment to the degree of severity, thereby setting a score used to categorize patients as low, medium and high complexity. 96,400 instances of inpatient care where the physician recommended physical therapy were categorized. This was from a total of 145,968 instances of inpatient care recorded throughout the duration of the study (17 quarters). Trends in adherence were analyzed using a Prais-Winsten regression (a first-order autoregressive model). The trends were compared using a repeated measures ANOVA for mixed models with a significance level of 0.05. The use of the CMCR was included as one of the organization's quality indicators associated with the hospital's accreditation processes.ResultsAdherence increased by 1.48% every quarter (p = 0.005) for both ICU and non-ICU patients. On average, adherence with ICU patients was 16.98% greater than with non-ICU patients. Although adherence was always greater with ICU patients, the rate of increase with non-ICU patients was significantly greater: 1.62% (p = 0.007) vs. 1.28% (p = 0.003), respectively.ConclusionThe CMCR facilitated adherence to standardized assessments by physical therapists working with ICU and non-ICU inpatients in an acute hospital, while linking this instrument to the organization's quality management process proved to be an effective strategy for the duration of this study (17 quarters).

Dataset Information

Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population.

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Clinician adherence to a standardized assessment battery across settings and disciplines in a poststroke rehabilitation population.

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