Deborah L. Wilkerson Early Career Award: Using Clinical Data to Understand Recovery Trajectories and Optimize Patient Care

Abstract

Objectives

For the Deborah L. Wilkerson Award, Dr Alison M. Cogan will report on study that aimed to examine the associations among the time and content of rehabilitation treatment with patient rate of gain in self-care and mobility for adults with acquired brain injury. In the context of the shift to value-based payments for postacute rehabilitation services, it is critical to be able to demonstrate how specific rehabilitation services drive change on relevant patient outcomes.

Design

Retrospective cohort study using electronic health record and billing data. Our team extracted demographic data, functional measures at admission and discharge, and all billed therapy services for patients’ first rehabilitation admission following a brain injury or stroke event.

Setting

Inpatient rehabilitation unit at a large academic medical center.

Participants

A total of 799 (N=799) adults with acquired brain injury who received inpatient rehabilitation services.

Interventions

Standard rehabilitation therapy.

Main Outcome Measures

Average change in self-care and mobility items from the Functional Independence Measure per length of stay day.

Results

Median length of rehabilitation stay was 10 days (interquartile range, 8-13d). Patients received 10.62 units of therapy (SD, 2.05) per day, on average. For self-care care gain per day, the best fitting model accounted for 32% of the variance. Only occupational therapy activities of daily living units were positively associated with gain rate. For mobility gain per day, the best fitting model accounted for 37% of the variance. Higher amounts of physical therapy bed mobility training were inversely associated with both self-care and mobility gain rate.

Conclusions

The transition to a value-based payment model in IRFs will shift more risk of patient outcomes to therapists, and facilities will need to make decisions about costs and service delivery to produce optimal results. In this changing context, rehabilitation teams have an opportunity to utilize their data to support informed decisions about what kinds of rehabilitation therapy drive improved patient outcomes, thus generating better value for patients and meeting facility goals. Dr Cogan will also discuss the benefits and challenges of using electronic health record data in research.

Disclosures

none.