Date of Award
Doctor of Philosophy
Interdisciplinary Health Sciences
Dr. Linda Shuster
Dr. Mackenzi Pergolotti
Dr. Ben Atchison
Quality of care, acute settings, post-acute settings
According to the Centers for Medicare and Medicaid (CMS), over the next 7 years, U.S. national healthcare spending is projected to grow at an average of 5.7% per year, up from 4.8% in 2019. Additionally, personal health care cost is expected to increase by 2.7% per year. As a result, there have been increased efforts among healthcare systems and hospital organizations to improve quality of care while decreasing healthcare cost. The research reported in this dissertation builds upon the existing literature regarding interventions to improve hospital performance and quality metrics. Two of the most researched and effective strategies for improving hospital per-formance and quality of care include predictive modeling and care coordination. Predictive models utilize historical data to predict the probability of an outcome, while care coordination organizes information among health care providers to deliver appropriate services to a patient. One aim of this research was to explore modifiable risk factors associated with quality metrics utilizing predictive modeling. A second aim was to explore the role of occupational therapists (OTs) in care coordination. Effective care coordination has been shown to lead to better patient outcomes and decreased healthcare costs.
The first two studies examined a national database of more than 800 inpatient rehabilita-tion facilities (IRFs) to determine patient characteristics predictive of discharge location. An IRF, considered a post-acute facility, is useful in examining modifiable risk factors and quality metrics due to its intensive rehabilitation of patients with various medical conditions. The source of data was the Functional Independence Measure (FIM®), a criterion-referenced measure of disability consisting of 18 items designed to assess the level of assistance an individual requires to perform activities of daily living (ADL). The studies examined how change in function as depicted by FIM® scores, as well as patient characteristics, could predict discharge location from the IRF. Additionally, a third study involved a survey examining OTs’ use of occupational or functional performance assessments in relation to care coordination and discharge planning.
The findings from the first two studies revealed the self-care FIM® subscale scores on admission were an important factor in determining discharge location when only function was considered in the predictive model. When patient characteristics, functional status (depicted by the FIM®), and diagnoses were considered, the admission FIM® motor subscale was the greatest predictor of discharge location followed by the cognitive FIM® subscale across the top five rehabil-itation impairment groups (stroke, brain injury, spinal cord injury, neurological impairment, and orthopedic injury).
The results from the survey indicated OTs utilize an occupational or functional performance assessment for discharge planning and participate in many care coordination activities including advocacy, caregiver education/training, and equipment recommendations. This suggests members from the interdisciplinary rehabilitation team, including OTs, may have a role in discharge planning and care coordination such as family education and interprofessional communication. Further research should continue to examine rehabilitation professionals’ role in care coordination and improving hospital performance, thus impacting quality metrics and healthcare costs.
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VanKoevering, Kelly L., "Methods for Improving Quality of Care within Acute and Post-Acute Settings" (2020). Dissertations. 3556.