In addition to the facility-specific aspects of our study, other limitations were that we collected limited information on the patients who received physical therapist evaluations. Furthermore, supporting the idea that therapists are appropriate in their recommendations, we expected an increased likelihood of hospital readmissions when recommendations were not implemented. Kaplan SL, Coulter C, Fetters L. Developing evidence-based physical therapy clinical practice guidelines. Use your supports (crutches, walker) as directed. WebPHYSICAL THERAPY DISCHARGE OF CHILDREN WITH DCD 307. Go to: Overview Download .nbib Complying With Medicare Signature Requirements fact sheet PR Certification and Recertification of Need for Treatment and Therapy Plans of Care Medicare Benefit Policy Manual, Chapter 15, Section 220.1.3. She reports motionless being incompetent to reach the upper shelf in her cupboards or lift a gallon of Clinical Practice Guidelines A poster presentation of this research was given at the Combined Sections Meeting of the American Physical Therapy Association; February 1720, 2010; San Diego, California. Mismatch with different services than recommended or extra servicesthe patient received home physical therapy instead of recommended outpatient therapy or the patient received home therapy when no follow-up therapy was recommended. Physical Therapy Progress Notes and Discharge Summaries Age was categorized as 35 years, 36 to 55 years, 56 to 70 years, 71 to 84 years, and 85 years. SJ Patients who were part of a mismatch should have been equally likely to be readmitted to our hospital compared with an outside hospital. JJ These cases ultimately reflect a lack of communication between the physical therapist and the practice management coordinator, even though the therapist recommendations were clearly documented in the electronic medical record. Physical National Library of Medicine Two research assistants were trained, using case studies, to access medical records and find the relevant information and enter it into the database. After consent, participating therapists were asked to provide the following background information: total months of practice as an acute care physical therapist, total months and setting of other, nonacute care physical therapist experience, and total months of practice as an acute care physical therapist at University of Michigan Hospital. Overall, physical therapists discharge recommendations were implemented 83% of the time. Therapists often are consulted to work with the patients who are more medically and functionally compromisedpatients who are more likely to have negative outcomes than their less compromised peers. The discharge locations of the patients from whom we collected data were as follows: home without physical therapy (44%), home with home therapy (26%), subacute rehabilitation/SNF (19%), acute rehabilitation (5.5%), expired (2.5%), home with outpatient therapy (2%), and extended care facility without therapy (1%). First, our response variable (readmission) is a dichotomous outcome. Patient refusal of placementthe therapist recommended placement or services, and the patient or his or her legal representative declined. Table 5 shows the results of follow-up hypothesis testing. Information for Consumers - Academy of Acute Care As physical therapists are experts at evaluating functional abilities and are able to incorporate various other factors relevant to discharge planning, it was expected that physical therapists recommendations of patient discharge location would be both accurate and appropriate. Although most mismatches occurred in patients who were ultimately discharged home, mismatches in the other category of reasons for mismatch did include patients who were subsequently discharged to a subacute rehabilitation facility or SNF. ST S Common discharge recommendations are: Home with Home Therapy (OT/PT): Recommendations are to return home with current setup and family support and continued therapy in the home. WebMD The authors thank the physical therapy staff at the University of Michigan Hospital for their participation and support, particularly Casandra Redmon and Lauren Lobert for data collection. Significant Clinical Improvement Was Predicted in a Cohort of Patients with Low Back Pain Early in the Care Process, Building the Science of Physical Therapy: Conundrums and a Wicked Problem, First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization, Learning Health Systems Are Well Suited to Define and Deliver the Physical Therapy Value Proposition, News From the Foundation for Physical Therapy Research, June 2023, Receive exclusive offers and updates from Oxford Academic, Time from admission to physical therapist evaluation (d), Time from physical therapist evaluation to discharge (d), Subacute rehabilitation/skilled nursing facility, Extended care facility, no physical therapy, Missing home physical therapy with recommendation, Received home physical therapy without recommendation, Copyright 2023 American Physical Therapy Association. This study determined how often the therapists recommendations for patient discharge location and services were implemented, representing the accuracy of the recommendations. S Planned admissions allow patients adequate time to confirm insurance benefits and consider discharge needs ahead of time. SJ Hickey Physical therapists in the acute care setting play an important role in the multidisciplinary discharge planning process. a Significantly different risk of readmission compared with match at P<.01. Guidelines Two research assistants were trained, using case studies, to access medical records and find the relevant information and enter it into the database. As 23 of the physical therapists had career experience beyond the acute care setting, the range of acute care experience was the same; however, the mean was lower (mean of 57.5 months of acute care experience). The reported results specified an independent correlation structure. Health care providers should regularly self-monitor for symptoms and respond accordingly. . In addition, some coordinators work with 1 or 2 specific services and make it a point to meet in person with the therapists, whereas other coordinators float among services and do not do so. The physical therapist documents his or her evaluation in the computerized patient medical record. Legal Considerations This publication was made possible with support from the Oregon Clinical and Translational Research Institute; grant UL1 RR024140 01 from the National Center for Research Resources, a component of the National Institutes of Health (NIH); and the NIH Roadmap for Medical Research. Acute care physical therapists contribute to the complex process of patient discharge planning. The University of Michigan Hospital is a 700-bed acute care teaching hospital. Although all physical therapist recommendations are consistently documented in the medical record in a standard manner, the remaining discharge process varies in how communication is exchanged. Does functional decline prompt emergency department visits and admission in older patients? . This retrospective study included the discharge recommendations of 40 acute care physical therapists for 762 patients in a large academic medical center. The predictor variables we included in the model were mismatch status, patient age, length of admission, and discharge location. Webgoals or when the physical therapist determines that the patient/client will no longer benefit from physical therapy. The initial parts of the process are standard; practice management coordinators use a screening form based on the factors associated with poor discharge outcomes to screen all admitted patients and identify those who are at increased risk for poor discharge outcomes. The therapist does an initial evaluation, with the exact procedures varying according to the ability of the patient to participate. Overall, readmission for any reason reflects a failure of the discharge plan, which may have been avoided with proper supportive postdischarge care. Dr Smith is supported by a National Institute of Aging Institutional Training Grant to Jeri Janowsky (principal investigator). CS TM We used Microsoft Excel software (Microsoft Office 2007)* for database formation and SPSS software (versions 16.0 and 17.0) for statistical analyses. B. SPSS Inc, 233 S Wacker Dr, Chicago, IL 60606. Additional evidence of discharge planning as a complex process is the lack of use of standardized quantitative measures to determine discharge recommendations. , et al. , et al. Patient refusal of placementthe therapist recommended placement or services, and the patient or his or her legal representative declined. When the discharge recommendation was not implemented and recommended follow-up services were not received, patients were 2.9 times more likely to be readmitted to our hospital within 30 days of discharge. Keck DL Future research, with a larger sample size, could investigate how clinical experience influences the accuracy of discharge recommendations of acute care physical therapists. Another aspect of containing health care costs relates to the employment of physical therapists in the acute care setting. Patients whose therapist discharge recommendations were not implemented and who received different services or extra services were not significantly more likely to be readmitted than patients with a match (mismatch with different services versus match, OR=1.42, 95% CI=0.792.56). To establish diagnoses, prognoses, and plans of care, physical therapists perform evaluations, synthesizing the examination data and determining whether the problems to be addressed are within the scope of physical therapist practice. Limited information about the patients was collected, and data on patient readmission to other facilities were not collected. The discharge summary is required for each episode of outpatient therapy treatment. Beyond the basic discharge planning process, some service areas of the hospital follow additional procedures that increase in-person communication between health care providers. Federal government websites often end in .gov or .mil. A study by Mamon and colleagues6 showed that multidisciplinary discharge planning efforts led by formal case managers appeared to be significantly more effective in arranging home nursing care and rehabilitation services than informal discharge planning; however, patients still often reported these and other needs were unmet after discharge. The frequency of mismatch between the physical therapist's recommendation and the patient's actual discharge location and services was calculated. An alpha level of .05 was used for all hypothesis testing. We accessed the medical records of all patients who received a physical therapist evaluation during our study period. In an effort to assess these many factors, formal discharge planning in the United States often is practiced as a collaborative, multidisciplinary effort led by a case manager, particularly for patients identified as having an increased risk for poor outcomes.4,5 Although the shift toward collaborative discharge planning has improved patient outcomes, there remains room for further improvement. Acute Care Physical Therapy WebMD Perhaps practice management coordinators need to screen patients for formal discharge planning needs at discharge or after discharge, not just at admission. Patients lacking necessary follow-up services are a problem that needs to be addressed, as our findings show that when physical therapist discharge recommendations were not implemented and recommended follow-up services were not received, patients were 2.9 times more likely to be readmitted to our hospital. Objective: Acute care physical therapists recommend discharge locations and services in part to help prevent falls during post-discharge recovery. Overall readmission rate was 18%, and patients discharged to extended care facilities without physical therapy were significantly more likely to be readmitted to the hospital within 30 days. The majority of mismatches occurred in patients who were discharged home. Coleman EA, Min SJ, Chomiak A, Kramer AM. Of further interest, although we acknowledge this information is specific to our facility, the frequency of mismatch was not evenly distributed across the different primary attending services that discharged the patients. They read the documentation on discharge recommendations from the physical therapist evaluation and any subsequent physical therapist documentation and incorporate it into a multidisciplinary discharge planning process, including any documentation they read from the medical/surgical team, unit nurses, and, when consulted, occupational therapists and social workers. We used hospital billing records to identify that 780 patients received a physical therapist evaluation during our specified 4 one-week periods, and we included all of them in our study. WebThis article gives guidance for billing, coding, and other guidelines in relation to local coverage policy Outpatient Physical and Occupational Therapy Services L34049. Your activity level will vary depending on whether you had a primary (routine) hip replacement or a complex one due to malignancy. We did not collect information on reason for admission, severity of illness, comorbidities, or functional level of the patients, which is information that would allow us to understand more about patterns of recommendation for discharge location or rates of readmission. To conduct our retrospective study of the outcomes of the discharge planning process, we obtained University of Michigan Privacy Board approval for waiver of informed consent to access patient medical records and institutional review board approval for the use of physical therapists as human participants.

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