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Poster 28: Predictors of Readmission to Acute Care and Mortality in the Inpatient Rehabilitation Setting Among Cardiovascular Patients
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
P⬍.002). Conclusions: Our results indicate that during CPET, the use of FFM rather than absolute weight provides a more accurate prediction of exercise capacity. Key Words: Exercise test; Nutrition; Rehabilitation. Poster 28 Predictors of Readmission to Acute Care and Mortality in the Inpatient Rehabilitation Setting Among Cardiovascular Patients. Heather K. Vincent, PhD, MS (University of Florida, Gainesville, FL); Sally Gamon, RN; Kevin R. Vincent, MD, PhD. Disclosure: H.K. Vincent, ARA Research Institute, AMRPA; S. Gamon, None; K.R. Vincent, None. Objective: To identify factors associated with readmission to acute care and mortality in the inpatient rehabilitation facility (IRF). Design: Retrospective study. Setting: A free-standing university-affiliated IRF. Participants: Cardiovascular patients who received acute care and subsequent inpatient rehabilitation (N⫽138; 64.1% men; age, 72.4⫾11.8y; 80.8% Medicare insured) from December 1, 2002, to March 31, 2006. Diagnoses included coronary artery disease, heart failure, peripheral vascular disease, aneurysms, acute myocardial infarction (MI), heart valve repair or replacement, heart transplant, and peripheral bypass graft. Interventions: Not applicable. Main Outcome Measures: Patient variables (interventions, diagnostic test results, care needs, FIM instrument scores), discharge disposition, readmissions to acute care, and mortality. Results: 15.4% of patients were readmitted to acute care for MI symptoms, failure to thrive, falls, mental status change, and infection. 2.4% of patients expired during rehabilitative care; causes of death included second infarctions, heart failure exacerbation, and blood loss. Patients readmitted to acute care had a longer IRF length of stay (LOS) than remaining patients (23.2⫾5.1d vs 13.8⫾7.8d, respectively; P⬍.05) but total IRF charges did not differ statistically ($23,550 vs $19,567, P⫽.279). Age- and sexadjusted regression models revealed that independent predictors of readmission to acute care included presence of dysrhythmias or foot ulcers, an indwelling catheter, angina, peripheral vascular disease, anxiety, lung atelectasis, development of infections, percentage of days active with therapies, and IRF LOS (all models, P⬍.05). Independent predictors of mortality in the IRF included previous infarction prior to rehabilitation, angina, presence of diabetes, and specific admission low FIM subscores (bathing, verbal expression, problem solving, memory, auditory comprehension) (all P⬍.05). Conclusions: Prediction of acute care readmission and mortality is multifaceted, and these preliminary findings can be used to start identifying which patients are less likely to succeed in the IRF. Key Words: Mortality; Rehabilitation. Poster 29 Inpatient Rehabilitation Outcomes Are Influenced by Cognitive Status, Comorbidities, and Skin Quality in Cardiopulmonary Patients. Heather K. Vincent, PhD, MS (University of Florida, Gainesville, FL); Sally Gamon, RN; Kevin R. Vincent, MD, PhD. Disclosure: H.K. Vincent, ARA Research Institute, AMRPA; S. Gamon, None; K.R. Vincent, None. Objective: To identify factors in cardiovascular and pulmonary patients that are associated with good clinical outcomes during inpatient rehabilitation. Design: A retrospective, exploratory study. Setting: 2 inpatient rehabilitation facilities. Participants: Patients admitted for inpatient rehabilitation following acute care (N⫽311). Patients were categorized by major ICD-9 classifications. Interventions: Not applicable. Main Outcome Measures: Length of stay (LOS), facility charges, patient variables (demographics, medical conditions, diagnostic labwork and tests, therapy volume, skin and continence treatments, nutrition, cognitive status). Results: Cardiovascular patients accumulated fewer occupational therapy hours during rehabilitation than pulArch Phys Med Rehabil Vol 88, September 2007
monary patients (12.0⫾0.6h vs 14.1⫾0.6h, P⫽.018), while the volume of physical therapy did not differ between groups (13.7⫾0.8 vs 15.1⫾0.6). Pulmonary patients had higher total ($24,373 vs $19,975), therapy, and pharmacy costs than cardiovascular patients, while LOS did not differ between groups (15.1d vs 14.7d, respectively). The longest LOS was found in pulmonary fibrosis and pleural effusion and femoral artery bypass (19.2⫺22d), and shortest in aortic valve replacement and respiratory failure (10.0⫺11.9d). Highest total charges occurred in lung transplant and pulmonary fibrosis ($35,807 and $35,330) and the lowest in valve replacement and coronary artery bypass graft ($12,295 and $15,590). Age- and sex-adjusted regression models for longer LOS revealed that significant contributors included duration of illness, depression, presence of indwelling catheter, disorientation, skin treatments, ulcer care, foot lesions (Braden scale value), development of infection, readmissions to acute care, total medications, comorbidity number, and Charlson Index (all models, P⬍.01). Adjusted models found that significant predictors for high total facility charges included these factors and parenteral nutrition and development of mental confusion during the stay (P⬍.05). Conclusions: Contributors to LOS and hospital charges are complex and are dependent on multiple individual patient variables. The patient as an entirety should be considered when preparing for resource allocation and discharge plans. Key Words: Outcome assessment (health care); Pulmonary diseases; Rehabilitation. Poster 30 Prevalence of Musculoskeletal Complaints, Pain Medication Usage, and Impact on Health-Related Quality of Life of an Outpatient Exercise Intervention as a Part of a Phase II Cardiac Rehabilitation Program. Manoj Mithal, MD, PhD (UB PM&R, Tonawanda, NY); John P. Naughton, MD; Jong-Chaur Shieh, MD; Carl V. Granger, MD; Danielle Rhodes, RN; Jennifer D. Jones, RN. Disclosure: M. Mithal, None; J.P. Naughton, None; J. Shieh, None; C.V. Granger, None; D. Rhodes, None; J.D. Jones, None. Objectives: To assess prevalence of musculoskeletal complaints in patients participating in outpatient cardiac rehabilitation; to assess the impact of outpatient cardiac rehabilitation on health-related quality of life (HRQOL); and to assess pain medication usage during participation in outpatient cardiac rehabilitation. Design: Pre- to postintervention study. Setting: Outpatient phase II cardiac rehabilitation (CR) program. Participants: 31 patients, 19 of whom completed the study. The patients were all men who had a mean age of 67.4 years (n⫽19). Intervention: 12-week outpatient phase II CR program with 24 sessions of aerobic exercise and 12 weeks of resistance exercise. Main Outcome Measures: Musculoskeletal complaints were recorded as a part of each patient’s history and physical. A graded exercise test was used to assess patients’ aerobic exercise capacity, expressed in metabolic equivalents (METS). The LIFEware Cardiac Assessment Instrument and the Short-Form 36-Item Health Survey were used for HRQOL. Medication usage was monitored using the electronic medical record. Results: Percentage increase in METS pre to post cardiac rehabilitation was 37.7%. 37% of the patients reported musculoskeletal complaints. Knee pain was the most common. Percentage improvement in HRQOL was statistically significant. Pain medication usage was 68% at pre, 47.4% at 12 sessions, and 42.1% at 24 sessions. Conclusions: Despite musculoskeletal complaints, patients derived significant benefit from CR, resulting in cardiovascular risk reduction. A decline in pain medication usage from pre to 24 sessions reflects a favorable trend as pain medications, especially nonsteriodal anti-inflammatories, increase cardiovascular risk. Improved tracking of musculoskeletal complaints is needed to better assess the affect of CR on
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
P⬍.002). Conclusions: Our results indicate that during CPET, the use of FFM rather than absolute weight provides a more accurate prediction of exercise capacity. Key Words: Exercise test; Nutrition; Rehabilitation. Poster 28 Predictors of Readmission to Acute Care and Mortality in the Inpatient Rehabilitation Setting Among Cardiovascular Patients. Heather K. Vincent, PhD, MS (University of Florida, Gainesville, FL); Sally Gamon, RN; Kevin R. Vincent, MD, PhD. Disclosure: H.K. Vincent, ARA Research Institute, AMRPA; S. Gamon, None; K.R. Vincent, None. Objective: To identify factors associated with readmission to acute care and mortality in the inpatient rehabilitation facility (IRF). Design: Retrospective study. Setting: A free-standing university-affiliated IRF. Participants: Cardiovascular patients who received acute care and subsequent inpatient rehabilitation (N⫽138; 64.1% men; age, 72.4⫾11.8y; 80.8% Medicare insured) from December 1, 2002, to March 31, 2006. Diagnoses included coronary artery disease, heart failure, peripheral vascular disease, aneurysms, acute myocardial infarction (MI), heart valve repair or replacement, heart transplant, and peripheral bypass graft. Interventions: Not applicable. Main Outcome Measures: Patient variables (interventions, diagnostic test results, care needs, FIM instrument scores), discharge disposition, readmissions to acute care, and mortality. Results: 15.4% of patients were readmitted to acute care for MI symptoms, failure to thrive, falls, mental status change, and infection. 2.4% of patients expired during rehabilitative care; causes of death included second infarctions, heart failure exacerbation, and blood loss. Patients readmitted to acute care had a longer IRF length of stay (LOS) than remaining patients (23.2⫾5.1d vs 13.8⫾7.8d, respectively; P⬍.05) but total IRF charges did not differ statistically ($23,550 vs $19,567, P⫽.279). Age- and sexadjusted regression models revealed that independent predictors of readmission to acute care included presence of dysrhythmias or foot ulcers, an indwelling catheter, angina, peripheral vascular disease, anxiety, lung atelectasis, development of infections, percentage of days active with therapies, and IRF LOS (all models, P⬍.05). Independent predictors of mortality in the IRF included previous infarction prior to rehabilitation, angina, presence of diabetes, and specific admission low FIM subscores (bathing, verbal expression, problem solving, memory, auditory comprehension) (all P⬍.05). Conclusions: Prediction of acute care readmission and mortality is multifaceted, and these preliminary findings can be used to start identifying which patients are less likely to succeed in the IRF. Key Words: Mortality; Rehabilitation. Poster 29 Inpatient Rehabilitation Outcomes Are Influenced by Cognitive Status, Comorbidities, and Skin Quality in Cardiopulmonary Patients. Heather K. Vincent, PhD, MS (University of Florida, Gainesville, FL); Sally Gamon, RN; Kevin R. Vincent, MD, PhD. Disclosure: H.K. Vincent, ARA Research Institute, AMRPA; S. Gamon, None; K.R. Vincent, None. Objective: To identify factors in cardiovascular and pulmonary patients that are associated with good clinical outcomes during inpatient rehabilitation. Design: A retrospective, exploratory study. Setting: 2 inpatient rehabilitation facilities. Participants: Patients admitted for inpatient rehabilitation following acute care (N⫽311). Patients were categorized by major ICD-9 classifications. Interventions: Not applicable. Main Outcome Measures: Length of stay (LOS), facility charges, patient variables (demographics, medical conditions, diagnostic labwork and tests, therapy volume, skin and continence treatments, nutrition, cognitive status). Results: Cardiovascular patients accumulated fewer occupational therapy hours during rehabilitation than pulArch Phys Med Rehabil Vol 88, September 2007
monary patients (12.0⫾0.6h vs 14.1⫾0.6h, P⫽.018), while the volume of physical therapy did not differ between groups (13.7⫾0.8 vs 15.1⫾0.6). Pulmonary patients had higher total ($24,373 vs $19,975), therapy, and pharmacy costs than cardiovascular patients, while LOS did not differ between groups (15.1d vs 14.7d, respectively). The longest LOS was found in pulmonary fibrosis and pleural effusion and femoral artery bypass (19.2⫺22d), and shortest in aortic valve replacement and respiratory failure (10.0⫺11.9d). Highest total charges occurred in lung transplant and pulmonary fibrosis ($35,807 and $35,330) and the lowest in valve replacement and coronary artery bypass graft ($12,295 and $15,590). Age- and sex-adjusted regression models for longer LOS revealed that significant contributors included duration of illness, depression, presence of indwelling catheter, disorientation, skin treatments, ulcer care, foot lesions (Braden scale value), development of infection, readmissions to acute care, total medications, comorbidity number, and Charlson Index (all models, P⬍.01). Adjusted models found that significant predictors for high total facility charges included these factors and parenteral nutrition and development of mental confusion during the stay (P⬍.05). Conclusions: Contributors to LOS and hospital charges are complex and are dependent on multiple individual patient variables. The patient as an entirety should be considered when preparing for resource allocation and discharge plans. Key Words: Outcome assessment (health care); Pulmonary diseases; Rehabilitation. Poster 30 Prevalence of Musculoskeletal Complaints, Pain Medication Usage, and Impact on Health-Related Quality of Life of an Outpatient Exercise Intervention as a Part of a Phase II Cardiac Rehabilitation Program. Manoj Mithal, MD, PhD (UB PM&R, Tonawanda, NY); John P. Naughton, MD; Jong-Chaur Shieh, MD; Carl V. Granger, MD; Danielle Rhodes, RN; Jennifer D. Jones, RN. Disclosure: M. Mithal, None; J.P. Naughton, None; J. Shieh, None; C.V. Granger, None; D. Rhodes, None; J.D. Jones, None. Objectives: To assess prevalence of musculoskeletal complaints in patients participating in outpatient cardiac rehabilitation; to assess the impact of outpatient cardiac rehabilitation on health-related quality of life (HRQOL); and to assess pain medication usage during participation in outpatient cardiac rehabilitation. Design: Pre- to postintervention study. Setting: Outpatient phase II cardiac rehabilitation (CR) program. Participants: 31 patients, 19 of whom completed the study. The patients were all men who had a mean age of 67.4 years (n⫽19). Intervention: 12-week outpatient phase II CR program with 24 sessions of aerobic exercise and 12 weeks of resistance exercise. Main Outcome Measures: Musculoskeletal complaints were recorded as a part of each patient’s history and physical. A graded exercise test was used to assess patients’ aerobic exercise capacity, expressed in metabolic equivalents (METS). The LIFEware Cardiac Assessment Instrument and the Short-Form 36-Item Health Survey were used for HRQOL. Medication usage was monitored using the electronic medical record. Results: Percentage increase in METS pre to post cardiac rehabilitation was 37.7%. 37% of the patients reported musculoskeletal complaints. Knee pain was the most common. Percentage improvement in HRQOL was statistically significant. Pain medication usage was 68% at pre, 47.4% at 12 sessions, and 42.1% at 24 sessions. Conclusions: Despite musculoskeletal complaints, patients derived significant benefit from CR, resulting in cardiovascular risk reduction. A decline in pain medication usage from pre to 24 sessions reflects a favorable trend as pain medications, especially nonsteriodal anti-inflammatories, increase cardiovascular risk. Improved tracking of musculoskeletal complaints is needed to better assess the affect of CR on