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Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21742
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Browsing Other by Author "Camp, Kathlene E."
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Item A STEP in the Right Direction: An Interdisciplinary Transitional Care Approach to Preventing Hospital Readmissions (2015)(2015-03) Loewen, Ashlee; Knebl, Janice; Yarabinec, Ashley; Camp, Kathlene E.; Johnson, Valerie; Stafford, Ashley; Allen, John G.; Shoukry, Emad; Wagner, Teresa; Greenlee, Quante; Turpin, ShirleyPurpose: The Affordable Care Act, calls for more focus on finding “innovative delivery systems that improve care, increase efficiency, and reduce costs” (Centers for Medicare and Medicaid Services, n.d., para. 4). The Safe Transitions for the Elderly Patients (STEP) program is a hybrid transitional care model developed to reduce readmission rates for Medicaid patients over 50 years of age in Tarrant County. Background: The STEP Program provides high quality transition of care services for discharged Medicaid elders of Tarrant County. A medical director, nurse practitioner, physician assistant, physical therapies, social workers, pharmacist, and nutritionist make up the in home care team. The foundation of the STEP Program was developed by the University of North Texas Health Science Center (UNTHSC) as part of an 1115 Waiver approved by CMS in 2012. The STEP Program is designed to improve the coordination and continuity of care for Medicaid patients 50 years of age and older transitioning from the hospital to the home setting following discharge. The primary goal of the STEP program is to identify discrepancies in transitional care and find solutions toward reducing all-cause 30-day hospital readmissions. Through the CMS 1115 waiver guidelines, we are also tracking patient BMI, smoking status, and pneumococcal vaccine status. Methods: The STEP Program will provide care transition services for 750 patients from October 1, 2013, to September 30, 2016, via referrals received from local hospital partners. STEP faculty and staff have developed evidence-based protocols and communication strategies aimed at meeting or exceeding performance metrics for reducing hospital readmission. The NextGen EMR is the primary means for gathering data for these metrics and assessing the impact of the evidence based protocols and communication strategies. Plan-Do-Study-Act methodology is used to regularly to evaluate and re-evaluate STEP Program practices to meet and exceed performance metrics, while improving overall performance. Current Results: The current 30-day readmission rate for patients enrolled in the STEP program is 9%, which is a significant improvement from the recent national readmission rate at 18.5% and Texas at 18.4% for Medicare specific beneficiaries (CMS, 2012). Conclusion: By reducing hospital readmission, the STEP Program can contribute to improving the quality of transitional care services as a sustainable practice model. This example of transitional care services can serve as a model to help reduce hospital expenditures, decrease hospital penalization for readmissions, and help provide quality outpatient management and coordinated care for this vulnerable patient population. Centers for Medicare and Medicaid Services. (n.d.). Section 1115 demonstrations. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html Centers for Medicare and Medicaid Services. (2012). National Medicare readmission findings: Recent data and trends. Retrieved from http://www.academyhealth.org/files/2012/sunday/brennan.pdfItem Reducing falls in post-acute Medicaid patients enrolled in the Safe Transitions for the Elderly Patient (STEP) Program(2015-03) Johnson, Valerie W.; Camp, Kathlene E.; Lardner, Dana; Bugnariu, Nicoleta; Knebl, JanicePurpose: The STEP Program is a hybrid transitional care model composed of interdisciplinary team members focused on reducing hospital readmissions, decreasing falls, and improving quality of life. Thus far, no transitional care program has been able to show a significant reduction in falls among post-acute, community dwelling older adults. As the first physical therapy (PT) team to be included in a transitional care program, we sought out to identify potential fallers and reduce falls in this vulnerable population. The purpose of this paper is to evaluate the contribution of PT intervention in the STEP program, specifically as it relates to decreasing falls and falls risk. Methods: We utilized a qualitative, subjective report instrument known as the 4-point Hopkins Falls Grading Scale (HFGS) with good face and content validity to discriminate between the severity and frequency of falls. A systematic, subjective history of falls and comprehensive fall risk assessment scores pre- and post- PT intervention were obtained and analyzed. All data was analyzed using SPSS, and according to the Shapiro-Wilk test, none of the fall data was normally distributed (all yielding p-values of .000). Therefore, we used the Wilcoxon Signed Rank Test to analyze the difference in medians for pre-STEP fall data at 3 months and post-STEP fall data. Results: Preliminary data of a subset of patients reveals promising results for the Hopkin’s Falls Grading Scale with 3 out of 4 grades showing a significant reduction in falls. The Wilcoxon Signed-Rank Test provided the following results. There was a significant decrease in number of Grade 4 Falls (p = .000). There was not enough evidence to support a significant difference in number of Grade 3 Falls (p = .065). There was a significant decrease in number of Grade 2 Falls (p = .000). Finally, there was a significant decrease in number of Grade 1 Falls (p = .004). Grade 3 falls showed no significant difference; however in our distribution, we only had 8 patients that reported Grade 3 falls, compared to 20 patients for Grade 4 falls, 22 patients for Grade 2 falls, and 19 patients for Grade 1 falls. Conclusions: These results confirm the need and importance of collecting pre- and post- PT intervention falls data. At this point in time, 3 out of 4 grades show a significant decrease in falls. The data suggests that transitional physical therapy is effective in showing a reduction in falls in older Medicaid patients recently discharged from the hospital.Item Role of Physical Therapy in the Interdisciplinary Team for Safe Transitions for Elderly Persons (STEP)(2015-03) Camp, Kathlene E.; Johnson, Valerie; Bugnariu, Nicoleta; Lardner, Dana; Knebl, JaniceBackground: Managing an effective transition from hospital to home is challenging due to the medical complexity of multiple diagnoses and care needs, especially in low income seniors. Early hospital readmission has been linked with many factors, including impaired mobility and ineffective management of diseases. Physical therapy (PT) can have an impactful role on addressing safety with mobility and supporting education on disease management. Purpose: The purpose of this report is to describe the role of PT on an interdisciplinary care team, describe the PT intervention, highlight fall risk assessments and results, and identify leading environmental hazards and supports that can impact fall risk. Methods: The STEP care team was comprised of a medical director, nurse practitioner or physician assistant, social worker, physical therapist, pharmacist and registered dietician. PT performed a comprehensive evaluation, appropriate fall risk assessment, and home safety evaluation. Recommendations and assistance were provided to improve home safety, education and intervention were implemented to address specific needs to improve safety with mobility, care was coordinated with home health resources, and community resources were utilized to access additional needs not met by insurer coverage. Final assessments were made at time period of 30+ days in accordance with successful transition in medical care. Results: 126 out of 161 patients enrolled into the STEP program received PT. Patients were in the STEP program for an average of 42 days and received an average of 3 PT visits. The most prevalent home safety hazards identified were lack of grab bars (45%), lack of supportive equipment for shower/tub (42%), unsafe bathroom tub/shower surfaces (30%), narrow/cluttered pathways (33%), and cluttered/soiled living areas (30%). The most common supports were adequate lighting (39%), appropriate commode height (58%), stable/supportive seating (40%), clear/accessible walkways (44%), and secure floor coverings (38%). Home modification opportunities were greatest for adjustment of commode and seating heights (79%, & 2%), providing adequate lighting and chair dressing support (60%), securing floor coverings (50%), and installing night lights (50%). For ambulatory clients, fall risk assessments indicated 96% were at risk for falls. There was an average of 9% of hospitalizations in the first 30 days; however none were related to falls. Conclusion: Reasons for falls are multifactorial and require an interdisciplinary approach to have effective reduction in risk. PT has a significant role in this reduction by addressing both the physical impairments and the environmental factors. Interprofessional collaboration on patient performance in the home can be instrumental in avoiding falls and preventing early hospital readmissions for this high risk population.