Freeman L.1,2, Wang A.3, Leland N.4
1Aegis Therapies, Office of Research, Plano, United States, 2Post-Acute Therapeutics and Health Clinical Research Institute, Office of Research, Sammamish, United States, 3Salude, Chief Medical Officer, Suwanee, United States, 4University of Southern California, Occupational Therapy, Los Angeles, United States
Background: The convergence of rising post-acute health care costs made reform a priority in many countries resulting in the development of new models of care that often extend the scope of practice and job duties among health professionals. In these new models, aimed to improve clinical and cost effectiveness of care,advance practice “transitionists” diagnose, triage, conservatively treat, and help patients navigate safe return to community. However, little is known about the effects of such models on post-acute outcomes.
Purpose: The purpose of this study was to evaluate the effectiveness of an advanced practice model of care in a transitional care unit (AP-TCU) on post-acute outcomes compared to standard care in skilled nursing facilities (SNF).
Methods: Secondary analysis of clinical and administrative data extracted from Electronic Medical Records (EMR) of patients (N =2880) admitted in the state of Georgia to an AP-TCU (n =1440) compared to SNFs (n =1440) between January 2014 and December 2015. SNF to AP-TCU cases were randomly control-matched by payer
(Medicare and Managed Care) and most prevalent medical diagnostic groups (orthopedics, neurological, pulmonary, and cardiac). Outcome variables included length of stay (LOS), functional gain, discharge level, discharge destination,
re-hospitalization rate and patient experience. To compare group differences, independent t -test was used for LOS, functional gain, re-hospitalization rate while the non-parametric equivalent was used for discharge disposition. Likertscale
survey based on phenomenological methods was used to measure as an overall factor of patient experience. Patient experience, defined as satisfaction with quality of care and overall satisfaction, was factored from nursing, rehabilitation, dining, and privacy-security indices.
Results: Significant differences were observed between AP-TCU and SNF in mean LOS (19.0 vs 27.3, p = .001), functional gain (1.1 vs 0.9, p = .001), discharge level (2.1 vs 1.7, p = .001), re-hospitalization rate (7.8% vs 14.3%, p= .02). Significant differences were also observed among AP-TCU and SNFs in discharge to the community (82.7%
vs 45.1, p = .001) and patient experience (96% vs 72, p = .04).
Conclusion(s): Compared to SNFs, patients receiving care within an AP-TCU model achieve better post-acute outcomes, greater functional recovery in less time, with a higher percentage of patients satisfied with overall experience and quality of care. Future studies should include EMR data from other post-acute practice data to compare cost effectiveness across different settings.s such as inpatient rehabilitation facilities as well as claims.
Implications: These results provide evidence supporting superior comparative clinical effectiveness of an AP-TCU versus standard SNF model of care for adults recovering from surgeries, trauma, acute exacerbations of chronic illnesses.
Funding acknowledgements: None
Topic: Disability & rehabilitation
Ethics approval: Rocky Mountain U of Health Professions
All authors, affiliations and abstracts have been published as submitted.
