Question #1: P: For adults who receive an acute-care admission for new or worsening disability resulting from injury or medical event I: Does providing rehabilitation services (e.g., physical therapy, speech therapy, occupational therapy, and/or psychological services) in the acute care setting

C: versus not providing rehabilitation services

O: lead to better outcomes in terms of:

functional outcomes at acute care discharge

discharge to post-acute care, of any type

functional outcomes, return to home, independent living, and life quality in the months or years following acute care discharge

number of services and/or total hours of outpatient/community rehabilitation received after acute care discharge

rehospitalizations in the months or years following acute care discharge

survival/mortality in the months or years following acute care discharge

costs to patients/families, third party payers or federal government related to health care or social services

To what extent does rehabilitation service provision during acute care produce differential outcomes based on:

rehabilitation diagnostic group (stroke, traumatic brain injury, other brain injury, spinal cord injury, and cancer)

severity of the physical, cognitive or behavioral impairments of patients in these groups

pre-admission living situation, e.g., living alone, and availability of a family caregiver

age

time post-injury that rehabilitation services began

scope/duration/intensity of the rehabilitation services delivered

Question #2: P: For adults who receive inpatient rehabilitation for new or worsening disability resulting from injury or medical event, I: Does providing longer inpatient rehabilitation stays C: versus shorter inpatient rehabilitation stays O: lead to better outcomes in terms of:

functional outcomes at discharge

discharge to institutional settting, of any type

functional outcomes, return to home, independent living, employment, or life quality in the months or years following rehabilitation care discharge

number of services and/or total hours of outpatient/community rehabilitation received after inpatient rehabilitation discharge

rehospitalizations in the months or years following inpatient rehabilitation discharge

survival/mortality in the months or years following inpatient rehabilitation discharge

costs to patients/families, third party payers or federal government related to health care or social services

Does the impact of longer lengths of stay impact outcomes differentially based on:

Setting where the inpatient rehabilitation services are provided, i.e., inpatient rehabilitation facility (IRF), long-term care hospital (LTCH), subacute rehabilitation program, or other inpatient rehabilitation program

Rehabilitation diagnostic group (stroke, traumatic brain injury, other brain injury, spinal cord injury, hip fracture, joint replacement, debility, cancer)

Severity of the disability

Time from onset of the disability

Age

pre-admission living situation, e.g., living alone, and availability of a family caregiver

• Relevant patients, group(s) or subgroups of people Primary rehabilitation diagnostic groups of interest include stroke, traumatic brain injury, other brain injury, and spinal cord injury, and cancer.
• Important health-related benefits/harms

Include:

functional outcomes, return to home, independent living, employment, and life quality

number of services and/or total hours of outpatient/community rehabilitation needed after discharge

rehospitalizations in the months or years following discharge from the program

survival/mortality in the months or years following discharge from the program

costs to patients/families, third party payers or federal governments related to health care or social services

The concept of patient rehabilitation readiness has long been a topic of substantial debate in the U.S. and other countries. Healthcare systems have taken substantially differing approaches to the timing, scope, and duration of rehabilitation provided. In the U.S., acute-care admissions have been increasingly reduced as a consequence of improved health care, DRGs, and similar payment system innovations. The introduction of rehabilitation services during the acute care stay has growing evidence of providing positive outcomes. For the last 25 years, lengths of stay in inpatient rehabilitation programs for persons with severe disability have also been declining, in some categories by more than 75 percent. While more efficient and effective rehabilitation may explain part of these reductions, cost-cutting and cost-shifting of rehabilitation services by third party payers likely plays a predominate role. The extent to which functional outcomes (as measured by the Functional Independence Measure) have declined in parallel with LOS reduction is unclear. There is evidence that the reduction in LOS has resulted in increased admissions to nursing homes, increased acute care readmissions, and other indicators of suboptimal results for patients. The extent to which these negative outcomes result in higher long-term costs for patients and payers of last resort is unclear. The identification of optimal timing of rehabilitation services for different health conditions, ages, and severity stratification could provide the U.S. healthcare system with valuable information for increasing high value acute care and rehabilitation services, particularly as payer systems transition to bundled payments and population-based capitation payment models.

Systematic review findings will provide educational information to key stakeholders including patients, their families, clinicians, administrators, payers, and policy makers on topics such as the timing/duration/scope of rehabilitation service provision in acute care and inpatient rehabilitation and its impact on outcomes. If the strength of the evidence exists, we will create formal practice recommendations for duration of service provision.

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Chair, Evidence and Practice Committee

If you are you making a suggestion on behalf of an organization, please state the name of the organization

American Congress of Rehabilitation

Please tell us how you heard about the Effective Health Care Program