- Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
The Effectiveness of Rehabilitation Treatment Based on Service Delivery Program Setting
Question #1: For adults who receive an acute-care admission for new or worsening disability resulting from injury or medical event, what percentage of people are discharged to an inpatient rehabilitation facility (IRF) versus another rehabilitation treatment setting (i.e., Long Term Care Hospital (LTCH), subacute rehabilitation program (nursing home), residential rehabilitation program, or home rehabilitation program) or home without services?
To what extent are there differences in acute care discharge destination related to:
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
age
time post-injury that rehabilitation services occur
health care payer
P: For adults who require rehabilitation services following an acute-care admission for new or worsening disability resulting from injury or medical event I: Does admission and treatment in an inpatient rehabilitation facility (IRF) C: Versus rehabilitation treatment in another setting (i.e., Long Term Care Hospital (LTCH), subacute rehabilitation program (nursing home), residential rehabilitation program, or home rehabilitation program) O: lead to better outcomes in terms of:
functional outcomes, return to independent home and living, or 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 government related to health care or social services
Are there differences between IRFs and other rehabilitation program sites on these critical outcomes based on patient characteristics such as:
rehabilitation diagnostic group (stroke, traumatic brain injury, other brain injury, spinal cord injury, hip fracture, joint replacement, debility, cancer)
severity of the physical, cognitive or behavioral impairments of patients in these groups
age
time post-injury that rehabilitation services occur
Source: Effective Health Care Program (http://effectivehealthcare.ahrq.gov)
To what extent are differences between IRFs and other rehabilitation program sites on these critical outcomes based on the duration/intensity/scope/structure of rehabilitation services provided?
- Relevant patients, group(s) or subgroups of people
Primary rehabilitation diagnostic groups of interest include stroke, traumatic brain injury, other brain injury, spinal cord injury, and cancer.
- Important health-related benefits/harms
Include:
functional outcomes, return to independent home and 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
- Describe why this topic is important.
Rehabilitation is an expensive aspect of the US healthcare system. A network of hospital-based and freestanding IRFs was created in the 1960s to better address patient healthcare needs. However, some evidence suggests that people are increasingly not offered inpatient rehabilitation, and are instead admitted to nursing homes or discharged home with home health and/or other community programs. Residential rehabilitation programs are, in some states, not allowed to operate as a medical rehabilitation program. It is unclear to what extent rehabilitation service provision decisions, including setting, are based on patient characteristics, treatment needs, and evidence of beneficial outcomes. Consequently, consumers cannot be certain that the rehabilitation program type they are provided is optimal for them, in the short- and long-term. Policymakers do not have clear evidence regarding high value rehabilitation services for different diagnostic, age, and severity subgroups. Information about best outcomes and related costs is particularly important as payment models move from fee-for-service to bundled care and population-based capitation payment models.
- How will an answer to your research question be used or help inform decisions for you or your group?
Systematic review findings will provide educational information to key stakeholders including patients, their families, clinicians, administrators, payers, and policy makers on topics such as referrals/admissions to rehabilitation service programs and differential outcomes based on service provision setting. If the strength of the evidence is sufficient, we will create formal practice recommendations for service provision.
- Other Information About You: (optional)
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- 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
- ACRM
- Please tell us how you heard about the Effective Health Care Program
- We ve been aware of the AHRQ Effective Health Care Program for a number of years. We received a formal introduction via Tom Getchius, managing director of practice guidelines for the AAN.
