Even though rehabilitation still provides a similar degree of improvement compared to decades past, patients are entering—and exiting—rehab in comparatively worse shape, said Kenneth Ottenbacher on March 28 during the first monthly Rehabilitation Science Seminar.
Ottenbacher, professor and director of the division of rehabilitation science, director of the Center for Rehabilitation Sciences and senior associate dean for research and graduate education in the School of Allied Health Sciences at the University of Texas Medical Branch, presented a talk on “Trends in Outcomes for Inpatient Medical Rehabilitation.”
Ottenbacher’s research analyzed data from 1994 to 2007, using information from both before and after the implementation of Medicare’s prospective payment system, or PPS, in 2002. Based on each patient’s history, condition and prognosis, the PPS allocates a specific amount of money for post-acute care, including rehabilitation, before the patient receives care.
“From 1994 to 2001, length of stay in rehab decreased from a median 20 days to median 12 days,” Ottenbacher said. “While effectiveness remained steady and efficiency increased, mortality at three to six months of follow-up also increased.”
Ottenbacher hypothesized that mortality may have increased due to changing referral patterns and possible decreases in length of acute care stays before rehabilitation. Premature discharge also can be costly in financial terms, he added.
“For instance, say someone had a stroke and was discharged without regaining good bowel and bladder control,” Ottenbacher said. “They could get a urinary tract infection and get re-hospitalized. In the long run, that doesn’t save money.”
The seminar came near the end of Ottenbacher’s month-long visit to USC. The audience included faculty and students from the USC School of Dentistry divisions of Biokinesiology and Physical Therapy and Occupational Science and Occupational Therapy.
At a reception following the seminar, Ottenbacher said the two divisions are uniquely well-equipped to tackle the tough challenges he addressed in his talk, especially when working together.
“It’s a very complex problem, and there’s no single solution,” he said. “But you have two of the highest ranked programs right here at USC; I am very impressed with the caliber of the faculty and the graduate students.”
“We have a tremendous capacity to expand our research potential through collaboration,” said Florence Clark, professor and chair of Occupational Science and Occupational Therapy. “We have great opportunities to look at what the best combination of services is to help make patients more independent.”
James Gordon, associate professor and Associate Dean of Biokinesiology and Physical Therapy, agreed that a cooperative approach, especially in the relatively young field of rehabilitation science, is the most effective way to address complex patient care challenges.
“What we’re trying to do is look beyond a discipline-specific viewpoint and look at patient problems in a broader context in order to treat the whole person,” Gordon said.