Trauma

Rehabilita.on:
Whats Really Happening Over
There in Physical Medicine and
Rehabilita.on (PM&R)?

Pamela Roberts, PhD, OTR/L, SCFES, FAOTA,
CPHQ, FNAP, FACRM

2017 Nursing Trauma Conference
June 12, 2017
 Disclosures

No relevant nancial disclosures

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 Objec.ves

Increase awareness of rehabilita6on across the

con6nuum
Outline eec6ve collabora6on for the trauma
popula6on for nursing and rehabilita6on
Iden6fy key opportuni6es for the trauma
popula6on from the acute care hospital to the
post-acute care venues

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Introduc.on

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 Changing Healthcare Environment

In todays constantly changing healthcare landscape,

organiza6ons are faced with a mul6tude of challenges
Challenges may include:
Demographics of the trauma popula6on
Policies and regula6ons
Funding/Insurance
With health care reform, there is an increased focus on care
management across the episode of care and outcomes

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Changing Healthcare Environment

Source: Sg2 6
 Trauma Data by Number of Cases
2014-2018 (Pacic)
Trauma.c Brain Injury Trauma.c Spinal Cord Injury
655 250
660
238
650 240
640
629 230
630
620 220 214
610
597 210
600 201
590 200
580 190
570
180
560
CY 2014 CY 2015 CY 2016
CY 2014 CY 2015 CY 2016

Mul.ple Trauma with Mul.ple Trauma

Brain Injury/Spinal Cord Injury 450
396
400 373
350 307 295 350
300 302
300
250
193 250
200
200
150
150
100
100
50
50
0 0
CY 2014 CY 2015 CY 2016 CY 2014 CY 2015 CY 2016

Source: e-rehab: www.erehabdata.com 7

Trauma Outcomes
Brain Injury (BI)
Spinal Cord Injury (SCI)
Mul.ple Trauma with BI/SCI
Mul.ple Trauma

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 Trauma.c Brain Injury Sta.s.cs
Variable Pacic Na.on

Age 68.08 63.81

Gender
Male 63.15% 64.65%
Female 36.85% 35.35%
Case Mix Index 1.27 1.44

Onset Days 14.62 days 14.19 days

Length of Stay 13.30 days 13.36 days

Community Discharge 81.74% 75.62%

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Trauma.c Spinal Cord Injury Sta.s.cs
Variable Pacic Na.on

Age 58.64 53.84

Gender
Male 66.00% 72.03%
Female 34.00% 27.97%
Case Mix Index 1.95 2.06

Onset Days 14.78 days 20.39 days

Length of Stay 20.94 days 19.20 days

Community Discharge 80.63% 76.12%

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Mul.ple Trauma with BI/SCI Sta.s.cs
Variable Pacic Na.on

Age 47.85 47.62

Gender
Male 65.22% 67.61%
Female 34.78% 32.39%
Case Mix Index 1.57 1.74

Onset Days 17.61 days 18.26 days

Length of Stay 16.98 days 18.43 days

Community Discharge 88.13% 75.80%

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 Mul.ple Trauma Sta.s.cs
Variable Pacic Na.on

Age 49.58 55.71

Gender
Male 50.54% 50.34%
Female 49.46% 49.66%
Case Mix Index 1.16 1.25

Onset Days 10.81 days 10.96 days

Length of Stay 12.46 days 13.29 days

Community Discharge 81.36% 80.66%

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Con.nuum of Care

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Con.nuum of Care

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 Post-Acute Care

Post-Acute Care includes four dis6nct provider

types:
Inpa6ent Rehabilita6on Facili6es (IRFs)
Long Term Acute Care Hospitals (LTCHs)
Skilled Nursing Facili6es (SNFs)
Home Health Agencies (HHAs)

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Post-Acute Care

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Post-Acute Care U.liza.on

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 Post-Acute Care (PAC)
U6liza6on of PAC accounts for a signicant
por6on of Medicare-paid services and is growing
rapidly
43% - the propor6on of Medicare pa6ents
discharged from hospitals to at least one post-
acute level of care
23 % - the por6on of total Medicare dollars spent
on post-acute care
+90% - the increase in per capita PAC spending
since 2000 (8% increase per year)

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 Goals of Rehabilita.on
To restore op.mal physical func.on and psycho-
social restora.on to enable the pa.ent to become
a produc.ve par.cipant in the community

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 Func.ons of Rehabilita.on
Preven6on, recogni6on, and management of
comorbidi.es and concurrent complica.ons
Training for the highest level of func.onal
independence
Facilita6ng psychosocial coping and adapta.on for
the pa6ent, family, and support system
Promo6ng community reintegra.on, including
resump6on of home, family, recrea6onal, and
voca6onal ac6vi6es

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 Prognos.c Factors for Predic.on
of Func.onal Outcome
Mul6plicity of factors determine outcome
Age
Comorbidi6es
Mul6ple decits
Severity of motor limita6ons
Sensory func6on
Communica6on decits
Cogni6ve decits
Bladder and Bowel management
Ac6vi6es of Daily living level of func6on
Support Network
Onset of rehabilita6on

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Rehabilita.on Team

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Rehabilita.on During the Acute Hospital Phase
Goals:
Medical and surgical stabiliza.on
Ini.ate rehabilita.on which may
include physical therapy,
occupa6onal therapy, speech-
language pathology and
neuropsychology (while in the ICU,
medical and/or surgical areas of the
hospital)
Discharge recommenda.ons

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 California Rehabilita.on Ins.tute
138 Inpa.ent Rehabilita.on
Beds
Joint Venture between
CSMC
UCLA
Select Medical
174,000 square foot facility at the intersec6on of Century Park East and Olympic Blvd
State of the art rehabilita6on
equipment and technology
Opened July 21, 2016
24/7 physician care
Rehabilita6on nurses
Rehabilita6on therapists (PT, OT, SLP,
recrea6onal therapists, respiratory therapists)
Neuropsychology/psychology
Case managers and social workers
 California Rehabilita.on Ins.tute
Key Inpa.ent Programs
Stroke
Spine/Spinal Cord Injury
Brain Injury
Neurologic
Orthopedic includes Mul6ple Trauma
Medically Complex
Complex outpa6ent program (not yet open)
 California Rehabilita.on Ins.tute
Mission: To provide pa6ents with an excep6onal pa6ent
care experience, help restore their func6on, and improve
their quality of life
Vision: To be the trusted leader in serving the
rehabilita6on needs of people recovering from illness and
injury
Values
Compassion
Respect
Excellence
Integrity
Teamwork
 Post-Acute Rehabilita.on
Sefng depends upon:
Severity of disability/burden of care
Number and level of services required
Social factors
Funding (insurance)
Preven6on of further
deteriora6on and to improve
overall func.onal status as well as reintegra6ng
the pa6ent and his/her family to home and the
community
Ini.al and ongoing assessments
are cri6cal to success of interven6ons
Family/caregiver involvement
is important
Peer support
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Follow My LeadRehabilita.on
Integra.on of Trunk and Extremity Movements
Rehabilita.on Strategies in Daily Ac.vi.es
Strategies in Rehabilita.on
 Technology in Rehabilita.on

Technology is used in various aspects

Health
Fitness
Assessment
Treatment
Motor
Cogni6ve
Communica6on
Vision
Videogames (e.g. Wii, etc.)
Home programs
Other
Technology in Rehabilita.on
Technology in Rehabilita.on
Exoskeleton
Upper Extremity and Hand Exoskeleton
Technology in Rehabilita.on
 Robo.cs

Upper extremity robo6cs

Studies show that through
repe66on and prac6ce,
recovery of motor func6on
is possible even years aher
a neurologic injury
Robo.cs
Robo.cs
Robo.cs
 Robo.cs and Androids

Personal Robo6c
Service Robo6c
Therapeu6c Robo6cs
Healthcare Delivery Systems:
Current and Future Models

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Healthcare Reform Changes Incen.ves

Current Health System Health Care Reform

Procedures = revenue procedures = cost
payment depends on payment depends on
site pa6ent
promotes silos of care coordina6on of care
promotes serial care improved care
limited alen6on to transi6ons
outcome alen6on to outcome
emphasizes ins6tu6onal promotes community
care care

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Health Care Reform Changes the Focus of Care

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 Summary

Focus on pa6ents
strengths, training and
empowerment
Ini6al and going
assessments are cri6cal
to success of
interven6ons
Family/caregiver/peer
involvement is important
 Contact Informa.on

Pamela Roberts, PhD, OTR/L, SCFES, FAOTA,

CPHQ, FNAP, FACRM
Director and Professor
Physical Medicine and Rehabilita6on and
Director Academic and Physician Informa6cs
Senior Director Quality, Outcomes, and
Research
California Rehabilita6on Ins6tute
Pamela.Roberts@cshs.org
818-590-0004

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Ques.ons

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