Beruflich Dokumente
Kultur Dokumente
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
2
Objec.ves
3
Introduc.on
4
Changing Healthcare Environment
5
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
8
Trauma.c Brain Injury Sta.s.cs
Variable Pacic Na.on
9
Trauma.c Spinal Cord Injury Sta.s.cs
Variable Pacic Na.on
10
Mul.ple Trauma with BI/SCI Sta.s.cs
Variable Pacic Na.on
11
Mul.ple Trauma Sta.s.cs
Variable Pacic Na.on
12
Con.nuum of Care
13
Con.nuum of Care
14
Post-Acute Care
15
Post-Acute Care
16
Post-Acute Care U.liza.on
17
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)
18
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
19
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
20
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
21
Rehabilita.on Team
22
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
23
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
27
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
Personal Robo6c
Service Robo6c
Therapeu6c Robo6cs
Healthcare Delivery Systems:
Current and Future Models
43
Healthcare Reform Changes Incen.ves
44
Health Care Reform Changes the Focus of Care
45
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
47
Ques.ons
48