Geriatric Patient Functional Independence and Recovery Increased with Interdisciplinary Model

David S. Kushner, M.D., clinical associate professor, and Doug Johnson-Greene, Ph.D., professor and Associate Vice Chair, both of the Department of Physical Medicine and Rehabilitation at the University of Miami Miller School of Medicine, have completed an observational study on use of the Siebens Domain Management Model (SDMM) in health care management of geriatric patients during inpatient rehabilitation. The study corroborates their earlier research, which demonstrated that implementing SDMM in a health care setting can positively impact stroke patient outcomes.

SDMM provides a standard format for weekly interdisciplinary team conferences, with a focus on potential medical, physical, cognitive, emotional and social barriers to recovery and community/home discharge. Its use has been shown to provide greater patient functional independence and fewer medical complications.

As previously reported in February, Kushner and Johnson-Greene completed a comparative study of stroke patient outcomes from before and after the integration of SDMM at HealthSouth Rehabilitation Hospital of Miami. Their findings were published in PM&R and indicated improved functional outcomes and community discharge rate, and fewer acute-care transfers despite a shortened length of stay.

In this latest study, Kushner and Johnson-Greene focused on geriatrics, evaluating almost 1,000 patients over 75 years old who were admitted for inpatient rehabilitation. Those who did not receive care with SDMM intervention had 2.6 days greater length of stay. In addition, those cared for after integration of SDMM were significantly more likely to be discharged to the home or community versus a long-term care facility.

“This latest study closely replicates the findings of our previous research with stroke patients and demonstrates that use of SDMM in geriatric health care management during inpatient rehabilitation improves patient outcomes, no matter the admitting diagnosis for which patients are receiving care,” Kushner said. “Of equal importance is the implication for Medicare reimbursement for facilities that incorporate SDMM into their patient care protocol as the model may be useful in both acute and post-acute facilities under the coming transition to value-based payments.”

According to Kushner and Johnson-Greene, whose newest study was published by Archives of Physical Medicine and Rehabilitation, “The prospective payment system used by the Centers for Medicare and Medicaid to reimburse health care facilities and providers has compelled the national trend of shorter inpatient rehabilitation lengths of stay while also imposing penalties for discharges to locations other than the home/community.

Furthermore, the Affordable Care Act has specific areas of focus that include improving the quality and efficiency of health care, which will be accomplished in part by linking payment to quality outcomes under the Medicare program.”

This past January, the federal government announced plans to shift Medicare away from the current fee-for-service payment model, with 30 percent of Medicare payments to be value-based by the end of 2016 and 50 percent by the end of 2018. Value-based models offer incentives to hospitals and other providers for meeting patient care targets of improved health outcomes, quality of care and cost management.

The research suggests that SDMM could affect reimbursement, while also providing patients with better outcomes. “Use of SDMM to improve interdisciplinary team communication and collaboration in patient care is a win-win for everyone,” Kushner said.

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