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STROKE REHABILITATION SURVEY

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					STROKE REHABILITATION
       SURVEY



           INDIANA
STROKE PREVENTION TASK FORCE

        PRESENTED BY VICKI SCOTT, MS, CTRS
    RECREATIONAL THERAPIST TASK FORCE MEMBER
           BACKGROUND
 Stroke is the third leading cause of death
  in all the Great Lakes Regional Stroke
  Network states
 Approximately, two-thirds of stroke
  survivors require rehabilitation
 Evidence that patients do better with a
  well-organized, multidisciplinary approach
  to post-acute rehabilitation after a stroke
 Need to inventory available rehabilitation
  resources in the Great Lakes region
          BACKGROUND
 Survey developed and validated by
  Great Lakes Regional Stroke Network –
  Illinois, Indiana, Michigan, Minnesota,
  Ohio and Wisconsin
 Pilot tested on a group of “Manager of
  Rehabilitation Specialists” identified
  through the Commission for the
  Accreditation of Rehabilitation
  Facilities (CARF)
 Adapted by the Indiana Governor’s
  Task Force on Stroke Prevention
 Targeted to inpatient and free standing
  rehabilitation centers in Indiana
           BACKGROUND

 The Indiana Governor’s Task Force on
  Stroke Prevention adapted the survey
     Added # of persons with stroke
      served per year
     Added ratio of staff to patients in
       therapy programs
     Added Home Care and Peer
      Mentoring Program under
      discharge/follow-up programs
     Added a question on carepaths,
       pathways and standards of care
       SURVEY METHODS
 Obtained contact information from the
  Indiana Hospital Association Rehab Task
  Force e-mail list
 Survey Monkey used to build the survey
 Distributed to 81 e-mail addresses
  targeting free standing rehabilitation
  centers and units within hospitals
 Represented 55 facilities
 Responses from 26 facilities
 47% response rate
      10 TOPICS ADDRESSED

   Survey respondent’s facility description
   Therapy Programs Offered
   Services or Programs Offered
   Discharge/Follow-up Programs
   CARF Stroke Specialty accreditation
   10 TOPICS ADDRESSED
 Outcome measures collected
 Format preferences for staff continuing
  education
 Biggest challenges to provide
  rehabilitation services to stroke
  survivors
 Stroke rehabilitation research or
  clinical trial involvement
 Stroke related topics of interest for
  continuing education
              INDIANA
        FACILITY DESCRIPTION

                          SUBACUTE
                             3%
                 ASSISTED LIVING               ACUTE CARE
                       2%                       HOSPITAL
        OUTPATIENT                                18%
           24%
                                                            HOME HEALTH
                                                                13%


HOSPITAL BASED
     SNF
      7%                                            FREESTANDING
                             INPATIENT REHAB           REHAB
   SKILLED NURSING
                                   UNIT                  10%
       FACILITY
          3%                       19%

                 LTACH
                   1%
 FACILITY DESCRIPTIONS
 GREAT LAKES RESULTS

 Skilled Nursing Facility   18%
 Outpatient                 16.9%
 Home Health                14.4%
 Acute Care Hospital        13.5%
 Inpatient Unit              7.2%
 Community Based             6.9%
 FACILITY DESCRIPTIONS

 GREAT LAKES RESULTS

    Hospital Based SNF     6.3%
    Assisted Living        5.5%
    Sub-Acute              5.2%
    Freestanding Rehab     3.7%
    Long Term Acute Care   2.3%
     # OF PERSONS WITH
      STROKE PER YEAR
 Acute Care Hospital
   30-600
 Home Health
   20-357
 Freestanding Rehab
   25 TO 326
 Skilled Nursing Facility
   36
     # OF PERSONS WITH
      STROKE PER YEAR
 Hospital Based SNF
   15-150
 Inpatient Rehab Unit
   20-200
 Outpatient
   15 TO 200
 Subacute
   36
                                                                                            # OF FACILITIES
SP
     EE
       C
           H
               A
                   N
                       D
                           LA
                                N
                                    G
                                     U
                                         A
                                             G
                                                 E




                                                                                    0
                                                                                        5
                                                                                            10
                                                                                                                                    15
                                                                                                                                           20
                                                                                                                                                25


                                                     PA
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                                                                                                                                                          OFFERED




                                              SI
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                                                                                                                                                     THERAPY PROGRAMS




                                                                                                           REFER
                                                                                                                                   OFFER




                                                                                             DON'T OFFER
                                                                                                                   OFFER LIMITED
     RATIO OF STAFF TO
         PATIENTS

 NURSING
   3:1 UP TO 8:1
   6.9 TO 9.02 Nursing Hours

 THERAPY
     4:1 TO 8:1
     8-15 Patients per Day
     75% Productivity
      THERAPY SERVICES
 GREAT LAKES RESULTS

 MOST FREQUENTLY OFFERED
  Physical Therapy
   Occupational Therapy
  Speech and Language Pathology
     PROGRAMS OFFERED

              OFFER OFFER     REFER   DON’T OFFER
                    LIMITED
PHYSIATRY     17              3       4
PSYCHOLOGY    15    2         6       1
NEUROPSYCH    10              9       4
SOCIAL SERV   22              2
INTERPRETER 16      3         5
PT/FAMILY     23              1
ED
CAREGIVER     13              5       5
SUPPORT
GROUP
ORTHOTIST-  8       1         14
PROSTHETIST
CHAPLAINCY    20              3       1
          PROGRAMS OFFERED

             OFFER OFFER LIMITED REFER   DON’T
                                         OFFER
SURVIVOR     10                  5       8
SUPPORT
GROUP
VOCATIONAL 1       1             20      2
COUNSELING
DIETITIAN    22                  2
PSYCHIATRY   8     3             9       4
BOWEL/       22                  1       1
BLADDER
CHILD        2     1             5       15
STROKE
MEDICAL      5                   18      1
EQUIPMENT
        PROGRAMS OFFERED

               OFFER   OFFER     REFER   DON’T OFFER
                       LIMITED
HOME REMODEL 1                   17      6
CONTRACTOR
COMMUNITY      2       1         18      3
TRANSPORT
COMMUNITY      2                 18      4
MEALS
IN CLINIC      5       2         14      3
DRIVING
ROAD TESTING   2       1         17      4
HOME           19      1         2       2
ASSESSMENT
TRIAL VISITS   16      1         1       6
HOME
          PROGRAMS
 GREAT LAKES RESULTS

 MOST FREQUENTLY OFFERED

  Patient/Family Education
  Social Services
  Dietitian
                               DISCHARGE/FOLLOW-UP
                  25
                                    PROGRAMS

                  20
# OF FACILITIES




                  15
                                                                                                   OFFER
                                                                                                   OFFER LIMITED
                                                                                                   REFER
                                                                                                   DON'T OFFER
                  10




                  5




                  0
                       TRANSITIONAL   TELEPHONE     STROKE    OUTPATIENT   HOME CARE      PEER
                           CARE       FOLLOW-UP   FOLLOW-UP    THERAPY                 MONTORING
                                                     CLINIC                             PROGRAM
         CARF/RESEARCH

 6 Facilities indicated CARF Stroke
  Specialty accredited
     6 were considering CARF Stroke
      Specialty accreditation

 4 Facilities involved with stroke
  rehabilitation research or clinical trials
 12 Facilities using carepaths,
  pathways, standards of care for stroke
                                                                                           PERCENT
                  N
                   IH
                           S
                               TR
                                 O
                                  K




                                                              0%
                                                                   10%
                                                                         20%
                                                                               30%
                                                                                     40%
                                                                                             50%
                                                                                                   60%
                                                                                                         70%
                                                                                                               80%
                                                                                                                     90%
                                                                                                                           100%
        M                                E
            O                                S
             D                                   C
              IF                                  A
                   IE                              LE
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                                                  A
                                                      LE




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                                                                                                                                  OUTCOME MEASURES




                                                       F
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                                              S
                                                  SI
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   OUTCOMES MEASURES
 GREAT LAKES RESULTS

 MOST FREQUENT
    Discharge of Patients Home
     FIM (Functional Independence
          Measure)
     Dysphagia Screens
                  PREFERRED CONTINUING
          40%
                    EDUCATION FORMAT
          35%



          30%



          25%
PERCENT




          20%


          15%



          10%



          5%



          0%
                CONFERENCE      STATE      WEB-BASED     REGIONAL    PERSONAL      NATIONAL  INSERVICES AT
                  CALLS      CONFERENCES               CONFERENCES   COMPUTER    CONFERENCES    FACILITY
                                                                     DVD OR CD
  CONTINUING EDUCATION
    PREFERRED FORMAT
 GREAT LAKES RESULTS

   #1 Workplace (25%)

   #2   State Conferences (16%)

   #3   Regional Conferences (14%)
                                                                                                          PERCENT
                        IN
                          S
                                U
                                 R
TR                                A
  A                                      N
      N                                   C
       S                                          E/
                                                     P
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                                                                                                                                          BIGGEST CHALLENGES




                                                               E
                                                                    FE
                                                                          R
                                                                           R
                                                                            A
                                                                                L
   BIGGEST CHALLENGES
 GREAT LAKES RESULTS

 #1 Insurance/Payor Source

 #2 Patient Compliance

  #3 Family/Social Support
  STROKE RELATED TOPICS
 Treatment Plans for L Brain R
  Brain Effects
 Etiology of Stroke
 Medication Management Post-
  Stroke
 Post Rehab Care Resources
 Available Grants and Outreach
  Services
 Functional Outcomes
    STROKE RELATED TOPICS
   Pathophysiology and PNF
   Remote Monitoring and Evaluation
   Cortical Stimulation
   Visual Retraining
   Constraint Induced Therapy
   Use of MNES
   Dealing with Behaviors Treating
    Cognitive Deficits
  STROKE RELATED TOPICS


 Role of Nursing in Skilled Inpatient
  Acute Rehab
 New Treatments and Medications
         TASK FORCE
      RECOMMENDATIONS
 Work with Insurance on
  Guidelines

 Start Peer Mentoring Programs

 Provide Continuing Education
  specific to Stroke Population
         DISCUSSION
 Next Steps for Task Force