Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 12, Supplement , Pages 16-33 , December 2005

Applying the Clinical Practice Improvement Approach to Stroke Rehabilitation: Methods Used and Baseline Results

  • Julie Gassaway, MS, RN

      Affiliations

    • Institute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT
    • ,
  • Susan D. Horn, PhD

      Affiliations

    • Institute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT
    • Corresponding Author InformationReprint requests to Susan D. Horn, Institute for Clinical Outcomes Research, 699 E South Temple, Ste 100, Salt Lake City, UT 84102-1282
    • ,
  • Gerben DeJong, PhD

      Affiliations

    • National Rehabilitation Hospital and Department of Rehabilitation Medicine, Georgetown University, Washington, DC
    • ,
  • Randall J. Smout, MS

      Affiliations

    • Institute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT
    • ,
  • Crystal Clark, MD, MPH

      Affiliations

    • Center for Clinical Effectiveness, Elmhurst Hospital Center, and Mount Sinai School of Medicine, New York, NY
    • ,
  • Roberta James, MStat

      Affiliations

    • Institute for Clinical Outcomes Research, International Severity Information Systems Inc, Salt Lake City, UT

References 

  1. Van Peppen RP , Kwakkel G , Wood-Dauphinee S , Hendricks HJ , Van der Wees PH , Dekker J . The impact of physical therapy on functional outcomes after stroke (what’s the evidence?) . Clin Rehabil . 2004;18:833–862
  2. Sulch D , Perez I , Melbourn A , Kalra L . Randomized controlled trial of integrated (managed) care pathway for stroke rehabilitation . Stroke . 2000;31:1929–1934
  3. Alexander H , Bugge C , Hagen S . What is the association between the different components of stroke rehabilitation and health outcomes? . Clin Rehabil . 2001;15:207–215
  4. Jette DU , Latham NK , Smout RJ , Gassaway J , Slavin MD , Horn SD . Physical therapy interventions for patients with stroke in in-patient rehabilitation facilities . Phys Ther . 2005;85:238–248
  5. Elman RJ , Bernstein-Ellis E . The efficacy of group communication treatment in adults with chronic aphasia . J Speech Lang Hear Res . 1999;42:411–419
  6. Bollinger R , Musson N , Holland AL . A study of group communication intervention with chronically aphasic persons . Aphasiology . 1993;7:301–313
  7. DeJong G , Horn SD , Conroy B , Nichols D , Healton EB . Opening the black box of poststroke rehabilitation (stroke rehabilitation patients, processes, and outcomes) . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S1–S7
  8. In:  Horn SD editors. Clinical practice improvement methodology (implementation and evaluation) . New York: Faulkner & Gray; 1997;
  9. Horn SD , DeJong G , Ryser DK , Veazie PJ , Teraoka J . Another look at observational studies in rehabilitation research (going beyond the holy grail of the randomized controlled trial) . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S8–S15
  10. McNaughton H , DeJong G , Smout RJ , Melvin JL , Brandstater M . A comparison of stroke rehabilitation practice and outcomes between New Zealand and United States facilities . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S115–S120
  11. In:  Hart AC ,  Schmidt KM ,  Aaron WS editor. ICD-9-CM code book . Reston: St. Anthony’s Publishing; 1999;
  12. DeJong G , Horn SD , Gassaway J , Dijkers M , Slavin M . Toward a taxonomy of rehabilitation interventions (using an inductive approach to examine the ‘black box’ of rehabilitation) . Arch Phys Med Rehabil . 2004;55:678–686
  13. Latham NK , Jette DU , Slavin M , et al.   Physical therapy during stroke rehabilitation for people with different walking abilities . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S41–S50
  14. Richards LG , Latham NK , Jette DU , Rosenberg L , Smout RJ , DeJong G . Characterizing occupational therapy practice in stroke rehabilitation . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S51–S60
  15. Hatfield B , Millet D , Coles J , Gassaway J , Conroy B , Smout RJ . Characterizing speech and language pathology outcomes in stroke rehabilitation . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S61–S72
  16. Horn SD , DeJong G , Smout RJ , Gassaway J , James R , Conroy B . Stroke rehabilitation patients, practice, and outcomes (is earlier and more aggressive therapy better?) . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S101–S114
  17. Bode R , Heinemann A , Semik P , Mallinson T . Patterns of therapy activities across length of stay and impairment levels (peering inside the “black box” of inpatient stroke rehabilitation) . Arch Phys Med Rehabil . 2004;85:1901–1908
  18. Horn SD , Sharkey PD , Gassaway J . Managed care outcomes project (study design, baseline patient characteristics, and outcome measures) . Am J Manag Care . 1996;2:237–247
  19. Willson DF , Horn SD , Smout RJ , Gassaway J , Torres A . Severity assessment in children hospitalized with bronchiolitis using the pediatric component of the Comprehensive Severity Index (CSI) . Pediatr Crit Care Med . 2000;1:127–132
  20. Horn SD , Sharkey PD , Buckle JM , Backofen JE , Averill RF , Horn RA . The relationship between severity of illness and hospital length of stay and mortality . Med Care . 1991;29:305–317
  21. Averill RF , McGuire TE , Manning BE , et al.   A study of the relationship between severity of illness and hospital cost in New Jersey hospitals . Health Serv Res . 1992;27:587–606 discussion 607-12
  22. Thomas TJ , Ashcraft ML . Measuring severity of illness (comparison of severity and severity systems in terms of ability to explain variation in costs) . Inquiry . 1991;28:39–55
  23. Alemi F , Rice J , Hankins R . Predicting in-hospital survival of myocardial infarction, a comparative study of various severity measures . Med Care . 1990;28:762–774
  24. Horn SD , Torres A , Willson D , Dean JM , Gassaway J , Smout R . Development of a pediatric age- and disease-specific severity measure . J Pediatr . 2002;141:496–503
  25. Conroy B , Zorowitz R , Horn SD , Ryser DK , Teraoka J , Smout RJ . An exploration of central nervous system medication use and outcomes in stroke rehabilitation . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S73–S81
  26. James R , Gines D , Menlove A , Horn SD , Gassaway J , Smout RJ . Nutrition support (tube feeding) as a rehabilitation intervention . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S82–S92
  27. Maulden SA , Gassaway J , Horn SD , Smout RJ , DeJong G . Timing of initiation of rehabilitation after stroke . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S34–S40
  28. DeJong G , Horn SD , Smout RJ , Ryser DK . The early impact of the inpatient rehabilitation facility prospective payment system on stroke rehabilitation case mix, practice patterns, and outcomes . Arch Phys Med Rehabil . 2005;86(12 Suppl 2):S93–S100
  29. Greenberg E , Treger J , Ring H . Post-stroke follow-up in rehabilitation outpatient clinic . Isr Med Assoc J . 2004;6:603–606
  30. Bohannon RW , Ahlquist M , Lee N , Maljanian R . Functional gains during acute hospitalization for stroke . Neurorehabil Neural Repair . 2003;17:192–195
  31. Hamilton BB , Laughlin JA , Fiedler RC , Granger CV . Interrater reliability of the 7-level functional independence measure (FIM) . Scand J Rehabil Med . 1994;26:115–119
  32. Centers for Medicare and Medicaid Services. Medicare Program; prospective payment system for inpatient rehabilitation facilities, final rule. 66 Federal Register 41315 (2001).

 Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133B990005) and the U.S. Army and Materiel Command (cooperative agreement award no. DAMD17-02-2-0032). The views, opinions, and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy, or decision unless so designated by other documentation.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

PII: S0003-9993(05)01147-0

doi: 10.1016/j.apmr.2005.08.114

Archives of Physical Medicine and Rehabilitation
Volume 86, Issue 12, Supplement , Pages 16-33 , December 2005

Article Tools