STROKE REHABILITATION SURVEY INDIANA STROKE PREVENTION TASK FORCE PRESENTED BY VICKI SCOTT, MS, CTRS RECREATIONAL THERAPIST TASK FORCE MEMBER
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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 rehabilitationresources 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 standingrehabilitation 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
ACUTE CARE
HOSPITAL
18%
HOME HEALTH
13%
FREESTANDING
REHAB
10%INPATIENT REHAB
UNIT
19%
LTACH
1%
SKILLED NURSING
FACILITY
3%
HOSPITAL BASED
SNF
7%
OUTPATIENT
24%
ASSISTED LIVING
2%
SUBACUTE
3%
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
THERAPY PROGRAMS OFFERED
0
5
10
15
20
25
SPEEC
H A
ND L
ANGUAG
E PATH
OLO
GY
PHYSIC
AL T
HERAPY
OCCU
PATI
ONAL T
HERAPY
REC
REA
TIONAL
THER
APY
REH
ABIL
ITATI
ON N
URSIN
G
MUSIC
THERA
PY
ART T
HERAPY
# O
F F
AC
ILIT
IES
OFFER
OFFER LIMITED
REFER
DON'T OFFER
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 LIMITED
REFER DON’T OFFER
PHYSIATRY 17 3 4
PSYCHOLOGY 15 2 6 1
NEUROPSYCH 10 9 4
SOCIAL SERV 22 2
INTERPRETER 16 3 5
PT/FAMILY ED
23 1
CAREGIVER SUPPORT GROUP
13 5 5
ORTHOTIST-
PROSTHETIST
8 1 14
CHAPLAINCY 20 3 1
PROGRAMS OFFERED
OFFER OFFER LIMITED REFER DON’T OFFER
SURVIVOR SUPPORT GROUP
10 5 8
VOCATIONAL COUNSELING
1 1 20 2
DIETITIAN 22 2
PSYCHIATRY 8 3 9 4
BOWEL/
BLADDER
22 1 1
CHILD STROKE
2 1 5 15
MEDICAL EQUIPMENT
5 18 1
PROGRAMS OFFERED
OFFER OFFER LIMITED
REFER DON’T OFFER
HOME REMODEL CONTRACTOR
1 17 6
COMMUNITY TRANSPORT
2 1 18 3
COMMUNITY MEALS
2 18 4
IN CLINIC DRIVING
5 2 14 3
ROAD TESTING 2 1 17 4
HOME ASSESSMENT
19 1 2 2
TRIAL VISITS HOME
16 1 1 6
PROGRAMS
GREAT LAKES RESULTS
MOST FREQUENTLY OFFERED
Patient/Family Education
Social Services
Dietitian
DISCHARGE/FOLLOW-UP PROGRAMS
0
5
10
15
20
25
TRANSITIONAL
CARE
TELEPHONE
FOLLOW-UP
STROKE
FOLLOW-UP
CLINIC
OUTPATIENT
THERAPY
HOME CARE PEER
MONTORING
PROGRAM
# O
F F
AC
ILIT
IES
OFFER
OFFER LIMITED
REFER
DON'T OFFER
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
OUTCOME MEASURES
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NIH S
TROK
E SCALE
MO
DIFIE
D R
ANKIN
SCA
LEFIM
BARTHEL A
DL INDEX
DYSPHAG
IA S
CREEN
DISCHA
RGE D
ESTINA
TION
HO
ME
DISCHA
RGE D
ESTINA
TION
SNF
DEPRESSION
PE
RC
EN
T
OUTCOMES MEASURES
GREAT LAKES RESULTS
MOST FREQUENT
Discharge of Patients Home
FIM (Functional Independence Measure)
Dysphagia Screens
PREFERRED CONTINUING EDUCATION FORMAT
0%
5%
10%
15%
20%
25%
30%
35%
40%
CONFERENCE
CALLS
STATE
CONFERENCES
WEB-BASED REGIONAL
CONFERENCES
PERSONAL
COMPUTER
DVD OR CD
NATIONAL
CONFERENCES
INSERVICES AT
FACILITY
PE
RC
EN
T
CONTINUING EDUCATION PREFERRED FORMAT
GREAT LAKES RESULTS
#1 Workplace (25%)
#2 State Conferences (16%)
#3 Regional Conferences (14%)
BIGGEST CHALLENGES
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
INSURA
NCE/P
AYOR S
OURC
E
TRANSPO
RTATION G
ETTING
TO
TREATM
ENT
PATIEN
T CO
MPLIA
NCE
FAMIL
Y/SO
CIAL S
UPPO
RT
STAFFING
LIM
ITATIO
NS/CO
NSTRAIN
TS
OB
TAIN
ING
PH
YSICIA
N REFERRA
L
PE
RC
EN
T
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
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