National Healthcare Disparities Report - LDI Health Economist

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Effectiveness of Care Functional Status Preservation and Rehabilitation Importance Chapter 2 Functional Status Preservation and Rehabilitation Demographics Noninstitutionalized adults needing help of another person with activities of daily living (ADLs) xxviii (2009) ....................................................................................4.4 million (Adams, et al., 2010) Noninstitutionalized adults needing help with instrumental activities of daily living (IADLs) xxix (2009)....................................................................................9.2 million (Adams, et al., 2010) Nursing home residents needing help with ADLs (2004) ..........................................1.5 million (NCHS, 2004) Number of Medicare beneficiaries receiving inpatient rehabilitation facility care (2009) ……………………………………………………………....361,000 (MedPAC, 2011) Costs Medicare payments for outpatient physical therapy (2006 est.)..........................................................$3.1 billion (Ciolek & Hwang, 2008) Medicare payments for outpatient occupational therapy (2006 est.)................................................$747 million (Ciolek & Hwang, 2008) Medicare payments for outpatient speech-language pathology services (2006 est.).......................$270 million (Ciolek & Hwang, 2008) Medicare payments for outpatient rehabilitation (2010) ............................................$3.8 billion (CMS, 2010a) Medicare payments for inpatient rehabilitation facility care (2010)......................$6.4 billion (MedPAC, 2011) Measures A person’s ability to function can decline with disease or age, but it is not always an inevitable consequence. Threats to function span a wide variety of medical conditions. Services to maximize function are delivered in a variety of settings, including providers’ offices, patients’ homes, long-term care facilities, and hospitals. Some health care interventions can help prevent diseases that commonly cause declines in functional status. Other interventions, such as physical activity, physical therapy, occupational therapy, and speech-language pathology services, can help patients regain function that has been lost or minimize the rate of decline in functioning. The NHQR and NHDR track several measures related to functional status preservation and rehabilitation. Two measures are highlighted in this section: n Improvement in mobility among home health care patients. n Nursing home residents needing more help with daily activities. xxviii ADLs consist of basic self-care tasks, such as bathing, dressing, eating, transferring, using the toilet, and walking. xxix IADLs consist of tasks needed for a person to live independently, such as shopping, doing housework, preparing meals, taking medications, using the telephone, and managing money. 120 National Healthcare Disparities Report, 2011
Effectiveness of Care In addition, this year we have a special focus section on functional improvement of inpatient rehabilitation facility (IRF) patients recovering from stroke. Findings Outcome: Improvement in Mobility Among Home Health Care Patients After an illness or injury, many patients receiving home health care may need temporary help to walk safely. This assistance can come from another person or from equipment, such as a cane. Patients who use a wheelchair may have difficulty moving around safely, but if they can perform this activity with little assistance, they are more independent, self-confident, and active. As patients recover from illness or injury, physical therapy can facilitate improvements in walking and moving with a wheelchair. However, in cases of patients with some neurologic conditions, such as progressive multiple sclerosis or Parkinson’s disease, ambulation may not improve even when the home health agency provides good care. In addition, the characteristics of patients referred to home health agencies vary across States. Figure 2.51. Adult home health care patients whose ability to walk or move around improved, by race and ethnicity, 2002-2009 Percent 60 White Black 55 50 45 40 Asian NHOPI 2008 Achievable Benchmark: 54% >1 Race AI/AN Percent 60 55 50 45 40 Non-Hispanic White Hispanic 2008 Achievable Benchmark: 54% Chapter 2 Functional Status Preservation and Rehabilitation 35 35 30 30 25 Z 0 2002 2003 2004 2005 2006 2007 2008 2009 Key: AI/AN = American Indian or Alaska Native; NHOPI = Native Hawaiian or Other Pacific Islander. Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set (OASIS), 2002-2009. Denominator: Adult nonmaternity patients completing an episode of skilled home health care and not already performing at the highest level at the start of the episode, according to the OASIS question on ambulation. 25 Z 0 2002 2003 2004 2005 2006 2007 2008 2009 National Healthcare Disparities Report, 2011 121
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U.S. Department of Health and Human
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