Biomedical subjects

Hilary Siebens

Publications and source records attributed to Hilary Siebens.

11 recordsLinked to original sources

PubMed2006

Computerized adaptive testing for follow-up after discharge from inpatient rehabilitation: I. Activity outcomes.

OBJECTIVE: To examine score agreement, precision, validity, efficiency, and responsiveness of a computerized adaptive testing (CAT) version of the Activity Measure for Post-Acute Care (AM-PAC-CAT) in a prospective, 3-month follow-up sample of inpatient rehabilitation patients recently discharged home. DESIGN: Longitudinal, prospective 1-group cohort study of patients followed approximately 2 weeks after hospital discharge and then 3 months after the initial home visit. SETTING: Follow-up visits conducted in patients' home setting. PARTICIPANTS: Ninety-four adults who were recently discharged from inpatient rehabilitation, with diagnoses of neurologic, orthopedic, and medically complex conditions. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Summary scores from AM-PAC-CAT, including 3 activity domains of movement and physical, personal care and instrumental, and applied cognition were compared with scores from a traditional fixed-length version of the AM-PAC with 66 items (AM-PAC-66). RESULTS: AM-PAC-CAT scores were in good agreement (intraclass correlation coefficient model 3,1 range, .77-.86) with scores from the AM-PAC-66. On average, the CAT programs required 43% of the time and 33% of the items compared with the AM-PAC-66. Both formats discriminated across functional severity groups. The standardized response mean (SRM) was greater for the movement and physical fixed form than the CAT; the effect size and SRM of the 2 other AM-PAC domains showed similar sensitivity between CAT and fixed formats. Using patients' own report as an anchor-based measure of change, the CAT and fixed length formats were comparable in responsiveness to patient-reported change over a 3-month interval. CONCLUSIONS: Accurate estimates for functional activity group-level changes can be obtained from CAT administrations, with a considerable reduction in administration time.

Activities of Daily Living↗

PubMed2006

Agreement in functional assessment: graphic approaches to displaying respondent effects.

OBJECTIVE: The objective of this study was to examine the agreement between respondents of summary scores from items representing three functional content areas (physical and mobility, personal care and instrumental, applied cognition) within the Activity Measure for Postacute Care (AM-PAC). We compare proxy vs. patient report in both hospital and community settings as represented by intraclass correlation coefficients and two graphic approaches. DESIGN: The authors conducted a prospective, cohort study of a convenience sample of adults (n = 47) receiving rehabilitation services either in hospital (n = 31) or community (n = 16) settings. In addition to using intraclass correlation coefficients (ICC) as indices of agreement, we applied two graphic approaches to serve as complements to help interpret the direction and magnitude of respondent disagreements. We created a "mountain plot" based on a cumulative distribution curve and a "survival-agreement plot" with step functions used in the analysis of survival data. RESULTS: ICCs on summary scores between patient and proxy report were physical and mobility ICC = 0.92, personal care and instrumental ICC = 0.93, and applied cognition ICC = 0.77. Although combined respondent agreement was acceptable, graphic approaches helped interpret differences in separate analyses of clinician and family agreement. CONCLUSIONS: Graphic analyses allow for a simple interpretation of agreement data and may be useful in determining the meaningfulness of the amount and direction of interrespondent variation.

Computer Graphics↗

PubMed2005

The patient care notebook: from pilot phase to successful hospitalwide dissemination.

BACKGROUND: A patient care notebook that patients take with them to different care settings improved disharge planning and patient education during a pilot find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) project on a 15-bed rehabilitation unit. The 296-bed rehabilitation hospital expanded the notebook's use to all hospital programs through a second PDCA cycle. ADAPTING THE NOTEBOOK: The three-ring binder notebook sections were modified from the pilot notebook to three sections standardized for all programs. Materials included information about hospital services and patients' rights and medical information about future appointments, specific diagnostic information, home medications and exercises, and equipment and home modifications. Staff were educated about the notebook through in-services and an educational video. RESULTS: When patients and their families who were discharged with home services were contacted, more than two-thirds reported that the notebooks were useful and easy to use. As staff became more familiar with the notebook, 75% or more reported that the notebooks were useful and easy to use and improved the discharge process. The notebooks were still used two years after their introduction. DISCUSSION: An innovative and helpful new care process, the patient care notebook can improve a rehabilitation hospital's patient education and discharge planning processes. It represents a better practice in health care provider/patient communication.

Boston↗

PubMed2005

Measuring physical function in patients with complex medical and postsurgical conditions: a computer adaptive approach.

OBJECTIVE: To examine whether the range of disability in the medically complex and postsurgical populations receiving rehabilitation is adequately sampled by the new Activity Measure--Post-Acute Care (AM-PAC), and to assess whether computer adaptive testing (CAT) can derive valid patient scores using fewer questions. DESIGN: Observational study of 158 subjects (mean age 67.2 yrs) receiving skilled rehabilitation services in inpatient (acute rehabilitation hospitals, skilled nursing facility units) and community (home health services, outpatient departments) settings for recent-onset or worsening disability from medical (excluding neurological) and surgical (excluding orthopedic) conditions. Measures were interviewer-administered activity questions (all patients) and physical functioning portion of the SF-36 (outpatients) and standardized chart items (11 Functional Independence Measure (FIM), 19 Standardized Outcome and Assessment Information Set (OASIS) items, and 22 Minimum Data Set (MDS) items). Rasch modeling analyzed all data and the relationship between person ability estimates and average item difficulty. CAT assessed the ability to derive accurate patient scores using a sample of questions. RESULTS: The 163-item activity item pool covered the range of physical movement and personal and instrumental activities. CAT analysis showed comparable scores between estimates using 10 items or the total item pool. CONCLUSION: The AM-PAC can assess a broad range of function in patients with complex medical illness. CAT achieves valid patient scores using fewer questions.

Activities of Daily Living↗

PubMed2005

The domain management model--a tool for teaching and management of older adults in emergency departments.

Older adults in emergency departments (EDs) can have complicated health problems that defy straightforward diagnosis and management. Implementation of the 11 core principles in the geriatric emergency care model requires changes in care processes. The Domain Management Model (DMM) is one solution to organize care efficiently using a standard language. Its use is consistent with the geriatric model. Patients' problems are organized into one of four domains: I. Medical/Surgical Issues; II. Mental Status/Emotions/Coping; III. Physical Function; and IV. Living Environment (A. Physical, B. Social, and C. Financial). Specific geriatric cases illustrate improved communication using these standard domains. This model can educate health care staff, facilitate team care, improve flow of relevant information, improve decision making, and facilitate more meaningful interactions with patients.

Aged↗

PubMed2004

Use of Geriatrics At Your Fingertips, a pocket guide, to educate physiatrists in geriatric care.

OBJECTIVE: To determine whether a geriatric pocket guide, Geriatrics At Your Fingertips, may be a useful tool in educating physiatrists about the care of their older patients. DESIGN: Geriatrics At Your Fingertips was distributed through the American Academy of Physical Medicine and Rehabilitation (AAPM&R) to physical medicine and rehabilitation (PM&R) residents and practicing physiatrists. Two questionnaires evaluated guide use. SETTING: Two academic PM&R departments and physiatrists in the United States. PARTICIPANTS: Two PM&R residency programs, members of AAPM&R's Geriatric Rehabilitation Special Interest Group (GR-SIG), and AAPM&R's membership. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Identification of clinically useful information by residents and GR-SIG members and frequency of guide use among AAPM&R membership. RESULTS: Forty-five PM&R residents and 17 GR-SIG members reported examples of useful information. Geriatrics At Your Fingertips was requested by 483 AAPM&R members. Forty-six percent returned questionnaires (N=223). Seventy percent had used the guide at least once and 49% 4 or more times. CONCLUSIONS: Geriatrics At Your Fingertips is a useful tool with which to educate PM&R residents and physiatrists about geriatric care.

Aged↗

PubMed2004

PoWER Program: People with Disabilities Educating Residents.

An educational program was developed incorporating people with disabilities (PWDs) as "consumer-trainers" who educate physical medicine and rehabilitation residents about challenges in everyday living and their solutions to these. During the residency postgraduate years 2 and 4, pairs of residents visited trainers in their homes and at their jobs to learn about their lifestyles and adaptations. Residents' described the experience as "excellent, outstanding, invaluable" in more than half of the evaluations. PWDs can educate physical medicine and rehabilitation residents about living with disabilities. This new residency educational strategy encourages residents to value the perspective of PWDs.

Adult↗

PubMed2004

Research agenda for geriatric rehabilitation.

The Research Agenda Setting Process is a joint endeavor by the American Geriatrics Society and the Hartford Foundation to increase geriatric expertise in the surgical and related specialties. This article provides the results of the Research Agenda Setting Process project on research needs in geriatric rehabilitation, which included a systematic review of the literature and a group consensus process. Explicit research questions and methodologies were developed for three cross-cutting research needs in geriatric rehabilitation and for the rehabilitation of eight specific conditions affecting older individuals.

Aged↗

PubMed2002

The domain management model: a tool to help organize care of stroke survivors in skilled nursing facilities.

More rehabilitative care takes place in nursing homes than in any other setting. Skilled nursing facilities (SNFs) face increasing challenges in delivering stroke rehabilitation care. The Domain Management Model (DMM) organizes care of stroke survivors by identifying four critical domains that include all problems patients and families may face. Problems identified through the Minimum Data Set and Resident Assessment Protocols can be organized by the domains as well. In the SNF setting, the DMM can help organize rehabilitation care by assisting in the identification of all relevant clinical problems and by serving as a structured format for team meetings, problem management, and discharge summaries.

Journal Article↗

PubMed2002

The domain management model: organizing care for stroke survivors and other persons with chronic diseases.

The US health care system is poorly designed to help patients with stroke and chronic health conditions and their functional consequences. These patients face multiple clinical problems. The Domain Management Model (DMM), based on the biopsychosocial model, describes four domains into which all patient and family problems can be classified. These problems are then managed over time through attention to care processes and outcomes. The use of the DMM in health care may help relieve patient and family suffering, guide resource use more efficiently, and improve satisfaction of health care providers (clinical, administrative, and financial) in treating complex patients with chronic health conditions.

Journal Article↗

PubMed2002

Clinical information systems for primary care: more than just an electronic medical record.

Massachusetts General Hospital Senior Health has integrated a computer-based clinical information system into all aspects of its patient care. This technology includes a longitudinal medical record but has broader functionality that encourages communication, education, and quality improvement activities. Care of geriatric patients is often challenging because of the complex nature of their clinical presentations. The case presented here, a patient at risk for stroke, illustrates how a clinical information system can facilitate quality care. The benefits, as well as difficulties, experienced as the system was integrated into the program's clinical practice are also described.

Journal Article↗