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    Innovation and Achievement: Forty-two Years of Success in Acute Rehabilitation

    Over the past several decades, California Pacific Regional Rehabilitation Center (CPRRC) has achieved a leading role in acute rehabilitation care in the United States. Our team of physical rehabilitation specialists, working within a recently constructed facility, provides a continuum of accredited specialty rehabilitation programs unique in Northern California. These innovative and comprehensive programs shaped by nationally recognized clinical research offer rehabilitation outcomes that exceed national benchmarks.

    The Commission for the Accreditation of Rehabilitation Facilities (CARF) has accredited all of CPRRC’s acute rehabilitation specialty programs. In fact, no other facility in Northern California has all of these CARF accreditations: Comprehensive Inpatient Rehabilitation, Stroke Rehabilitation, Brain Injury Inpatient Rehabilitation, Brain Injury Outpatient Day Treatment Rehabilitation, Spinal Cord Rehabilitation (Inpatient and Day Treatment) Systems of Care, Stroke Rehabilitation, and Rehabilitation Case Management. CPRRC is also accredited by the Joint Commission. These accreditations ensure that we meet the highest international standards of rehabilitation care.

    The Regional Rehabilitation Center—an integral part of California Pacific Medical Center (CPMC), one of the largest private, community-based, not-for-profit, teaching medical centers in California—serves as a regional tertiary referral center with a distinguished reputation for providing access to advanced medicine and personalized care.

    The Regional Rehabilitation Center’s acute rehabilitation program is on CPMC’s Davies Campus along with the Neuroscience Institute and the Microsurgery Center. The continuum of care available within this single campus – from ICU and acute care through acute rehabilitation, skilled nursing, and outpatient services – fosters a high degree of collaboration across providers as patients move through the health care system. The extended CPMC hospital community provides other specialized services and levels of care such as the sub-acute unit for ventilator-weaning and low level brain injury rehabilitation. More than 1,000 physician and surgeon specialists provide in-house, 24-hour, state-of-the-art services.

    Providing Patients Access to Comprehensive Therapy

    Acute rehabilitation is an intensive level of care that reaches its optimum potential only when a team of uniquely specialized providers, services, and resources come together with a unified intention of meeting a patient’s needs. The Regional Rehabilitation Center’s acute rehabilitation patients therefore have access to a wide array of specialists, services, and levels of care essential to helping them achieve superior rehabilitation outcomes.

    Rehabilitation starts with medical stabilization. Our neurosurgery team provides a mainstay of support essential to providing care for persons with complicated, catastrophic neurological injury. In addition, Davies Campus is home to a Joint Commission-accredited Primary Stroke Center that can boast one of the nation’s best intravenous tPA administration rates while maintaining low complication rates. The Stroke Center also includes one of the first fully integrated neurointerventional suites in the western United States, where both interventional neuro-radiology and neurosurgery procedures are performed. The exceptional skill of these neurosurgeons sets the stage for neurological healing and the restoration of function that begins in the rehabilitation phase.

    Microsurgery Center provides clinical excellence for the many acute rehabilitation patients who require microsurgery and microvascular repair of traumatic injury. CPRRC’s hand specialists provide an advanced level of intervention for patients needing wound healing, customized postoperative splinting, and dynamic rehabilitative splinting.

    Acute Rehabilitation Research Agenda

    CPMC has a history of robust clinical and bench research leading to breakthrough science, and to medical and technological advances. CPRRC is proud to carry that tradition into the field of rehabilitation. We are honored that our recent clinical research has received national recognition for its contribution to neurology and neurorehabilitation. The abstract "Challenges and New Directions in the Rehabilitation of Executive Functioning: Theory, Application, and Pilot Study Results" (Novakovic, Rome, and Chen), was selected by the American Academy of Neurology as one of the top 5 percent of abstracts presented at that academy’s 2009 Annual Conference. The study examines the therapeutic effects of a novel cognitive rehabilitation treatment for frontal lobe dysfunction in persons with acquired brain injury such as closed head injury and stroke. The use of functional MRI, psychometric testing, and a newly validated clinical tool to evaluate frontal lobe function in a real-world setting holds the potential of elucidating the neurophysiologic mechanisms that underlie functional recovery in these patients. Preliminary results are promising, 16 of 16 patients having significantly improved from baseline measures in testing of targeted cognitive domains. "Rehabilitation of Executive Functioning with Training in Attention Regulation Applied to Individually Defined Goals: A Pilot Study Bridging Theory, Assessment and Treatment" is at press in the Journal of Head Trauma and Rehabilitation. The trial’s functional MRI results, the validation of our new clinical tool, and a paper outlining the theoretical basis have been accepted for publication in separate journal articles.

    Quality Measurements

    CPRRC developed an Accountable Care Model of program evaluation and reporting that stimulates continuous improvement in safety, quality, and efficiency. This model, with more than 80 indicators, drives our system of checks and balances in clinical outcomes, compliance, patient satisfaction, and fiscal performance. This information is then reported throughout the organization. Key performance indicators are shared with community stakeholders, including payers and prospective patients. Functional outcomes are reported and analyzed through the State University of New York at Buffalo, using the Uniform Data System for Medical Rehabilitation® (UDSMR®). UCSMR uses The FIM System® to manage rehabilitation data for changes in functional status. The FIM instrument quantifies a patient’s performance in functional domains such as self-care, mobility, locomotion, communication, continence, socialization, communication, and cognitive skills. The FIM System provides data about changes in functional performance from admission through discharge, as well as other quality data. Furthermore, the durability of outcomes is measured through sample testing after discharge at three months and annually up to three years.

    As in years past, our most recent outcomes data (July 2009 – June 2010) were in the top 2.5 percent of national outcomes. Most significantly, this superior performance was demonstrated in FIM rating score change as an aggregate of all patients, and in the specialty programs for Stroke and Traumatic Brain Injury (Tables 1-6). Our outcomes reflect even more positively when measured against the distribution of discharge destinations of our national cohort (Tables 7-9).

    The California Regional Rehabilitation Center has achieved an impressive standard for acute rehabilitation care. We consider this standard to be a departure point for further advances in our effective array of programs addressing the complex medical and rehabilitation needs of our patients.

    References:
    Novakovic, Rome, and Chen. “Challenges and New Directions in the Rehabilitation of Executive Functioning: Theory, Application, and Pilot Study Results” [abstract presented at American Academy of Neurology 2009 Annual Conference.]

    Additional reading (Peer Reviewed Publications):
    Novakovic-Agopian, T, Chen, A., Rome, S., Abrams, G., Castelli, H., Rossi, A, McKim, R., Hills N. & D’Esposito, M. Rehabilitation of Executive Functioning with Training in Attention Regulation Applied to Individually Defined Goals: A Pilot Study Bridging Theory, Assessment and Treatment. Journal of Head Trauma Rehabilitation. (in press)

    The FIM System® is an outcomes management program reported and analyzed through the State University of New York at Buffalo using the Uniform Data System for Medical Rehabilitation® (UDSMR®) and is regarded as the gold standard for measuring patient function. For over 15 years, FIM was an acronym for "Functional Independence Measure" now referred to only as FIM. FIM measures patient independent performance in self-care, sphincter control, transfers, locomotion, communication, and social cognition. The FIM assessment is completed upon admission and again upon discharge tracking patient functional changes. FIM measures 18 subcategories of 6 functions, each receiving a score of 1 – 7 (1=total assistance required to 7= complete independence). These 18 measures are added together to reach the individual FIM score. By adding the points for each item, the possible total score ranges from 18 (lowest) to 126 (highest) level of independence.

    FIM change represents the FIM score upon discharge compared to the FIM score when admitted for acute rehabilitation.

    FIM 1 – 7 Levels

    • No Helper

    • 7 = Complete Independence

    • 6= Modified Independence Helper (modified Dependence)

    • 5 = Supervision

    • 4= Minimal Assistance

    • 3=Moderate Assistance Helper (complete dependence)

    • 2=Maximal assistance

    • 1=Total assistance


    FIM measures patient independent performance in:
    Self Care
    • Eating

    • Grooming

    • Bathing

    • Dressing – upper Body

    • Dressing- lower body

    • Toileting

    Sphincter Control
    • Bladder

    • Bowel

    Mobility
    • Bed, Chair, Wheelchair

    • Toilet

    • Tub/Shower

    Locomotion
    • Walk/Wheelchair

    • Stairs

    Communications
    • Comprehension

    • Expression

    • Social Cognition

    • Social interaction

    • Problem solving

    • Memory

    Tables 1, 2 and 3


    FIM Change: July 2009 –June 2010





    Data for Tables 1, 2, 3
    FIM Change: July 2009 – June 2010

    Note: a higher FIM Change is better.
    Patient DiagnosisCPMC
    FIM Change
    CPMC
    Number of Patients
    National
    FIM Change
    National
    Number of Patients

    All Patients 28.346325.2424,794
    Stroke27.517524.893,737
    Traumatic Brain Injury36.54027.416,403

    Tables 4, 5 and 6

    Admit and Discharge FIM



    Data for Tables 4, 5, 6
    Admit and Discharge FIM: July 2009 –June 2010

    Note: a higher FIM score upon discharge is better
    Patient Diagnosis CPMC AdmitCPMC DischargeNational Average AdmitNational Average Discharge
    All Patients61.389.661.987.1
    Traumatic Brain Injury58.995.461.488.8
    Stroke54.381.856.581.3

    Tables 7, 8 and 9

    Discharge Destination
    Discharge destination graphs measure discharge location of CPMC acute rehabilitation patients in the following categories: community (home, board & care, assisted living), LTCF (long-term care facility) or acute care (acute hospital bed) against national acute rehabilitation facility discharge destinations in the same categories using UDSMR system data.




    Data for Tables 7, 8, 9
    Discharge Destination

    Note: discharging patient to community is better as more patients return home
    Patient DiagnosisCPMC CommunityCPMC LTCFCPMC Acute CareNation CommunityNation LTCFNation Acute Care
    All Patients78.8%1.9%9.4%75.6%8.1%10.1%
    Traumatic Brain Injury82.9%0%12.2%76.5%7.2%10%
    Stroke77.4%28%8.5%70.4%10.9%10.3%