A Population Health Approach to Transitional Care Management for High-Risk Patients with Diabetes: Outcomes at a Rural Hospital.

Patient transitions from inpatient to home care are an important area of focus for reducing costly unplanned hospital readmissions. In rural settings, the challenge of reducing unplanned readmissions is amplified by limited access to both ambulatory and acute care as well as high levels of social disadvantage. In addition, there is a scarcity of evidence regarding strategies that have been proven to improve care transitions and related patient outcomes in this setting. This paper describes the process for implementation and results of a telephone-based transitional care management (TCM) program designed to reduce readmissions for patients with diabetes in a rural hospital in Scotland County, North Carolina. Data were collected from July 2016 to January 2019 using billing records to identify adult patients with high or very high risk of readmission based on length of stay, acuity, comorbidity, and emergency department visits (LACE) scores. Care managers contacted eligible patients by phone after discharge to review discharge instructions, assess need for home health services and transportation assistance, and schedule primary care follow-up visits. Overall, 13.8% of 15,271 discharges were targeted for TCM; 68.2% of these involved a patient with diabetes. The post-intervention 30-day readmission rate was 18.0% among patients identified as high or very high risk versus 8.8% among the overall population and did not differ significantly between TCM participants with diabetes and those without (22.9% vs.18.8%; P = 0.525). Findings highlight challenges with implementing transition of care interventions in rural settings, which include staffing, patient volume, and accessing data from out-of-network providers.

The effects of strength training on gait in adolescents with cerebral palsy.

PURPOSE: This study was designed to examine the effects of strength training on gait velocity, cadence, step length, and energy expenditure as well as the distance ambulated during a three-minute walk test in adolescents with cerebral palsy (CP) and to provide an assessment of subjects' preference for exercising in a community fitness setting. METHODS: Seven adolescents with CP participated in a six-week strengthening program. Two subjects performed the program at a local fitness center, and five participated at a local high school gym. Subjects, aged 12 to 20 years, were evaluated before and after intervention for trunk and lower extremity muscle strength, gait velocity, cadence, step length, energy expenditure, and the distance ambulated during a three-minute walk test. Data were analyzed using the nonparametric, Wilcoxon signed-rank test. RESULTS: All five dependent variables were found to change significantly after the intervention period. CONCLUSION: Strength training is an important aspect of physical therapy intervention in general, and this study suggests that it is also an effective intervention for the population of adolescents with CP. In addition, all subjects provided subjective feedback supporting their preference for completing the strengthening program in a fitness center or school gym as opposed to exercising during a typical physical therapy session.