Aspiration in rehabilitation patients: videofluoroscopy vs bedside clinical assessment.

This paper reports the results of a blinded study comparing videofluoroscopy with bedside clinical evaluations by speech/language pathologists in the diagnosis of aspiration. One hundred and seven inpatients from a general rehabilitation hospital were evaluated over a four-month period. Of the total patient population, 43 (40%) aspirated at least one consistency of food during videofluoroscopy. Bedside evaluation identified only 18 (42%) of these patients. The positive predictive value of bedside assessment was 0.75; negative predictive value was 0.70. Aspirators on videofluoroscopy were more likely to have brainstem or multilobe central nervous system involvement than nonaspirators. However, there was no statistically significant difference in lesion sites between clinically detected and "silent" aspirators. While the significance of aspiration noted on videofluoroscopy is debatable, it is clear that bedside evaluation alone underestimates the frequency of aspiration in patients with neurologic dysfunction.

Computerized tomography head scans as predictors of functional outcome of stroke patients.

Preadmission computerized tomography (CT) scans of the head were used to help develop a clinical method for the prediction of outcome of stroke patients. The functional gains and discharge outcomes of 100 stroke patients after inpatient rehabilitation were considered. Reports of preadmission (acute care hospital) CT scans of the head were analyzed and placed into six groups representing progressive anatomic involvement. Functional status was measured at admission and discharge using the patient evaluation and conference system (PECS) and placed into four functional groups. The groups ranged from normal to totally dependent in self-care activities, ambulation, and bladder and bowel functioning. Admission CT head scans reported in two categories--"normal" or "small superficial infarct"--were associated with return to independent functioning. Bihemispheric infarcts were associated with discharge to nursing home (71%), rather than to independent living. Of all patients with functional gain as measured with PECS, 79% returned home.

Computerized data bases: an integrated approach to monitoring quality of patient care.

Common information is shared by rehabilitation program evaluation, utilization review, and quality assurance. These administrative functions sometimes operate in isolation, not taking advantage of information sharing. This approach fails to recognize the potential for increased efficiency of integrating pertinent information to produce timely and useful reports. We report on a system design which addresses this concern by encouraging information sharing, reducing data duplication and creating a data base to produce needed statistical and management reports. Our discussion highlights the key elements of program evaluation, utilization review, and quality assurance. These elements are described as an integrated approach to meet the Commission on Accreditation of Rehabilitation Facilities and revised Joint Commission on Accreditation of Hospitals standards.