AHCA/NCAL is a not-for-profit trade association which represents close to 15,000 nursing homes, assisted living communities, and facilities specializing in the care of people with intellectual and developmental disabilities. It’s mission is to “improve lives by providing solutions for quality care”. AHCA represents the long-term care community to the nation at large – to government, business leaders, and the general public. We serve as a force for change, providing information, education, and administrative tools that enhance quality at every level.

AHCA is a federate organization, comprised of state affiliates in every state but Montana (note most of the SNFs in Montana join AHCA through another state affiliate). SNFs and ALs cannot join AHCA directly but become members as part of their state membership. We divide our members into 3 councils based on size: (Large Chains with >40 SNFs, multi-regional SNFs with between 10 to 40 facilities, Independent owners with <10 SNFs). We also have a not-for-profit council of all NFP SNFs.  AHCA represents approximately 2/3rds of all the for-profit nursing homes, nearly 50% of not-for-profit as well as government owned facilities (e.g. county or state facilities). The top 150 chains in the country are also members but represent about 3,500 facilities in the country. Just over 50% of members are independent often family owned organizations comprised of less 10 SNFs/NFs. 

AHCA/NCAL serve as forces for change: providing information, education, and administrative tools that enhance quality at every level. It’s national Quality Initiatives include improving care for people with dementia and reducing off-label antipsychotic medication use in this population, so non-pharmacological interventions are of particular interest to us. So, too, is quickening the pace of research. AHCA advocates for quality care and services for frail, elderly, and disabled Americans.AHCA/NCAL members provide essential care to approximately one million individuals in over 13,500 not-for-profit and proprietary member facilities.

As part of our extensive portfolio of member services, AHCA maintains legislative, regulatory and public affairs. 

AHCA/NCAL dedicated staff work both internally and externally to assist member providers, the government, and the general public.  AHCA, its affiliates, and member providers advocate for individuals who – because of social needs, disability, trauma or illness – require services provided in a long-term care setting. 

AHCA/NCAL continues to advocate for the continuing vitality of the long-term care provider community. It is committed to developing necessary and reasonable public policies which balance economic and regulatory principles to support quality care and quality of life.

AHCA/NCAL provides education and tools for our members to improve their quality. It maintains an online learning management system (i.e., ahcancalED) with curriculum covering many clinical and regulatory issues facing nursing homes. It is also maintaining an online data benchmarking tool (i.e., Long Term Care Trend Tracker) that allows members to trend their performance and benchmark to various peer groups on many quality measures (e.g. Five Star, survey findings, nursing home quality measures, staffing including both levels and turnover, as well as financial metrics from CMS cost reports). AHCA/NCAL are the largest affiliated Baldrige Performance Excellence program in the country with over 1,200 applications per year. 

Unwavering in its commitment to the community, BMC is a private, not-for-profit, 514-bed, academic medical center located in Boston’s historic South End. The primary teaching affiliate for Boston University School of Medicine, BMC is the largest safety net hospital and busiest trauma and emergency services center in New England. BMC is dedicated to providing accessible healthcare to everyone; 57% of its patients are from under-served populations and 32% of patients do not speak English as a primary language. Through its commitment to serve everyone, BMC offers numerous outreach programs and services such as: Health Screenings, Smoking Cessation, Preventive Food Pantry, and Interpreter Services in over 250 Languages, 24 hours a day

Seeing more than one million patient visits a year in over 70 medical specialties and subspecialties, BMC physicians are leaders in their fields with the most advanced medical technology at their fingertips and working alongside a highly skilled nursing and professional staff. No matter who you meet at BMC – from the x-ray technologist to the critical care nurse, the admissions staff to the chief of surgery – everyone is committed to providing quality care to every patient and family member with respect, warmth and compassion. BMC employs 764 physicians in 70 medical specialties and subspecialties, 821 residents and fellows, 1,731 nurses and 5,691 Full-Time equivalent employees. In 2018, BMC serviced 26,339 inpatient and 1,001,304 outpatient cases (840,893 outpatient clinic visits, 137,864 emergency room visits, 13,163 ambulatory surgery, and 9,384 outpatient observations). 

Health Equity Accelerator

The Health Equity Accelerator at Boston Medical Center is working to transform healthcare to eliminate gaps in life expectancy and quality of life among different races and ethnicities. The Health Equity Accelerator work to date has focused on clinical areas where there are major disparities. Chronic conditions, pregnancy, cancer, infectious disease and behavioral health. The Heath Equity Accelerator is focused on creating holistic change at BMC. The Accelerator provides opportunities for future medical leaders to have an acute understanding of the challenges that communities of color uniquely face in getting access to equitable healthcare. They offer a Health Equity Fellowship, that reflects their commitment to creating change across the entire healthcare delivery spectrum including the people who will lead the next generation. Elena Mendez-Escobar, PhD, MBA,Executive Director of Strategy and the Health Equity Accelerator, is a proposed LeaHD site mentor.  

Rehabilitation Services at BMC

The department of Rehabilitation Services provides skilled intervention in both the Inpatient and outpatient hospital setting. Our scope of service includes evaluation, direct treatment, patient and family education, equipment assessment, as well as consultative services in many specialty areas including management of lymphedema and pelvic floor dysfunction. We have expanding staff of 100+ employees, and completed approximately 80,000 patient visits last year.  We work with students and faculty from the BU Sargent College, providing placement for capstone work and clinical internship.  We are presently expanding our outpatient practice to 4 clinics that are geographically positioned in our community to best service our patient population. Our focus remains on the improvement of transition of care, building relationships with our post-acute partners, improving mobility in the acute setting, reducing re-admission by ensuring correct discharge disposition, improvement of patient flow, and ensuring evidence based practice.  

Boston HealthNet

Focusing strongly on urban health, Boston Medical Center is a founder of Boston HealthNet, a network affiliation of the medical center, Boston University School of Medicine, and 14 community health centers. Established in 1995, Boston HealthNet is an integrated healthcare delivery system whose partners provide outreach, prevention, primary care and specialty care, and dental services at sites located throughout Boston and in nearby communities. Physicians who practice at HealthNet locations provide a wide range of comprehensive healthcare services with a focus on disease prevention and health education. Patients receiving primary care at HealthNet sites have access to highly trained specialists and cutting-edge technology at BMC while maintaining individualized and culturally sensitive care in their neighborhoods. In 2016, Boston HealthNet health center patients accounted for 32.7 percent of outpatient visits and 37.8 percent of all inpatient admissions to Boston Medical Center.

BMC HealthNet Plan, Inc.

BMC HealthNet Plan (BMCHP) is a not-for-profit health maintenance organization founded in 1997 by Boston Medical Center. BMCHP’s Massachusetts business, BMC HealthNet Plan, serves over 240,000 members across the state through several product lines that include MassHealth (Medicaid, including CarePlus) and Qualified Health Plan. BMCHP also offers a senior care options plan for individuals age 65 and older who are also eligible for Medicaid. Because of its ongoing commitment to quality, BMC Health HealthNet Plan’s HMO has been awarded Excellent Accreditation status and is rated 4 out of 5 by the National Committee for Quality Assurance. BMC HealthNet Plan’s Medicaid HMO also has been awarded Excellent status. In addition, BMC HealthNet Plan’s Qualified Health Plan program has been awarded Accredited status from NCQA, the highest accreditation level available at this time.

In New Hampshire, BMCHP does business as Well Sense Health Plan. More than 70,000 Medicaid recipients have joined Well Sense Health Plan since New Hampshire began offering managed care coverage to Medicaid recipients in December 2013. Well Sense Health Plan’s Medicaid HMO has received Commendable Accreditation status and is rated 4.5 out of 5 among Medicaid plans in the U.S. by the National Committee for Quality Assurance (NCQA). Well Sense is the highest rated Medicaid plan in New Hampshire and one of the highest rated plans nationwide. Comprehensive coverage for hospital, primary, specialty, and behavioral healthcare are among the benefits and services provided to all members. In addition, members receive extras beyond traditional benefits, such as free car safety seats and bike helmets for kids, manual breast pumps and dental kits (including electric toothbrush), access to a 24/7 Nurse Advice line, and reimbursements for Weight Watchers® and qualified gym memberships. 

Teaching

As the principal teaching affiliate of Boston University School of Medicine, BMC is devoted to training future generations of healthcare professionals. Every member of the hospital’s medical and dental staff holds an academic appointment at the Boston University School of Medicine or at the Boston University Goldman School of Dental Medicine. BMC operates 66 residency training programs with 817 resident and fellowship positions.

Research

Boston Medical Center is a recognized leader in groundbreaking medical research. BMC is the 15th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. BMC received more than $116 million in budgeted sponsored research funding in 2016 and oversees 581 research and service projects separate from research activities at Boston University School of Medicine. The world-renowned researchers at Boston Medical Center conduct both basic, laboratory-based biomedical research, and clinical research programs, including substance use disorder, violence intervention, infectious disease, cardiology, Parkinson’s disease, geriatrics, endocrinology, and hematology/oncology.

The Cleveland Clinic (CCF) is an $8.9 billion, 5,000 bed non-profit healthcare system with 20 patient-centered institutes. It includes a tertiary care main campus in Cleveland with 11 regional hospitals and over 180 outpatient locations in Northeast Ohio. The system also includes hospitals in Southeast Florida with 230 beds, an outpatient center for brain health in Las Vegas, Nevada, a general outpatient center in Toronto, and a 364-bed hospital in Abu Dhabi. Cleveland Clinic London, a 185-bed hospital, will open in 2021. The system provides care for over 2 million patients annually across all settings and specialties.  

CCF Department of Physical Medicine and Rehabilitation

The Department of Physical Medicine and Rehabilitation features an integrated academic practice model, linking the main campus with nine acute care hospitals, three inpatient rehabilitation hospitals, 56 outpatient therapy venues, Cleveland Clinic’s Center for Connected Care, and a number of skilled nursing facilities and long-term acute care hospitals operated in partnership with other local health systems. This enterprise employs a fully operational disease-based rehabilitation care delivery system. All of the department’s clinicians work side by side with the surgeons and medical specialists who share their subspecialty interests and expertise. Patients benefit from innovative rehabilitation strategies provided by a unified academic faculty, with access to the full range of specialty consultants, sophisticated laboratory and imaging resources and Cleveland Clinic treatment protocols and carepaths. 

The department’s 24 staff physicians provide care for patients in acute, post-acute, and outpatient care settings. Outpatient rehabilitation physician services include a botox and baclofen pump clinic, a concussion clinic, cognitive rehabilitation, interventional pain management, musculoskeletal injury rehabilitation, pelvic floor rehabilitation, rehabilitation psychology, and a stroke and spinal cord injury clinic, among others. This care is accomplished across settings in synergy with providers in Cleveland Clinic Rehabilitation and Sports Therapy (CCRST). Importantly, the department features an inclusive leadership structure that engages all of the therapy disciplines in meaningful roles.  

Research in the department is consistent with the CCF mission to care for patients, caregivers, the community, and the organization. Academic efforts in the department focus on innovative technologies and interventions for patients with functional deficits associated with a wide range of medical conditions. There is a widespread emphasis on measuring and understanding the outcomes resulting from rehabilitation practices and using this knowledge to promote quality improvement. Accordingly, the department is a major participant in the Knowledge Program©, sponsored by Cleveland Clinic’s Neurological Institute, which promotes the use and evaluation of patient-reported outcomes across the Cleveland Clinic enterprise. These interests also lead to the development and validation by department staff, in partnership with Boston University’s Rehabilitation Outcomes Center, of the “6-clicks” inpatient short forms of the Activity Measure for Post-Acute Care. These short forms provide important patient-level information of functional status for hospitalized patients and have been adopted in over 1,000 hospitals across the United States. Locally, information gained from the operational implementation of 6-clicks facilitates ongoing research studies for staff in the department.

Cleveland Clinic Rehabilitation and Sports Therapy (CCRST)

In 2010, therapy services were integrated across CCF to form CCRST. The organization now includes 923 therapy professionals across physical and occupational therapy, speech and language pathology, athletic training, exercise physiology, and recreational therapy. These providers treat patients in each of the 14 U.S.-based CCF acute care hospital and 56 outpatient centers in addition to outreach services provided at 52 high schools, 5 colleges, and for two professional athletic teams. Annually, they provide care for nearly 100,000 new outpatients over more than 560,000 visits and nearly 170,000 new inpatients over more than 320,000 visits. 

Devoted to education and research, CCRST staff includes 77 board-certified specialists and 15 with joint appointments on faculty at local universities. CCRST also provides training in three residency programs and operates 32 special interest groups ranging from particular practice areas to community service and research. Specialty staff members with responsibilities in quality improvement and informatics facilitate much of the academic and scholarly endeavors that are encouraged among all staff. These efforts have led to CCRST providing a consistent presence at local and national professional meetings.  

CCF Connected Care

The Center for Connected Care consists of a multi-specialty team (including PTs, OTs, and SLPs) providing care in home settings, transitional care facilities, mobile practice settings, and in partnered skilled nursing and inpatient rehabilitation facilities. The Center collaborates with 116 affiliated skilled nursing facilities, 26 of which are partners in the Cleveland Clinic Accountable Care Organization, and with 3 inpatient rehabilitation facilities. 

The Division of Home Care reaches patients in16 counties throughout Northeast Ohio, providing care for approximately 1500 patients over 165,414 visits annually. The staff in Home Care includes 89 FTE physical therapists,18 FTE occupational therapists, and 72 FTE nurses.

InnovAge is a market leader in managing the care of high-cost, dual-eligible seniors through the Program of All-inclusive Care for the Elderly (PACE). With a mission of enabling older adults to age independently in their own homes for as long as safely possible, InnovAge’s patient-centered care model is designed to improve the quality of care its participants receive while reducing over-utilization of high-cost care settings. Most participants in the program have or are eligible for both Medicare and Medicaid and enjoy PACE at little to no cost. 

As of December 31, 2022, InnovAge operates 18 PACE centers in 5 states, where it serves approximately 6,460 older individuals – more than any other PACE provider. In each community we serve, InnovAge operates and coordinates a comprehensive system of care that creates values for all stakeholders:

• Participants age in their community, rather than nursing facilities
• Families of our participants enjoy greater peace of mind
• Government payors create access to care and save money
• Providers spend more time with participants

The individuals we serve are complex and require coordinated, personalized, interdisciplinary care. The average age of our participants is 77, and as of June 30, 2022, they have eight chronic conditions; they require assistance with 2+ activities of daily living based on our most recent available data from a 2018 health outcomes survey; and they have a Medicare RAF score of 2.35 as of Sept. 30, 2022.

The PACE model of care is built on an interdisciplinary care team (IDT) that manages and coordinates all aspects each participant’s unique care plan. The 11 disciplines on the IDT are:

• Primary Care Physician;
• Registered Nurse;
• Master’s Level Social Worker;
• Physical Therapist;
• Occupational Therapist;
• Recreational Therapist or Activity Coordinator;
• Dietitian;
• PACE Center Manager;
• Home Care Coordinator;
• Personal Care Attendant or his or her representative;
• Driver or his or her representative.

Our mission at InnovAge is to help frail seniors age in their own homes with dignity. We are committed to providing high quality services, promoting health equity, and reducing health disparities. One example of this is our development and implementation with Epic of the first-ever PACE-specific instance of its electronic medical record platform that is purpose-built to support core PACE workflows and streamline care delivery. Among other benefits, we believe Epic will be a cornerstone to operating more efficiently and capturing the clinical information needed to deliver more targeted care interventions. 

InnovAge also aims to promote a culture of continuous quality improvement and learning. We understand the value of using data and analytics to inform and evaluate practice and have a comprehensive enterprise data warehouse to provide advanced analytic capabilities. We are particularly excited about partnering with the LeaHD Center to foster our efforts to become a learning health system.

Data and Informatics:

InnovAge has a population health team, and a quality management team that analyze their programmatic data. All data is housed in a data warehouse. We use a single EPIC EHR customized for PACE.

Intermountain Healthcare is a nonprofit health system based in Salt Lake City, Utah, with 23 hospitals, ​about 1,400 employed primary care and secondary care physicians at more than 185 clinics in the Intermountain Medical Group, a broad range of clinics and services, and health insurance plans from SelectHealth. They are the largest healthcare provider in the Intermountain West, with over 37,000 employees serving the healthcare needs of Utah and southeastern Idaho residents. Intermountain Healthcare’s mission is helping people live the healthiest lives possible. The Intermountain Medical Group provided care for over 1.5 million patient visits in the past year.

As a not-for-profit healthcare system committed to our patients, plan members, and community, Intermountain exists to help others. It seeks to provide the most effective care, based on proven best practices and to engage patients in decisions about their treatments, listening to them and respecting their preferences. We seek to empower people to achieve their best possible health. Intermountain passionately encourages lifelong healthy habits that reduce the need for medical interventions. It works with others in the community to provide ready access to care, and e extend a helping hand to those in need, providing paths to renewal and recovery, for the human spirit as well as the body. Extraordinary care, always, for the people we serve, is our quest. 

Intermountain specialty areas include: Dialysis, Hearing & Balance Center, Heart & Vascular Services, Homecare, Hospice, Medical Equipment & Infusion Therapy, Imaging Services, Disaster Preparedness Laboratory Services, Medical Group Clinics, Life Flight, Rehabilitation Services, Pharmacy Services, Plastic Surgery, Precision Medicine, Spine Institute, Surgical & Endoscopy Services, Transplant Services, and Women & Newborns.

Intermountain Rehabilitation Services: Intermountain Rehabilitation Services include physical therapy, occupational therapy, speech pathology, rehabilitation nursing, exercise physiology, and athletic training. Rehabilitation Services employees 1,500 clinicians and support personnel at all 22 hospitals and 80 outpatient clinics throughout Utah and southeastern Idaho. Services are provided across the continuum of care, including acute care, inpatient rehabilitation, transitional care, home health, and outpatient services.  Rehabilitation Services works closely with Clinical Programs and other service lines at Intermountain to offer less-costly interventions to injury and physical dysfunction and expedite hospital discharge, prevent readmission, and allow people to better function in their homes and community.  We also offer a wide variety of specialized therapy programs including lymphedema management, balance and vestibular rehabilitation, hand therapy, aquatic therapy, industrial rehabilitation, oncology rehabilitation, pelvic health, and sports performance programs.  Rehabilitation providers at Intermountain have a long history of participation in continuous quality improvement efforts and formal research with an aim to improve the quality and value of care provided. Rehabilitation Services utilizes the same Electronic Health Record (iCentra) as the rest of Intermountain Healthcare for seamless communication between disciplines.

Intermountain Rehabilitation Outcomes Management System (ROMS): Intermountain ROMS is a web-based application and analytic system developed at Intermountain which serves as a central repository of patients’ self-reported pain and disability measures.  The data collected is used to improve the quality and process of patient care at Intermountain as well as reduce costs for patients and payers.  Intermountain ROMS has been used for 20 years within outpatient physical therapy services at Intermountain, with over 513,000 unique patients collected in total, completing over 2.4 million patient-reported outcomes.  Every patient presenting to outpatient physical therapy completes a self-reported outcome measure at every visit, which is used to engage the patient in treatment more effectively and measure meaningful improvement.  Intermountain ROMS is currently expanding into acute care, home health, and neurological domains to serve the continuum of patients’ experience.

Research Resources: Intermountain has a long and distinguished history of leading and supporting cutting-edge clinical research. Back in the 1950s, long before Intermountain came into being in 1975, investigators at our original flagship LDS Hospital were conducting formal, structured biomedical research studies. Since then, Intermountain research activities have expanded dramatically. Our current flagship tertiary adult facility, Intermountain Medical Center, joins the region’s leading academic children’s institution, Primary Children’s Hospital, three other major tertiary teaching hospitals, 17 community hospitals, and almost 200 community-based outpatient clinics in advancing the healing professions’ shared biomedical knowledge. Over the years, Intermountain has been involved in many thousands of studies across dozens of clinical specialties. Currently more than 1,500 studies are open and actively underway within the Intermountain system.

Medical research complements Intermountain’s core mission “helping people live the healthiest lives possible” by providing and improving excellent patient care. We have invested very heavily in clinical data systems and management structure to assure world-leading clinical performance. Our aim is to consistently provide our patients “the best medical result at the lowest necessary cost.” The resulting data infrastructure means that every patient treated at any Intermountain inpatient or outpatient facility contributes structured data for formal learning. Intermountain thus stands as an example of a “Learning Healthcare System,” where routine state-of-the-art patient care also produces rapid advances in formal medical knowledge.

Intermountain-based research expands our patients’ access to a wide variety of treatment options. It also helps attract leading physicians, nurses and other caregivers who are interested in world-class clinical investigation that leads to demonstrably better patient care.

Institute for Healthcare Leadership: The Institute was founded in 1990 with the directive of improving quality and reducing the cost of healthcare services. These goals are accomplished by providing technical support and education for clinical research and process management within Intermountain Healthcare. The Institute aims to improve quality and reduce the cost of healthcare services by delivering education, providing technical support, generating/disseminating evidence, and conducting research in support of operational and service excellence and process management across the Intermountain Healthcare system and with external partners. Strategic priorities are recommended and supported by the Institute leadership regarding healthcare delivery, clinical epidemiology, and health services/outcomes research based on community, clinician, and administrative needs. Resources at the Institute are available to provide data, statistical analyses, multidisciplinary research design, dissemination, and coordination to internal and external healthcare delivery and clinical research efforts that advance Intermountain’s strategic goals and attainment of mission critical objectives.

Homer Warner Center for Informatics Research

The Homer Warner Center for Informatics Research (also referred to as Homer Warner Center) is a world-class research facility dedicated to the discovery and implementation of innovative information technologies for the improvement of clinical care.  It is named after Dr. Homer R. Warner, a pioneer in the medical informatics field who did much of his research at LDS Hospital in Salt Lake City, Utah. Continuing Dr. Warner’s legacy, the Homer Warner Center is focused on the pursuit of excellence in research, education, and collaboration in the medical informatics field and translates data, analytics, informatics, and medical model development into improved healthcare for Intermountain. Through applied research, the Homer Warner Center helps improve best practice care by developing information system tools and advanced technologies that help doctors and nurses better care for patients.  The Center enhances Intermountain’s brand and is considered one of the eminent Medical Informatics centers in the world.  In 2012, the Center was a big part of why Intermountain earned the top spot among large hospitals in the “Where to Work: BEST Hospital IT Departments” program for the second year in a row.

The Homer Warner Center is heavily involved in multiple collaborations inside and outside of Intermountain.  Collaborators include government agencies, universities, various research groups, and healthcare-related businesses.  Researchers at the Center participate on several national standards bodies that help drive standards for healthcare data and interchange. The Homer Warner Center is a valuable asset to Intermountain.  It is a specific location where clinicians with research questions can be directed and where research can be synthesized from available data and analytics.  Together with the Office of Research, the informatics researchers at the Homer Warner Center are at the forefront of Institutional Review Board (IRB)-approved patient studies at Intermountain.

The Center regularly applies its research to improving clinical operations.  Research from the Center helps detect Sepsis in the Emergency Department so we are able to more quickly diagnose and treat our sepsis patients.   The success of the initial Sepsis program led the Intermountain Board to create a system-wide goal to adopt our Sepsis screening protocol across the entire organization in 2013.  The Community Acquired Pneumonia (CAP) system was also created at the Homer Warner Center, and provides a diagnostic tool that evaluates potential pneumonia patients during their Emergency Department visit and provides an appropriate care delivery protocol.  A similar approach has yielded a Glucose Management System used in a variety of intensive care settings within Intermountain. 

Collaborations with other healthcare providers include the Homer Warner Center’s partnership with Mayo Clinic, Children’s Hospital Boston, and Harvard Medical School.  A typical recent collaboration has focused on efforts to build a high value infrastructure for secondary use of Electronic Health Record data from multiple healthcare organizations.   The various and increasing number of collaborations initiated by The Homer Warner Center create visibility for Intermountain among other providers and potential partners.  Collaborations also allow the Homer Warner Center to bring in revenue streams for Intermountain in the form of shared grants and multi-year commercial partnerships.

The Homer Warner Center vision is to leverage data, analytics, research, and commercial partnerships to accelerate the improvements of care at Intermountain Healthcare to support the organizational goals of providing the best quality care at a reasonable cost.  To the extent possible, the Homer Warner Center will continue to champion clinical system development and push the limits of technologies and care through research and clinical collaboration.

Enterprise Data Warehouse (EDW)

The Intermountain Healthcare EDW contains data capturing over more than ten years of patient care experience with volumes increasing steadily over time.  It has surpassed 1 million patients and 3 million clinical encounters for each of the last 5 years. It is the repository into which the majority of the inpatient and outpatient, clinical data flow from Intermountain’s facilities and participating providers.  Its contents represent the electronic documentation of approximately half the medical care delivered in the state of Utah.

Historically, the EDW’s development has focused on acquisition of new data sources and the creation of data marts and registries for specific diseases or patient populations.  For instance, there are data marts used to track diabetic patients, data marts devoted to intensive care patients, data marts to track the course of oncology patients, and a variety of others.  This approach has allowed Intermountain to make important strides in targeted quality improvement and the EDW itself has been recognized as a key contributor to Intermountain’s role as a leading healthcare innovator in the United States.

Johns Hopkins Medicine has six academic and community hospitals, four suburban health care and surgery centers, over 40 patient care locations, a home care group and an international division, and offers an array of health care services. 

Physical Medicine and Rehabilitation

Currently, the department spans the Baltimore-Washington Metropolitan area. There is acute comprehensive inpatient rehabilitation and outpatient programs at both The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center, with a pediatric rehabilitation unit at the Kennedy Krieger Institute and in the Bloomberg Children Center. Eight additional outpatient operations extend throughout Maryland with plans to expand to other locations throughout the region. Acute hospital rehabilitation inclusive of critical care rehabilitation extends to all Johns Hopkins Health System location including:  Johns Hopkins Hospital, Bayview Medical Center, Howard County General Hospital, Sibley Memorial Hospital and Suburban Hospital. 

Research programs have expanded significantly with support of research grants and career development awards from the National Institute of Health, Department of Defense and private foundations. The department has numerous training programs including psychology, physical therapy residency programs, occupational therapy fellowships, speech language pathology fellowships and specialized medical fellowships.

The department includes a Division of Psychology as well as full-time faculty members, residents, postdoctoral fellows and clinical physiatrists. At The Johns Hopkins Hospital and outpatient locations, the department has responsibility for rehabilitation nursing and rehabilitation therapy services: physical therapy, occupational therapy and speech-language pathology. Areas of special expertise include rehabilitation of individuals with stroke, dysphagia, spinal disorders, amputation, traumatic brain injury, musculoskeletal disorders, cerebral palsy and spinal cord injury.

The departmental faculty, staff and trainees are committed to the tripartite mission of Johns Hopkins: creating and recognizing excellence in research, education and patient care. 

Teaching and Education

Activity and Mobility Promotion (AMP) Health Services Research and Training Fellowship

In collaboration with the Center of Health Services Training and Research (CoHSTAR), Johns Hopkins Activity and Mobility Promotion (AMP) embeds a researcher within Johns Hopkins for 18 months to investigate questions related to acute hospital functional outcomes, transitions of care and hospital acquired immobility. An emphasis is placed is on implementation science methods, leveraging electronic health records and clinical data systems.  The goal of this fellowship is to fuse academic investigation with real-world clinical challenges and translate research into practice.

Physical Medicine and Rehabilitation Residency

The Physical Medicine and Rehabilitation residency has become one of the most competitive nationally, with 379 applicants for six openings for the PGY2 class of 2017. Our residents were matched through the National Resident Matching Program ranking. United States Medical Licensing Examination scores ranged from 210 to 245, averaging approximately 230. Residents rotate at The Johns Hopkins Hospital, Johns Hopkins Bayview, Kennedy Krieger Institute and University of Maryland Rehabilitation Institute. 

Rehabilitation Therapy Clinical Education and Post-Doctoral Training

Rehabilitation Therapy Services takes pride in providing educational opportunities for therapists. Our clinical education team is proud to provide programming that is innovative and beyond basic affiliations or residency offerings. The programs are multidisciplinary and are close to other university partners to bring exciting and multifaceted clinical education opportunities. The rehabilitation therapy programs include affiliation education, residencies, fellowships, continuing education and volunteer opportunities for approximately 30 students per year from all disciplines. Rehabilitation Therapy Residency/Fellowship programs include:

• Neurology Physical Therapist Residency
• Orthopaedic Physical Therapist Residency
• Sports Physical Therapy Residency
• Acute Care Physical Therapist Residency
• Pediatric Physical Therapy Residency
• Hand Occupational Therapy Fellowship
• Mental Health Occupational Therapy Fellowship
• Performing Arts Physical Therapy Fellowship
• Acute Care Occupational Therapy Fellowship
• Speech Language Pathology Clinical Fellowship

Physical Medicine and Rehabilitation Fellowships

Pediatric Rehabilitation Medicine

The Pediatric Rehabilitation Medicine Fellowship started in 1999 and was among the first group of fellowships granted Accreditation Council for Graduate Medical Education (ACGME) accreditation. It offers one position per year through the National Resident Matching Program. To date, 10 pediatric rehabilitation medicine physiatrists have been trained through this program.

The training program is based at the Kennedy Krieger Institute (KKI), a major center focused on clinical care and research for children with brain injury, spinal cord injuries and other neurological disorders. It is located on the campus of the Johns Hopkins University School of Medicine. Both inpatient and outpatient rotations would lead to qualification for pediatric rehabilitation medicine subspecialty board examination.

Spinal Cord Injury Medicine

A one-year fellowship-training program in spinal cord injury medicine (SCIM) was started in 2006 and ACGME accredited in 2007. One trainee is accepted each year. Of the SCIM Fellows who have completed training, all of them practice spinal cord injury medicine in academic centers throughout the US.

Spine and Musculoskeletal

This one-year program, has one position per year and includes training on musculoskeletal, sports, injection procedures, electromyography and patient management in the inpatient and outpatient setting.

Rehabilitation Psychology

The psychology postdoctoral clinical fellowships are available to individuals who have completed their doctoral degree in psychology. They are full-time, two-year programs focused on the assessment and treatment of adult patients with a wide range of injuries, illnesses, disabilities, and acute and chronic health conditions. The fellowships provide an organized sequence of didactic and experiential education and training activities, with focused supervision and mentoring, whereby residents can develop advanced competencies in the specialty area sufficient for independent practice, eligibility for board certification, and leadership in patient care and research.

The fellowships are divided into two areas. One trains two fellows in rehabilitation psychology. The second one, run by a member of the Association of Postdoctoral Programs in Clinical Neuropsychology, trains two fellows in neuropsychology.

Rehabilitation Psychology Clinical Externships

The psychology clinical externships are available to individuals who are enrolled in psychology doctoral programs. They are part-time, nine-month programs focused on the assessment and treatment of adult hospital inpatients or outpatients with a wide range of injuries, illnesses, disabilities, and acute and chronic health conditions. The externships provide an organized sequence of experiential education and training activities, with focused supervision, whereby externs can develop beginning competencies in rehabilitation psychology and neuropsychology.

Rehabilitation Psychology Research Externships

The psychology research externships are available to individuals who are enrolled in psychology master’s degree programs. They are part-time, nine-month programs focused on research assistantship and development of research skills.

Clinical Services

At Johns Hopkins Medicine, our physical medicine and rehabilitation team is devoted to the diagnosis, treatment and prevention of all types of disabilities with world-class, patient-centered care. The department’s clinical services are distributed across two primary sites: The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center. In addition, physical therapy and occupational therapy services are provided at community locations.

Additional rehabilitation services are provided throughout Johns Hopkins Health System hospital including Howard County General Hospital, Suburban Hospital and Sibley Memorial Hospital.

Comprehensive Integrated Inpatient Rehabilitation Programs (CIIRP)

Our multidisciplinary team of physiatrists, physical and occupational therapists, speech- language pathologists, psychologists, nurses, social workers, pharmacists, and dieticians works with patients who have a reasonable expectation to improve function and achieve a satisfactory discharge plan. All patients must be willing and able to tolerate at least three hours of therapy daily, or up to 15 hours of therapy weekly. The team of experts specializes in rehabilitation care for amputation, spinal cord injury and dysfunction, complex medical conditions, brain injury and illness, musculoskeletal injury, and stroke, among other disabling disorders.

CIIRP Locations:

• The Johns Hopkins Hospital: The Commission on Accreditation of Rehabilitation Facilities (CARF)-accredited CIIRP on Meyer 7 has 18 private rooms. 
• Johns Hopkins Bayview Medical Center: Houses a 28-bed CARF-accredited unit as part of the specialty hospital located in the John R. Burton Pavilion. 

Acute Hospital Rehabilitation Therapy Services

In addition to providing therapy on the CIIRP units, Rehabilitation Therapy Services (RTS) provides daily physical therapy, occupational therapy and speech-language pathology services in multiple adult and pediatric settings at The Johns Hopkins Hospital, including ICU, stepdown and inpatient hospital units. Our therapy staff is divided into multidisciplinary therapy teams, including cardiac, ICU, surgery, medicine, neurosciences and oncology.

Critical Care Rehabilitation Program

The multi-disciplinary Critical Care Rehabilitation program is renowned, establishing early rehabilitation as a standard of ICU practice.  The program’s goal is to reduce deep sedation and get patients mobilized and engaged in functional activities. When early intervention is started within a few days of initiating mechanical ventilation, patients experience less hospital-acquired impairments, have shorter length of stay, and are more often discharged to their home rather than to a skilled nursing or rehabilitation facility

 Rehabilitation Physician Consult Services

Inpatient Physical Medicine and Rehabilitation physician consultation is provided at our primary hospital sites—The Johns Hopkins Hospital and Johns Hopkins Bayview. Consultation staff also include physician assistants and rehabilitation nurse liaisons, who assist in the evaluation of patients referred to our CIIRPs. Our enhanced consultation service provides an extra level of assistance and support to long-stay patients.

Outpatient Rehabilitation

Outpatient Rehabilitation Clinical Programs and Specialties

The Department of Physical Medicine and Rehabilitation physiatrists, therapists, and psychologists treat a number of rehabilitation conditions in the outpatient setting. Our experienced team works with individuals to address rehabilitation needs and restore function for a variety of conditions, including: spasticity, musculoskeletal and spine pain, back and neck injury, brain and spinal cord injury, stroke, deconditioning and fatigue, falls and balance difficulties, injuries, lymphedema, cognitive and communication disorders, aphasia, swallowing disorders, voice disorders, and other neurological conditions.

Outpatient procedures include botulinum and phenol injections to treat spasticity, intrathecal baclofen pump assessment and management, spinal procedures, and soft tissue joint injections, which include ultrasound-guided procedures. Electrodiagnostic medicine, used for the evaluation of various neurological disorders, takes place at our The Johns Hopkins Hospital, Johns Hopkins Bayview and Green Spring Station locations.

Specialty programs include:

• Amputation and prosthetics clinics at The Johns Hopkins Hospital and Green Spring Station help patients transition to wearing a prosthetic limb and living more independently. The clinic provides optimal prescriptions and a continuum of care throughout training and fitting.
• Brain and stroke rehabilitation program is a multidisciplinary clinic staffed by physiatrists, psychologists, and rehabilitation therapists. Located on our Johns Hopkins Hospital campus, this program provides evaluation and treatment for patients with acquired brain injury and associated disabilities.
• The Cancer Rehabilitation Program provides both newly diagnosed and recovering patients with consultation from physiatrists, physical therapists, occupational therapists, rehabilitation psychologists and speech- language pathologists as needed. Clinics are offered at The Johns Hopkins Hospital and Green Spring Station locations.
• Multiple Sclerosis Rehabilitation Program provides individualized treatments based upon the unique needs of MS patients. In collaboration with the Department of Neurology, the rehabilitation treatment team works to assess health needs, address pain, help restore function and reduce the impact of symptoms on the patient’s quality of life.
• Musculoskeletal and spine program delivers the most effective treatment techniques for maximizing activities of daily living and minimizing pain. Our experts treat patients with arthritis, automobile injuries, whiplash, cervical spondylosis, disc disease or herniation and pinched nerves.
• Neuromuscular Rehabilitation Program offers custom evaluations and exercise-based treatments for people with myositis and other neuromuscular disorders. As part of the Johns Hopkins Myositis Center, this program offers a variety of specialists in the same location who provide a multidisciplinary management approach to care. Our experts are known for cutting- edge research leading to rehabilitation strategies for patients with painful or damaged tissues, ensuring the best possible treatment for these complex conditions.
• Noninvasive Brain Stimulation Program offers treatment of neurological conditions and movement disorders including stroke, traumatic brain injury, aphasia, dystonia and Parkinson’s Disease. This innovative program uses brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) along with evidence-based rehabilitation to enhance recovery or to relieve symptoms.
• Performing Arts Physical Therapy Program accommodates the unique needs of dancers, musicians, vocal artists, aerialists, figure skaters and other performing artists. They provide therapy for acute injures, as well as regular preventive screening, backstage evaluations, and education for local dance schools.
• The International Center for Spinal Cord Injury at Kennedy Krieger Institute  offers an intense, medically-supervised therapy program with a unique focus on Activity-Based Restorative Therapy. ICSCI is one of the first facilities in the world to combine innovative research with a unique focus on restoration and rehabilitation for both children and adults with chronic paralysis.

Additional outpatient areas of specialty include sport-specific rehabilitation and performance enhancement programs, falls prevention, wound care, Lymphedema, men’s and women’s pelvic floor pain and incontinence, augmentative and alternative communications and video swallow studies.

Other multidisciplinary collaborative clinics with other service lines at Johns Hopkins Medicine include amyotrophic lateral sclerosis, cystic fibrosis, muscular dystrophy, ataxia and hand therapy.

Pediatric Outpatient Rehabilitation

The state-of-the-art Pediatric Rehabilitation Clinic at the Johns Hopkins Children’s Center provides a therapeutic environment for children from birth to 21 years old as they receive outpatient physical and occupational therapy services. The specialized pediatric programs are for orthopaedics, hand therapy, cancer, traumatic brain injury and children requiring pulmonary rehabilitation due to conditions like cystic fibrosis.

Psychiatric Rehabilitation Services

The rehabilitation psychology and neuropsychology providers play an integral role in evaluating the full spectrum of cognitive, behavioral and psychosocial functioning for rehabilitation patients. Our psychologists also provide interventions to aid patients and their families in managing chronic illness, pain and disability. Outpatient services are offered at The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Green Spring Station.

Occupational therapists provide care for adult and pediatric inpatient psychiatry and day hospital patients as needed based on consult or referral. Outpatient occupational therapy and physical therapy services occur in an ambulatory setting, during home visits or in the community. Our occupational therapists assess executive function, affective and emotional components affecting function, or community living skills via standardized and non- standardized screening and assessment. Therapists make recommendations for the treatment and safe discharge of these patients. Occupational therapy treatment educates and provides opportunities for clients to practice life management skills.

The Department of Physical Medicine and Rehabilitation at the Kennedy Krieger Institute

The Department of Physical Medicine and Rehabilitation has 10 faculty members deployed in the Kennedy Krieger Institute. Here, a wide array of innovative clinical and research programs focusing on pediatric rehabilitation and spinal cord injury are delivered.

The Kennedy Krieger Institute Rehabilitation Continuum of Care has been accredited by CARF. It includes a 50-bed inpatient pediatric rehabilitation hospital, a rehabilitation day hospital program for providing coordinated interdisciplinary therapies, a community-based rehabilitation program for providing service in the home and outpatient clinics that provide ongoing rehabilitation care. Unique resources at the institute include a state-of-the-art aquatic therapy center; inpatient and outpatient therapy gyms equipped with a large variety of robotic, electrical stimulation and virtual reality technology; a gait analysis laboratory; and a neuroimaging center.

Over 20,000 distinct patients with approximately 165,000 visits are served in the outpatient programs at the institute each year, where they receive coordinated and specialized care. Rehabilitation diagnoses served include brachial plexus injury, cerebral palsy, chronic pain, concussion, hemiplegia, leukodystrophies, limb differences, muscular dystrophy and other muscle disorders, osteogenesis imperfecta, plagiocephaly, Rett syndrome, spina bifida and traumatic brain injury.

A Path Towards a Learning Health System (PaTH) 

Johns Hopkins is  a members of the PCORI funded Clinical Research Network, A Path Towards a Learning Health System (PaTH) (PaTH CR_).  PaTH  is a partnership of 12 academic and clinical health systems across the mid-Atlantic and Midwest regions of the United States.  PaTH is a member of PCORnet. the infrastructure funded by PCORI to support patient-centered research, with an emphasis on the use of EMR data across multiple sites. PaTH provides infrastructure, rigorous security standards, and regulatory support to help researchers collaborate across our six health systems and learn from patients’ experience.

Lifespan is a not-for-profit comprehensive, integrated, academic health system affiliated with Brown University that was founded by Rhode Island Hospital and The Miriam Hospital; other entities have joined since. Lifespan is the largest healthcare system in Rhode Island and southeastern Massachusetts and provides medical care through over 250,000 emergency department visits, 400,000 outpatient visits, and 55,000 inpatient visits annually. Of the nearly 14,000 Lifespan employees, more than 600 are residents or fellows in 70 academic medical programs. Research across Lifespan institutions received over $100 million annually in extramural funding support. Among the Lifespan facilities of utmost importance to this application are: The Miriam Hospital (TMH), a 247-patient bed general and specialty care academic community hospital in Providence and a major teaching hospital for the Alpert Medical School of Brown University, Rhode Island Hospital, a 719-patient bed general and specialty care academic medical center in Providence, and the principal teaching hospital for the Alpert Medical School of Brown University, and Newport Hospital, a 129-bed community hospital with state-of-the-art in- and outpatient rehabilitation services including specialized neurorehabilitation expertise. 

Quality Data Analytics

Located in the Department of Quality and Care Transformation, the quality analytics team offers a variety of services for data collection and abstraction, public reporting, registry oversight, and custom analytic projects to support operations and quality improvement. The department has developed a suite of self-help dashboards and analytic tools in Power BI that allow end-users to perform a variety of analyses at aggregate and individual levels of analyses. The analytics team has special expertise in data integration, drawing resources from EPIC electronic medical record system, data registries, human resources, and financial systems to support decision making and operational improvements.

Lifespan Laboratories

Lifespan is the parent corporation of The Miriam and Rhode Island Hospitals. Lifespan Laboratories are found at 38 locations throughout Rhode Island and southeastern Massachusetts, each offering a complete range of the most advanced laboratory tests. The instrument section is outfitted with advanced technology, including liquid chromatographs (LC) coupled with tandem mass spectrometers, quadrupole time of flight (QTOF), and gas chromatographs mass spectrometers(GC/MS) from various vendors. 

Lifespan Biostatistics Consultation Services and Data Management

The Lifespan Biostatistics Core (located on the RIH campus) provides centralized biostatistics consultation for researchers in the Lifespan hospital group. It staffs 2 PhDs, one Masters Biostatistician, and hosts an externship. Members have more than 200 combined peer-review publications. Researchers are encouraged to participate in all phases of their projects from conceptualization through dissemination. The core either supplies direct support or assists in resource acquisition through its Data and Computational Resources Network. As a central resource for a vast array of research subjects, it serves as a hub for collaboration and cross pollination of ideas, techniques, and capabilities. Specific biostatistics services may include: 

• Experimental design for study development 
• Data management 
• Power analysis 
• Descriptive and inferential statistical analyses of study results 
• Technical writing of study methods, analysis, and results 
• Data queries and interim analysis 
• Customized reports and data displays. Consultations and services are offered on a fee-for-service basis, with opportunity to form formal collaborative efforts in co-investigator roles for percent effort.

The Core focuses on maximizing the validity of scientific analysis, which sandwiches methodology and statistical analysis between conceptualization and interpretation. The intimate dependency of “analysis” on prior knowledge, logic, methodology, and statistics is a focus of the core. Researchers of all academic and funding levels are encouraged to involve biostatistics as early in their process as possible, including brainstorming sessions on theory development, hypothesis generation, methodology, measurement selection and assessment, and ultimately data analysis and dissemination. The Core also serves as a point of intersection for hundreds of researchers, having facilitated the creation of numerous new collaborations between researchers who may not have otherwise crossed paths. The Core is directed by Jason T. Machan, Ph.D.

Rhode Island Medical Simulation Center

The Rhode Island Medical Simulation Center is a state-of-the-art facility which helps train medical professionals and medical students in specialized techniques through high fidelity medical simulation, in order to minimize medical error in complicated, high-stress situations. Occupying 3000 square feet in the Coro West Building at Rhode Island Hospital, the Simulation Center allows Emergency Medicine and other clinical faculty members to develop and run training curricula in order to enhance the performance of physicians, staff, and students alike. The Simulation Center applies engineering principles directly to the development of improved patient care models in a unique collaboration of investigators from Rhode Island Hospital, Miriam Hospital, Memorial Hospital of Rhode Island, and Brown Medical School. The Simulation Center is a resource to improve clinical practice, training, and experimental procedures.

Library Facilities

Library facilities are available at the nearby sciences library located at Brown University. Both physical collections and online resources are available to Brown University and Brown Medical School faculty and staff. The Brown University libraries contain over 3.8 million items and add 60,000 more per year. The collections are housed in 5 separate facilities. The Brown library is a member of the Center for Research Libraries and the Research Libraries Group, which provides researchers with free interlibrary loan services, including photocopying of articles as needed. Online access to several medical research databases is available through the Brown University Library Webpage. Lifespan Library is an integrated information management center, serving clients at the Bradley, Hasbro Children’s, Miriam, Rhode Island, and Women & Infants Hospitals. The individual libraries share circulating materials and services for the benefit of their clients. The library holds more than 40,000 serial volumes, subscribes to 820 journals, and houses over 8,000 books. Among the library’s strengths are electronic literature searching, online cataloging, collection management, library instruction, and research consultation.

Spaulding Rehabilitation Hospital (SRH) is the flagship rehabilitation facility of the Spaulding Rehabilitation Network (SRN). SRH is affiliated with Harvard Medical School (HMS), the Massachusetts General Hospital Institute of Health Professionals (MGH-IHP), and Mass General Brigham (MGB), an integrated health care delivery system that includes Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH). SRH is a leader in the greater Boston metropolitan area in providing comprehensive rehabilitation and complex medical management services. The HMS Department of Physical Medicine and Rehabilitation is based at Spaulding. SRH has 132 beds, more than 3000 inpatient admissions per year and a large outpatient service. The main campus also offers more than 15 specialty rehabilitation programs with representatives from 30 medical specialties, including Cardiology, Pulmonology, and Rheumatology. SRN offers a unique, high-volume, multi-site rehabilitation system of care with strong infrastructure that draws on multidisciplinary rehabilitation expertise beginning in the acute care setting. Clinical care is guided and fostered by basic science, translational and clinical research programs, cutting-edge information and biotechnology labs, innovative quality and safety management initiatives and top-ranked university and academic medical centers. Spaulding strives to continually update and improve its programs to offer patients the latest, high-quality care through its leading, expert providers. This is demonstrated by the awarding of Model Systems designation in three specialty areas, Traumatic Brain Injury, Spinal Cord Injury, and Burn Injury Rehabilitation by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) in two consecutive funding cycles. 

Spaulding Hospital Cambridge: SHC is a 145-bed long-term acute care hospital (LTACH) that provides healthcare services to persons with serious conditions characterized by high medical complexity. The multidisciplinary rehabilitation team at SHC consists of a physiatrist, a pulmonologist, RN, PT, OT, SLP, and RT. Assessment, rehabilitation planning, and service delivery are carried out in the same manner as described above for SRH.  The SRN continuum of care is one of only a few centers in the U.S. that has the capacity to provide integrated multidisciplinary rehabilitation services across an acute inpatient rehabilitation hospital and a long-term acute care hospital.

The Ellen R. and Melvin J. Gordon Center for the Cure and Treatment of Paralysis was established by the Cele H. & William B. Rubin Family Fund, Inc. at SRH and HMS with an initial $5 million award in 2013 to foster collaborative, comprehensive approaches for the treatment and potential cure of paralysis.

The Kelley Adaptive Sports Research Institute was launched in the spring of 2015 to promote and facilitate research investigating the impact of adaptive sports participation on the health and wellness of individuals with disabilities. In partnership with Spaulding Adaptive Sports Centers, the research institute has collaborated with the Brigham Orthopedic Center for Outcomes Research to begin prospective data collection on sports participants.

Neuromodulation Laboratory: The Neuromodulation Laboratory at SRH, directed by Felipe Fregni, MD, PhD, MPH, occupies 800 square feet within SRH and is equipped with transcranial Direct Current Stimulators, Transcranial Magnetic Stimulators (paired pulse and repetitive), frameless stereotactic systems (Brainsight and Brainvoyager), and high-resolution EEG, electroneuromyography and eye-tracking systems. 

Motion Analysis Laboratory (MAL): The MAL, directed by Paolo Bonato, PhD, is located within SRH and is affiliated with the Harvard-MIT Division of Health Sciences and Technology (HST) and the Wyss Institute. The central focus of the MAL is assessment of movement patterns in people with mobility-limiting conditions.  The Lab is equipped with computer-based motion simulators, oscilloscopes, signal generators, and ambulatory (Vitaport 3, Temec) and wireless sensor (SHIMMER) recording devices. The MAL also includes a Robotics Center that houses state-of-the-art systems including eLegs (Berkeley Bionics), an exoskeleton-assisted ambulation device, the Lokomat (Hocoma AG), a robotics-assisted treadmill gait training system and the Erigo (Hocoma AG), a motorized tilt table outfitted with physiologic monitoring devices and an automated stepping mechanism.

Rehabilitation Outcomes Center at Spaulding (ROCS): ROCS, co-directed by Drs. Schneider and Giacino, is committed to advancing data-driven care from inpatient through community living. Strategic use of data to guide delivery care is central to ROCS mission. ROCS has developed collaborative partnerships across SRN in the following areas: clinical application, advocacy and education, research, equity and accessibility.

Resources

Harvard Catalyst is a pan-Harvard University enterprise dedicated to improving human health. It is a shared enterprise of Harvard University, its ten schools and 18 affiliated academic healthcare centers. The resources of Harvard Catalyst, several of which have particular value for our investigators, are available to all faculty members at Harvard. These resources provide guidance in clinical trials, biostatistical support, and access to clinical research facilities and bioimaging samples.

The Partners Biobank aims to foster collaborations among investigators. This enterprise-wide project is at the forefront of developing the tools needed to expedite research and the translation of discoveries into clinical care. The samples at the Biobank are available for distribution to MGB investigators with required approval from the MGB Institutional Review Board. They are linked to clinical data stored in the MGB Research Patient Data Registry, as well as some additional health information and survey data. To date, more than 36,000 patients have consented to participate in the Partners Biobank at SRH, BWH, and MGH. The repository is located close to our center making transportation feasible, and the Biobank. 

Biostatistics Core: The Biostatistics Center is staffed with over 50 PhD-level biostatisticians who provide statistics and design consultation to investigators. The Center also serves as a Coordinating Center for several federally supported projects. 

Office of Research Administration: MGB Research Management will provide all research and administrative support for this grant. This includes standard post-award budget management, personnel administration, time and effort reporting, time keeping, grant-related accounting, financial status reporting and monitoring of education in the Responsible Conduct of Research.

MGB Research Information Systems (IS): MGB Research Computing is a distinct service unit within the 300 million dollar per year MGB IS Department that maintains dedicated hardware and facilities for scientific computing. All grant/contract proposals within SRN have access to these facilities and services which include database hosting, large storage and archive enterprise solutions (> 200 terabytes), server hosting and secure data transfers. 

Research Electronic Data Capture (REDCap): REDCap is a secure, HIPAA-compliant web-based application hosted by the Enterprise Research Infrastructure & Services (ERIS) group for MGB Research. This service provides an intuitive interface to enter data with real time validation (automated data type and range checks), audit trails, reports for monitoring and querying participant records, and an automated export mechanism to common statistical packages (SPSS, SAS, Stata, R/S-Plus). 

Accessibility of Facilities, Equipment and Resources.

The SRN system and its affiliated institutions have made a strong commitment to exceed ADA compliance guidelines to ensure unfettered accessibility to all clinical and research facilities and resources for persons with disability. SRN employs people with disabilities, sponsors internships with the Massachusetts Rehabilitation Commission and regularly conducts educational presentations for staff depicting life experiences of people with disabilities. 

UPMC is an integrated global health enterprise and one of the nation’s leading academic healthcare systems, with $19 billion in revenues. UPMC integrates 85,000 employees; more than 5,800 affiliated physicians, including 4,600 employed by the health system; more than 30 tertiary care, specialty, and community hospitals; as well as specialized outpatient facilities, cancer centers, rehabilitation facilities, retirement and long-term care facilities, imaging services, doctors’ offices, and a health insurance plan covering 3.4 million members. UPMC has created a genuinely integrated health delivery system. Among the many centers specific to this application are the Rehabilitation Institute, the Comprehensive Spine Center, the Aging Institute, the Arthritis Institute, the Eye and Ear Institute, Hillman Cancer Center, the Stroke Institute, and Western Psychiatric Institute. In addition, the Centers for Rehabilitation Services, an affiliate of UPMC, is comprised of over 90 occupational and physical therapy facilities throughout the Pittsburgh metropolitan area and western Pennsylvania.

With renowned centers of excellence in transplantation, cancer, neurosurgery, psychiatry, orthopaedics, rehabilitation, geriatrics, and women’s health, it currently is ranked No. 12 in the nation on the U.S. News & World Report Honor Roll of America’s Best Hospitals—with 15 ranked adult specialties. UPMC is a recognized innovator in information technology. UPMC was an early adopter of electronic medical records and the interoperability solutions that tie them together. Its clinical and technological capabilities have attracted such technology partners as General Electric, IBM, and Oracle. UPMC is nimble in its ability to implement new and wide-reaching models of care, impacting patient populations in Western PA and beyond. UPMC, with a culture of regular and rapid change, has been a leader in the development of novel care paradigms, and its integrated delivery and finance system will ensure that the value offered by improved personalized care models (the right treatment for the right patient at the right time) will be maximally leveraged within our system. 

With over 44 hospitals and an integrated network of care across the continuum, from tertiary acute care to inpatient and outpatient rehabilitation to home care, UPMC has access to every patient population influenced by the center. UPMC has been at the forefront of implementation of Health Information Technology (HIT) resources, starting with the conception of its Medical Archival Retrieval System (MARS) in 1990 and continuing to its present ranking among the top five in the Infoweek rating of top 100 “most wired corporations in America.” The centerpiece of UPMC’s information technology efforts is the eRecord, UPMC’s electronic health record, which involves collaboration with the Cerner Corporation (Cerner Millennium HNA, Kansas City, Missouri) for the inpatient portion of the record and with the EpicCare system (Epic Systems Corp., Madison, Wisconsin) for most of the ambulatory record. UPMC has established a contractual agreement with dbMotion (Tel Aviv, Israel) to assure interoperability among its electronic medical record (EHR) systems.

The robust foundation of HIT, ongoing work to maintain state-of-the-art systems, and rich patient mix make UPMC an ideal partner for the  proposed project. As an academic medical center, UPMC integrates breakthrough research, solid financial support, and superb academic leadership. Collaborating closely with the University of Pittsburgh, the nation’s sixth-largest recipient of National Institutes of Health (NIH) grants and the home of the nation’s third-largest medical residency program, UPMC nurtures a vibrant, symbiotic relationship that marries clinical and research capabilities and pioneers clinical achievements that revolutionize patient care by effectively personalizing disease treatment. The collaborative UPMC and the University of Pittsburgh structure combines excellence in state-of-the-art research and implementation science to rapidly adopt new models of care.

UPMC and the University of Pittsburgh’s Schools of Health Sciences function as a highly integrated and collaborative environment. The University of Pittsburgh Schools of the Health Sciences (Dental, Pharmacy, Medicine, Health and Rehabilitation Sciences, Nursing, and Public Health) represent a robust research infrastructure with networks of multi-disciplinary collaboration across schools and departments, with the University consistently ranking in the top 10 in NIH funding. The University of Pittsburgh Schools of the Health Sciences are uniquely suited to develop translational research. With an extensive history of translating innovative biomedical discoveries to humans and clinical practice and an ingrained culture of collaboration among investigators in its six health sciences schools, the Schools of the Health Sciences will provide optimal support to our Center’s investigators. The Schools of the Health Sciences are uniquely integrated with the constantly evolving and successful UPMC and have a track record of institutional commitment to clinical and translational research.

A Path Towards a Learning Health System (PaTH) 

UPMC Health System and the University of Pittsburgh are members of the PCORI funded Clinical Research Network  , A Path Towards a Learning Health System (PaTH) (PaTH CRN_). PaTH  is a partnership of 12 academic and clinical health systems across the mid-Atlantic and Midwest regions of the United States that is led by the University of Pittsburgh.  PaTH is a member of PCORnet. the infrastructure funded by PCORI to support patient-centered research, with an emphasis on the use of EMR data across multiple sites. PaTH provides infrastructure, rigorous security standards, and regulatory support to help researchers collaborate across our six health systems and learn from patients’ experience

UPMC Centers for Rehabilitation Services

The UPMC Centers for Rehab Services (CRS) is the region’s largest network of community-based comprehensive outpatient providers of physical, occupational and speech therapy.  CRS is a division of the University of Pittsburgh Medical Center (UPMC), which is a nationally and internationally acclaimed integrated academic health care delivery and financing system that is associated with the University of Pittsburgh.  CRS operates 69 clinics throughout western Pennsylvania. CRS provides staffing and leadership for rehabilitation services in 17 UPMC inpatient acute care and acute rehabilitation hospitals and 8 skilled nursing facilities.  CRS employees 376 outpatient physical and occupational therapists and 496 inpatient physical and occupational therapists.  Annually, CRS provides outpatient rehabilitation services to more than 80,000 new patients of which approximately 85% (68,000) have a musculoskeletal disorder, resulting in more than 700,000 total visits annually.  Many of the CRS physical therapists in the outpatient offices have advanced specialty certification, including 42 board certified orthopaedic physical therapists, 13 board certified sports physical therapists and more than 30 physical therapists that are certified as a primary spine practitioner.  

Since 1996 the Chair of the Pitt Department of Physical Therapy has served as the CRS Vice President of Education and Research, another example of the interwoven relationship between UPMC, CRS, and the University of Pittsburgh. Until 2016, that role was fulfilled by Dr. Anthony Delitto, who is now Dean of the University of Pittsburgh School of Health and Rehabilitation Sciences. Currently, Dr. Irrgang serves as Vice President for Education and Research for CRS. Given the relationship between the Pitt Department of Physical Therapy and CRS, CRS has a rich history of supporting clinical research efforts of the faculty from the Department of Physical Therapy.  Examples of this include participation of CRS physical therapists in the PCORI-funded TARGET Trial, which was a cluster randomized clinical trial in which study participants with acute low back pain at high risk for transition to chronic low back pain were randomized to receive accepted guideline-based physical therapy or psychologically-informed physical therapy that was delivered by CRS PTs.  Participation in this pragmatic multicenter clinical trial required participation of more than 65 CRS physical therapist in a 12-hour long weekend course to become certified in the provision of psychologically-informed physical therapy.  

Currently, CRS physical therapists are supporting the STaR and TeMPO studies by providing physical therapy services for study participants.  For the STaR Trial, patients who underwent surgical treatment for a multiple ligament knee injury are randomized to early or delayed post-operative rehabilitation, in which the physical therapists follow standard of care post-operative guidelines that are initiated within 7 to 10 days of surgery or 4 weeks after surgery. For the TeMPO study, CRS physical therapists provide 12 research visits of physical therapy to study participants which are randomized to either strengthening exercises and manual therapy or topical treatments. CRS is reimbursed a research rate for the treatments provided for the TeMPO study.  

Given the support of past and current clinical studies conducted by Pitt research faculty, the CRS provides a unique and supportive environment for providing physical therapy and other rehabilitation services for clinical efficacy and effectiveness trials that are supported by Pitt RESURGE investigators and Research Community.

UPMC’s Center for Assistive Technology

UPMC-Center for Assistive Technology is an outpatient center within UPMC that enhances the ability of people with disabilities to fulfill life goals through the coordination and provision of various appropriate assistive technology (AT) services and devices ranging from but not limited to: personal mobility (i.e. manual wheelchairs and power wheelchairs), seating and positioning, augmentative communication, audiology, computer access, ergonomic design, adaptive driving, and recreational devices. The CAT has evolved to become a model AT service delivery program both national and internationally recognized. The majority of the clinicians and faculty providing services at CAT are licensed rehabilitation clinicians and engineers with board certified RESNA Assistive Technology Professionals (ATPs).

UPMC’s Innovative Homecare Solutions (UIHS) 

UPMC’s Innovative Homecare Solutions (UIHS) is a not-for-profit UPMC company designed to implement innovative post-acute and community-based programs that provide high-value care while improving the patient experience.  UIHS works within the UPMC integrated delivery and finance system structure with the goal of transforming clinical care and creating new community-based programs to better serve our patients.

UPMC Wolff Center for Quality, Safety and Innovation

The Wolff Center is a centralized resource for the UPMC system to support quality, safety, and innovation and provides expertise for improving outcomes and quality of care within the UPMC system. Their staff of over 100 professionals provides a wide variety of services, including clinical and patient experience improvement work, regulatory support, data and analytic support, and educational development. These services extend to more than 40 hospitals, 4,500 physicians, 600 outpatient sites, and a multitude of rehabilitation and long-term care sites across all clinical specialties. The Quality Analytics team, have access to and experience with extracting, analyzing, and reporting on electronic health record, claims, and other data, including clinical and patient-reported data and related patient information. Resources include Health Catalyst, a late binding data warehouse that brings together multiple data sources, including electronic health records (inpatient, outpatient, and post-acute), ancillary services (imaging and labs), billing, patient experience surveys, infection, risk events, and human resources. Subject Area Marts support reporting tool development to extract data or generate data visualization through the business intelligence tool, QlikView. The Quality Improvement team leads the innovative quality care programs and has an extensive career history in managing physician practices as well as implementing innovative electronic health record solutions in practice, including electronic collection of clinical and patient-reported data. 

The Wolff Center staff, currently collaborate on many ongoing quality improvement and clinical research projects.  Currently, representatives from the Department of Orthopaedic Surgery, including Dr. MaCalus Hogan, Vice Chair for of Education and Residency Program Directors, who is also Medical Director of Outcomes for the Wolff Center and Senior Medical Director for UPMC Health Plan Orthopaedic and Musculoskeletal Care Services together with Drs. Irrgang and McDonough and Mr. Guattery, Senior Research Scientist in Orthopaedic Surgery meet monthly with the Wolff Center quality improvement and analytics team to discuss and review orthopaedic and rehabilitation quality improvement and clinical research projects. This collaboration has allowed for the development and implementation of innovations in the delivery of orthopaedic and rehabilitation services for the management of musculoskeletal disorders including joint arthroplasty, hip fractures, fall prevention and collection and use of patient-reported outcomes to improve care processes and treatment outcomes.