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Priority Topics for Health System Partners

American Health Care Association and National Center for Assisted Living (AHCA/NCAL)

Targeted Priorities:

  • Improving efficiency in improving rate to achieve functional outcomes for SNF short-stay residents 
  • Workforce issues impacting care delivery in nursing centers and/or assisted living communities 
  • Effectiveness of technology improvements (e.g., EHR, telehealth, remote patient monitoring) in nursing centers and/or assisted living communities 
  • Effective follow-up programs after discharge home or back to the community from a SNF short-stay to improve likelihood of successful discharges (reduce 30-day readmission rates)

Priority Topics:

  • Evidence-based fall prevention programs in nursing centers (short- or long-stays)and/or assisted living communities that do not negatively impact resident mobility/freedom 
  • Impact of an embedded Nurse Practitioner on SNF hospital readmissions (all residents), length of SNF short-term stay, or likelihood of a community dwelling person to return to community from a short-term SNF stay
  • Evidence-based clinical and functional care approaches for long Covid in nursing centers and/or assisted living communities
  • Effective transitions of care models across the continuum impacting nursing centers and/or assisted living communities

BAYADA Home Health Care

Targeted Priorities:

  • Disease specific best practice reviews to enhance patient outcomes

Priority Topics:

  • Interdisciplinary Care Coordination and Episode Visit optimization through a huddle process
  • PDSA for optimal outcomes in both CMS VBP Total Performance Scores, and STARS
  • Micro learning for both field and office staff with a focus on both best practices as well as clinician safety

Boston Medical Center (BMC)

Targeted Priority:

  • Optimizing utilization of Rehabilitation therapy services in acute care

    The Cleveland Clinic

    Targeted Priority:

    • Targeting rehabilitation interventions to facilitate discharge from the hospital to home 

    Priority Topics:

    • Transitions of care across the continuum, particularly from the acute hospital to home health care
    • Effectiveness of pre-habilitation in surgical care
    • Using patient-reported outcomes to evaluate and improve outpatient rehabilitation
    • Disparities in access, quality, and outcomes of rehabilitation
    • Novel modalities for virtual rehabilitation and remote monitoring

    View our current LeaRRn Scholar.

    Intermountain Health

    Targeted Priority:

    • Transitions of care across the continuum

    Priority Topics:

    • Value-based care pathways
    • Health equity
    • Effectiveness of rehabilitation for high-need / high-cost patients
    • Team-based models of care, care coordination
    • Telehealth for triage and treatment
    • Integrating evidence-based decision support into an EHR
    • Use of technology to improve care delivery

    View our current LeaRRn Scholar.

    Ivy Rehab Network

    Pediatric-Focused Priority Topics:

    An organizational priority across both Ivy Rehab Physical Therapy (Adult Ortho) and Ivy Rehab for Kids is: 

    • The use of Ivy’s advanced data ecosystem to apply advanced/predictive analytics and Machine Learning/AI to develop smart data products & reporting to improve patient outcomes and operational efficiency and effectiveness across Ivy Rehab Network ( Adult & Pediatric populations)

    Ivy’s Pediatric Focused Research Priorities (Behavior, Occupational, Physical, and Speech Therapy)

    • Impact of pediatric-residency trained clinicians on patient outcomes and care delivery 
    • Internal quality improvement initiatives related to care quality and operational efficiencies

     Adult-Ortho Focused Priority Topics:

    • Impact of Residency Trained clinicians on patient outcomes and care delivery 
    • Effectiveness of digital-health technologies (RTM, TH, hybrid)  integrated into outpatient rehabilitation care plans on patient outcomes and healthcare spend 
    • Effectiveness of PT-first care models on patient outcomes
    • Determination of key characteristics and criteria for admittance into a residency program

    Johns Hopkins Medicine, Physical Medicine and Rehabilitation (PMR)

    Targeted Priorities: 

    • Implementation of systematic approach to mobility in the acute care hospital inclusive of pediatrics.
    • Precision Rehabilitation: Using high information content measurement to personalize rehabilitation interventions across the healthcare continuum
    • Development of rehabilitation models of care to reduce skilled nursing facility utilization

    Priority Topics:

    • Use of remote monitoring as part of a learning health system
    • Effectiveness of innovative care delivery models prior to surgery especially for geriatric populations
    • Development of Pediatric Activity and Mobility Promotion effort for the Acute Hospital including development of standardized tools and implementation of the JH-AMP framework adapted to pediatrics.
    • Implementation of systematic approach to mobility in the acute care hospital inclusive of pediatrics.

    Spaulding Rehabilitation Network

    Targeted Priorities:

    • Disparities in access, quality, and outcomes of rehabilitation
    • Traumatic Injuries as a chronic condition
      • Assessing the clinical & cost effectiveness of a Trauma Survivorship Clinic
      • Development of a Chronic Care Model for Traumatic Conditions
      • Risk of chronic disease after trauma

    Priority Topics:

    • Standardizing clinical care for real-time visualization and application of EHR data
    • Maximizing outcomes and discharge to the community
    • Evaluating alternative nursing workflows to maximize patient outcomes

     

    UPMC's Center for Assistive Technology (UPMC CAT)

    Priority Topics:

    • Evaluation and development of a telehealth protocol for assistive technology
    • Implementation of a streamlined data collection process (on assistive technology) in clinical practice
    • Development of a new wheelchair prescription policy for seating and mobility clinics

    Visit UPMC CAT

    UPMC Rehabilitation Institute 

    Priority Topics:

    • Using outcome measures in acute care to identify at risk patients post-acutely  
    • Transitions of care across the continuum
    • Effectiveness of rehabilitation for high-need / high-cost patients
    • Adherence to clinical practice guideline recommendations and associated clinical outcomes

    View our first LeaRRn Scholar.

    View our second LeaRRn Scholar.

    UPMC’s Innovative Homecare Solutions (UIHS)

    Priority Topics:

    • Efficient use of rehabilitation services in the home health setting
    • Use of technology in the home health setting to augment or as a substitute for nurse and/or therapist care
    • Moving traditionally hospital based care into the home setting