By James Sliwa, DO, Chief Medical Officer, Chief Quality and Safety Officer, and Senior Vice President, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago)
Rehabilitation, unlike other medical specialties, has no equivalent to an objective blood test or an X-ray to help measure or direct the results of treatment. Current assessment tools are not well-equipped to identify patient progress at low or high limits of function; form a basis for comparison of gains between patients, facilities or levels of care; and direct patient-specific treatments. This needs to change, for the benefit of patients and payors.
Rehabilitation: An Inflection Point
In 2016, Medicare spent $7.7 billion on fee-for-service inpatient rehabilitation care for approximately 350,000 adults and children, some of whom have the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. Approximately 12.8 percent of the United States’ population lives with some form of disability — a rate that is projected to grow as once-fatal diseases become chronic, and as the population ages. Impaired physical and cognitive function has compounding negative effects on individuals, society and the economy. As a result, it is imperative that patients receive the best, most appropriate and most efficient level of care.
The Current Landscape
Patients are presented with many choices among levels of rehabilitation care. However, a lack of sensitive and objective outcomes measures makes it difficult to demonstrate how and where patients will progress most and achieve the best outcomes. As a result, the true value of various levels of post-acute care is unclear.
In a special communication published in the Archives of Physical Medicine and Rehabilitation, the authors praise recent efforts to standardize data across post-acute care. Within this context, they propose that the field develop evidenced-based guidelines to help identify the most appropriate post-acute care settings — and further, to help predict patients’ clinical trajectories. They argue that such initiatives should include:
- Standardization of outcomes measures;
- Linking outcomes to a patient’s clinical course, and;
- Adoption of valid predictive measures that inform the development of patient-specific treatment programs and support value-based care — precision medicine.
With the convergence of scientific disciplines that is producing groundbreaking discoveries — from brain imaging to tissue engineering — the field of rehabilitation has entered an early stage of revolution. Rehabilitation research has taken on increasing sophistication and novel application and the inpatient rehabilitation facility (IRF) environment is the ideal setting to leverage this new knowledge. Scientific discoveries are now affecting patient outcomes more directly. For example, advances in technology allow us to collect data and operationalize it, putting it to work for the benefit of better, faster patient recoveries.
The field of rehabilitation is a multi-billion dollar healthcare sector, one that is growing rapidly due to evolving demographics. Long overdue is a quantitative, objective, standardized assessment tool that will reliably measure — and even predict — patient progress across the full range of rehabilitation and recovery, at all levels.
Better measurements are critical to helping patients achieve the highest level of function and to advance the field of rehabilitation. With a more objective outcomes system, we have the potential to modernize and advance treatment strategies, interventions and recoveries for the benefit of patients worldwide. The future is closer than it might seem.
About Dr. James Sliwa
Through his medical expertise and leadership, James Sliwa, DO, is focused on driving the highest level of performance for patient care, safety and outcomes. As Chief Medical Officer and Chief Quality and Safety Officer, he is responsible for overseeing patient quality and safety throughout the Shirley Ryan AbilityLab system of care. Dr. Sliwa has been a practicing physician for Shirley Ryan AbilityLab since 1984, specializing in serving a medically complex population. He has also led development of the Ability Quotient™ (AQ) and its implementation into clinical care. He earned his BA from Indiana University and his DO from the Chicago College of Osteopathic Medicine. He completed his residency in Physical Medicine and Rehabilitation at Northwestern University/Shirley Ryan AbilityLab (then the Rehabilitation Institute of Chicago).
About Shirley Ryan AbilityLab
Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. The organization expands and accelerates leadership in the field that began at RIC in 1953. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Upon opening in March 2017, the $550 million, 1.2-million-square-foot Shirley Ryan AbilityLab became the first-ever “translational” research hospital in which clinicians, scientists, innovators and technologists work together in the same space, surrounding patients, discovering new approaches and applying (or “translating”) research real time. This unique model enables patients to have 24/7 access to the brightest minds, the latest research and the best opportunity for recovery. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization. For more information, go to www.sralab.org.
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This is NOT a paid placement.