Clinical Utility of the CARE Item Set

Abstract

The Continuity Assessment Record Evaluation (CARE) Item Set provides a reliable, valid measure of mobility and self-care outcomes in post-acute settings. If the CARE Item Set can provide direction for the therapy plan of care, its value is multiplied. The assessment and treatment planning process would be streamlined if rehabilitation therapists can use the CARE Item Set to identify risk factors for adverse events, focus interventions on the most critical tasks for community discharge, and quantify function for rehabilitation goals.

Post-acute patients participating in occupational (OT) and/or physical therapy (PT) programs in skilled nursing facilities (SNF) were the focus of this study. Data were extracted from the PT and OT documentation and the Minimum Data Set including CARE Item Set scores at admission and discharge, age, diagnoses, discharge placement, therapy program duration, and prior level of function.

The primary aims of the first study (Chapter Two) were to determine the extent to which scores on the CARE Item Set mobility scale and subsets of the scale (bed mobility, transfers, and combined basic mobility items) of the scale were responsive to change in function and associated with community discharge. Findings indicated that the mobility scale items and the bed mobility, transfer, and combined basic mobility items were responsive to change over the course of the PT program and were associated with differences in the meaningful outcome of community discharge. The total CARE mobility scale and basic mobility subscales provided an effective way to describe baseline status, establish goals and demonstrate progress for post-acute care patients in the SNF setting.

The primary aim of the second study (Chapter Three) was to use demographic and clinical information and CARE Item Set scores at time of therapy evaluation to identify patients at risk for interruption of the rehabilitation program with a hospital readmission. While mobility and self-care scores were significantly different between groups (p < .001), only decline in self-care abilities during the hospital stay contributed to readmission risk in the decision tree and logistic regression prediction models. Length of stay in the SNF was the strongest predictor of hospital readmission in the decision tree model. Patients were more likely to be readmitted to the hospital during the first eight days of the SNF stay. Patients with medical conditions including pneumonia, COPD, heart failure and operative hip fracture were at increased risk of readmission.

The primary aim of the third study (Chapter Four) was to identify the functional tasks most strongly associated with discharge to the community. Results can inform care planning and prioritization of treatment goals and interventions. Toileting was the most critical functional task for community discharge in this group of inpatients. Focusing therapy plans of care on toileting and transfer tasks may be the most efficacious approach for patients whose goal is to return to the community from the SNF.