November 29, 2020

Heath PosterPresentation

I conducted my systematic review, mydoctoral experience, and my capstone project exploring the relationshipbetween occupational therapy intervention and readmissions forpatients with congestive heart failure.

CHF places a significant financialburden on the United States' healthcare system.

It is estimated that by the year 2030 the direct cost associated with patient care for this population willrise to 53 billion dollars.

Unplanned hospital readmissionscontribute significantly to this overall spending.

In 2016, researchers from John Hopkins University and the University of Maryland School of Medicine conducted a research study and determined that occupational therapy was the onlyspending category where additional spending had a significant associationwith lower readmission rates for three patient populations, including heartfailure.

So for my systematic review I started with this broader PICO questionof: In individuals with congestive heart failure, what factors contribute tohospital readmission.

In particular, I was interested in those factors thatwere within the scope of occupational therapy.

After completion of the PRISMAprocess, I ended up with 36 studies included in the final qualitativesynthesis.

And what I found was that the factors associated with readmission forpatients with congestive heart failure fell into these two broader categories ofprotective factors and risk factors for readmission.

In this table here I'veoutlined those protective and risk factors and have starred those factorsthat are within the scope of occupational therapy.

So the results ofthe review suggested that higher hospital spending on occupationaltherapy intervention, particularly focused on these areas that wereidentified by the literature as associated with readmission andwithin the scope of occupational therapy, may result in decreased readmissionrates for patients with congestive heart failure.

So my doctoral experience tookplace a Riverside Methodist Hospital in Columbus, Ohio.

And really my primaryon-site role was to gain a thorough understanding of the continuum of carefor patients with congestive heart failure.

I participated in a variety ofsupplemental activities and projects while at Riverside and, in particular, Igot to participate in interdisciplinary interviews and observation, as well as the observation of care across a variety of different settings.

Now priorto any on-site experience, really, I was recommending to my site anall-encompassing intervention protocol focused on those five factors identifiedwithin the literature as within the scope of occupational therapy.

However, once on-site, through conversation with my site mentor, we realized that perhapsthis packaged program that was really all-encompassing for those factorsidentified within the literature was not necessarily appropriate forimplementation at this time.

And really since there was so muchinterdisciplinary involvement across a variety of different settings, I firstneeded to gain an understanding of what the current continuum of care lookedlike for patients with heart failure.

And so I underwent an implementationanalysis where my two primary goals were to gain an understanding of eachdisciplines' role within the care of patients with congestive heart failureand to gain an understanding of occupational therapy's process of care forpatients with heart failure.

And one way I did this was through the conduction ofinterdisciplinary interviews and observations.

So I had a standardizedquestionnaire that I would ask each discipline and the last question on thatquestionnaire was if the discipline recognized or identified any gap in care orany opportunity for increased occupational therapy intervention todecrease readmissions for this patient population.

So really I wanted to use theinsight from the literature, the insight from this interdisciplinary feedback, andmy clinical experience with the patient population to identify logicalopportunities for increased occupational therapy intervention.

So after patientcare with this population and after identifying that there was consistencyand the areas that the literature identified as important for occupationaltherapy intervention and the areas that the team identified as important foroccupational therapy intervention, I identified a multitude of opportunityfor increased occupational therapy, that I have outlined in this process map, right here.

I identified the most opportunity in theevaluation and intervention component of care, within the areas of cognitive andhealth literacy assessment, patient mobility, and caregiver involvement.

Andalthough there's not a one-to-one correlation between these threecomponents and the five factors that were identified in theliterature, it was determined through patient care and through collaborationwith an interdisciplinary team that occupational therapy intervention inthese three areas is how we can best support patients discharging from thehospital with the required supports and services needed to participate in theirCHF disease management.

I identified two areas for prioritywhere immediate and effective change could take place in everyday therapy sessionsand those were in the areas of cognitive and health literacy screening andincreasing patient mobility during the hospital stay.

I will now take some timeto answer questions regarding my poster the first question is about the AIDETtraining.

So the AIDET training was really a hospital-wide initiative for all staffmembers to participate in this training.

And AIDET, itself, stands for Acknowledge, Introduce, Duration, Expectation, and Thank you.

And so we were provided, through this training we were provided with a communication framework to guidenot only inter-professional communication but also patient care communication.

Thesecond question is regarding a further explanation of this “are referralssufficient?” bubble.

And so while I was at Riverside, on the two units that I was on, we were keeping track of the amount of patients who had heart failure comparedto the amount of those patients that received an occupational therapy consult.

And we determined that only 65% of the patients on those units that had heartfailure were receiving occupational therapy.

So really we were just exploringthis to answer these two questions: “Are we getting the consults early enoughduring the hospital stay?” and “Are we getting enough consults, in general?” forthis patient population.

And the third question is regarding a furtherexplanation of this “Gas Gauge Analogy” bubble.

So part of our intervention withpatients who have congestive heart failure is energy conservation training.

One way that we teach patients about energy conservation is throughproviding them with a tool to monitor their energy exertion.

And right now, Riverside was using the Borg scale to provide patients with that tool tomonitor their own energy exertion.

What I was finding was that this scale, itself, was not necessarily intuitive for patients or approachable to patientsparticularly with varying levels of cognitive and health literacy abilities.

And so I modified that scale into a simplified gas gauge analogy and what Iwas finding that with this simplified version for a patient to monitor theirenergy exertion, I was seeing increased carryover from one patient session tothe next, and an increased comprehension of monitoring energy exertion, in general.

Sothat was just one small change that I made while I was at Riverside.

Thank youfor your time.


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