The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.
Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services
Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.
Part 2
Dr. Flemming described the functional results obtained from their intervention. They specifically chose the activity measure proposed for post-acute care, abbreviated as AM-PAC. It showed improvement over time and it allowed looking at specific subsections within rehabilitation, such as basic mobility, daily activity, and cognitive scores. An AM-PAC score is a recognized tool by Medicare used in multiple post-acute care settings. Dr. Cuccurullo indicated that according to an article published in 2011 in the journal Stroke, the all-cause mortality for stroke patients in the U.S. is 31%. In one year, the all-cause mortality in their program was 1.47%. Their results were published in the American Journal of Physical Medicine and Rehabilitation. The paper received the Excellence in Research Writing Award for the most impactful article of the year. Significantly, the manuscript attracted the attention of Medicare officials who asked them to present their findings. CMS wanted to know if it can be proved that the stroke recovery program saves money, can they validate their previous improvement in mortality with more patients, and can they replicate the results at other institutions nationally. Drs. Fleming and Cuccurullo described what they did in response to these questions.
A Question & Answer period followed.
The introduction is done by Dr. Steven Flanagan, Chairperson of the Department of Rehabilitation at NYU Langone Health.
Sara Cuccurullo MD is Professor and Chairman, Residency Program Director in the Department of Physical Medicine and Rehabilitation at Hackensack Meridian School of Medicine, Rutgers- Robert Wood Johnson Medical School; Medical Director, VP at JFK Johnson Rehabilitation Institute; and Physician in Chief of HMH Rehabilitation Care Transformation Services
Talya Flemming MD is Medical Director: Stroke Recovery Program, Post-COVID Rehabilitation Program, Aftercare Program ABMS, Brain Injury Medicine Certified JFK Johnson Rehabilitation Institute, Department of Physical Medicine and Rehabilitation Clinical Associate Professor, Rutgers Robert Wood Johnson Medical School Core Associate Professor, Hackensack Meridian School of Medicine.
Part 1
Dr. Cuccurullo began by discussing their stroke recovery program, specifically investigating and analyzing the effects of a comprehensive initiative on all-cause mortality, function, and readmissions. She listed the learning objectives for today’s grand round presentation. Strokes are the number one admission in their inpatient rehab facility. Twenty-two percent of their patients comply with going to the facility. Their patients have a finite resource for Medicare once they leave inpatient or the acute care setting. Payment caps compromise the ability to have outpatient therapies that prevent them from having a full recovery. Dr. Flemming pointed out that there is an overlap with patients who have neurologic disease after stroke as well as patients who have cardiac disease. So, they designed their program to combine both elements of neurorehabilitation and a modified cardiac rehabilitation program, which starts with an outpatient visit with a stroke physiatrist. Common challenges that need to be addressed are patients with: weakness on their one side versus the other, cognitive or attention deficits, poor safety awareness, and post-stroke fatigue. They decided that it would be important to collect medical and functional outcome data to see if the program could affect hospital readmissions, the recurrence of stroke, and overall mortality.