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5/16/2020
1
COVID-19: ICU to Home Transition
Presenters:
Kirby P. Mayer, DPT, PhD
Heidi Engel, PT, DPT
Paul Ricard, PT, DPT, CCS
Jason R. Falvey, PT, DPT, PhD
Moderators:Leonard D. Arguelles, PT, DPT, CCSJim Smith, PT, DPT
Kirby P. Mayer, DPT, PhDUniversity of Kentucky
ICU to Home Transitions
Post-Intensive Care Syndrome
@KirbyMayerDPT
Disclosures
No financial disclosures to announce
Acknowledgments
Ashley Montgomery-Yates, MD Director ICU Recovery Clinic
Kirby P. Mayer, DPT, PhD
Critical Illness
Pre-ICU HealthCo-morbidities
PsychosocialSupport
Activity Level/PLOF
ICU Critical illness
SedationVentilationImmobility
Sleep disruptionOrgan failure
Sepsis/infection
Ward/FloorResolving acute illness
FatigueWeakness
Delirium/Cognitive dysfunction
Anxiety/depressionSleep disruption
HomeNew co-morbidities?Resolving symptoms?Prolonged disability?
Dependency?Lost wages?
Readmission risk?Follow-up care?
RehabPhysical deficits
Cognitive dysfunction Anxiety
DepressionSleep disruption
PTSD
Collins TL, Falvey JR. Home Healthc Now. 2019
Kirby P. Mayer, DPT, PhD
Critical Illness
Iwashyna, T. J. Trajectories of recovery and dysfunction after acute illness, with implications for clinical trial design. American journal of respiratory and critical care medicine, 186(4), 302-304; 2012.
Kirby P. Mayer, DPT, PhD
Intro to PICS
Post Intensive Care Syndrome
Cognitive Mental Health
• Weakness• Functional
impairments• Pulmonary deficits• Dysphagia• Pain• Sleep disruption
• Memory loss (short and long-term)
• Attention deficits• Motor planning • Executive function
impairments
• Anxiety• Depression• Mood disorder• Post-traumatic
stress disorder (PTSD)
Physical
Needham 2012 Critical Care MedSmith 2020 PTJ
5/16/2020
2
Intro to PICS
Needham 2012 Critical Care Med
Kirby P. Mayer, DPT, PhD
Risk factors for PICS
High disease severity
Female
Age
Co-morbidities
Mental Health
Prolong MV
ARDS
Immobility
Delirium
Risk factors
PICS
Lee 2019 Aus Crit Care
Intro to PICS
Inoue 2019 Acute Med & Surg
Covid-19 (viral infections)
Delirium
Anxiety, depression & PTSD
One year after critical illness • 10-20% incidence of PTSD• 30-40% incidence of depression • 32% incidence of anxiety
(Hatch et al. 2018)(Parker 2015)(Nikayin et al. 2016)(Rabiee et al. 2016)
PICS-family• Significant variations in reporting • Prevalence of anxiety 2-80%, depression ranges 4-94% and PTSD 3-62%
(Johnson, Suchyta et al. 2019)
Cognitive Impairments
One year after critical illness • 50% have cognitive impairments (ARDS survivors)
(Hopkins et al. 2005)
• 34% of critical illness survivors had scores similar to moderate TBI on the RBANS and TMT
(Pandharipande et al. 2013)
5/16/2020
3
Physical Impairments & Disability
One year after critical illness • Up to 70% of survivors will still have a physical complication• 33% report disability with ADLs• 33% unable to return to driving• 44-70% will not return to prior level of employment
• 31% will have a major occupation
Two years after critical illness • 6-minute walk distance: 52-69% predicted • SF-36 PFS mean 72%
Five years after Critical illness• 6-minute walk distance = 76% predicted
(van der Schaaf et al. 2009)(Ohtake et al. 2018)(Kamdar et al. 2017)(Herridge et al. 2011)(Fan et al. 2014)
F u t u r e D i r e c t i o n sTransitions from ICU to Home
ICU Primary team physician, resident, advanced nurse
practitioner, nurse, consulting physician,
resident, physical therapist, occupational therapist,
respiratory therapy, dietician, nursing
technician, mobility ability, nurse manager, hospitalist
REHAB Primary team physician,
advanced nurse practitioner, nurse, physical therapist,
occupational therapist, respiratory therapy,
dietician, nursing technician
HOMEPrimary Care Provider,
Nurse, physical therapist, occupational
therapist
20
10
1-4
Kirby P. Mayer, DPT, PhD
Resources
http://www.icudelirium.org/testimonials.html/
Facebook group for ICU Survivors
https://www.sccm.org/MyICUCare/THRIVE/Post-intensive-Care-Syndrome
https://www.aftertheicu.org/what-is-pics
https://www.myicucare.org
https://www.improvelto.com/
Kirby P. Mayer, DPT, PhD
References1. IwashynaTJ. Trajectories of recovery and dysfunction after acute illness, with implications for clinical trial design. American journal of respiratory and critical care
medicine. 2012;186(4):302-304.2. Needham DM, Davidson J, Cohen H, et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders' conference. Critical
care medicine. 2012;40(2):502-509.3. Smith JM, Lee AC, Zeleznik H, et al. Home and Community-Based Physical Therapist Management of Adults With Post–Intensive Care Syndrome. Physical therapy.
2020.4. Lee, M., et al. (2020). "Risk factors for post–intensive care syndrome: A systematic review and meta-analysis." Australian Critical Care 33(3): 287-294.5. Inoue, S., et al. (2019). "Post-intensive care syndrome: its pathophysiology, prevention, and future directions." Acute Med Surg 6(3): 233-246.6. Ohtake PJ, Lee AC, Scott JC, et al. Physical Impairments Associated With Post-Intensive Care Syndrome: Systematic Review Based on the World Health Organization's
International Classification of Functioning, Disability and Health Framework. Physical therapy. 2018;98(8):631-6457. Herridge MS, Tansey CM, Matté A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011 Apr 7;364(14):1293-1304.8. Marra A, Pandharipande PP, Girard TD, et al. Co-Occurrence of Post-Intensive Care Syndrome Problems Among 406 Survivors of Critical Illness. Critical care medicine.
2018;46(9):1393-1401.9. Jackson JC, Pandharipande PP, Girard TD, et al. Depression, post-traumatic stress disorder, and functional disability in survivors of critical illness in the BRAIN-ICU
study: a longitudinal cohort study. The Lancet Respiratory medicine. 2014;2(5):369-379.10. van der Schaaf, M., et al. (2009). "Poor functional recovery after a critical illness: a longitudinal study." J Rehabil Med 41(13): 1041-1048.11. Kamdar, B. B., et al. (2017). "Return to work and lost earnings after acute respiratory distress syndrome: a 5-year prospective, longitudinal study of long-term
survivors." Thorax.12. Hopkins, R. O., et al. (2005). "Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome." Am J Respir Crit Care Med 171(4):
340-347.13. Hatch, R., et al. (2018). "Anxiety, Depression and Post Traumatic Stress Disorder after critical illness: a UK-wide prospective cohort study." Crit Care 22(1): 310.14. Johnson, C. C., et al. (2019). "Psychological Sequelae in Family Caregivers of Critically III Intensive Care Unit Patients. A Systematic Review." Ann Am Thorac Soc 16(7):
894-909.15. Pandharipande, P. P., et al. (2013). "Long-term cognitive impairment after critical illness." N Engl J Med 369(14): 1306-1316.16. Rabiee, A., et al. (2016). "Depressive Symptoms After Critical Illness: A Systematic Review and Meta-Analysis." Crit Care Med 44(9): 1744-1753.17. Nikayin, S., et al. (2016). "Anxiety symptoms in survivors of critical illness: a systematic review and meta-analysis." Gen Hosp Psychiatry 43: 23-29.18. Fan, E., et al. (2014). "Physical complications in acute lung injury survivors: a two-year longitudinal prospective study." Crit Care Med 42(4): 849-859.
Over 400 manuscripts in PubMed with search term “post intensive care syndrome”roughly 120 since January 2019
Transitions from ICU to Home for COVID-19 PatientsAPTA Academy of Acute Care PT
Heidi Engel, PT, [email protected]@HeidiEngel4
The Way We Were
5/16/2020
4
ICU Early Mobility for Non-COVID
“ When am I going to walk? I walked yesterday. It’s better than just being in the chair. I feel better when I am walking.”-Patient with ARDS acute on chronic pulmonary condition
Early was within a few days of admission to ICU
Family
Communication
Reducing isolation
The COVID-19 ICU Mobility Reality
Need for prolonged sedation, paralytics, prone position
Isolation and noise
Delirium
Hemodynamic lability
Neurologic symptoms
The Underwater Phase (1 to 4 weeks)
• Fast descent into hypoxemic respiratory failure requiring transition from HFLO2 to intubation.
• Requires ARDS Net lung protective ventilation
• Weeks of deep sedation, paralytics, NiO2, pressor medications, prone positioning, CRRT, a-fib, amiodorne, CRRT circuit clotting, DIC, skin rash, multi-organ dysfunciton cytokine storm
Resilience
Admitting
Event
(not the same as
diagnosis)
Week 1
Disease and Chronic Medical Burden, Co-morbid conditions
Week 2
Physiologic Reserve, Functional Baseline, Psychosocial Support, Physical Performance History, Age
Week 3 and beyond
A perturbing altered reality
Disturbed sense of time- time lost, disoriented sleep-wake cycles
Omnipresent feeling of fear, overwhelming powerlessness, learned helplessness, agoraphobia, kinesiophobia, regression- pacifier devices
Disconnected discordant identity
Isolation versus the impact of human connection, a sense of disconnection from inability to communicate
Perceiving surreal eventsOrtega, DG (2019).
Timing- ICU Liberation Still Applies
“In adjusted models, those who implemented exercise with sedation interruption and delirium screening were 3.5 [CI 1.4-8.6] times more likely to achieve higher levels of exercise in ventilated patients than those who implemented exercise without both sedation interruption and delirium screening. “
Miller MA, Govindan S, Watson SR, Hyzy RC, Iwashyna TJ: (2015).
Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill S et al: (2015).
5/16/2020
5
The Roller Coaster emerging from Underwater phase
PT Evaluation initiated when SAT/SBT begun, finding right timing in the patient day can cause more delay
Hemodynamically labile, unpredictable drop or rise in BP or HR, with work of breathing supported during PT, does not tend to de-sat, LOW activity tolerance, frequent rest breaks during activity.
Start learning survival is possible
Upright is normal
This Photo by Unknown Author is licensed under CC BY
Adaptions- ICU Acquired Weakness
Change in architecture of muscle fibers within 18 to 69 hours
Loss of bone mineral density, bone adapts to the load placed on it, ALI patients have 19% greater risk of fracturing, 10 day study with average patient age of 55
Frailty: Fried Frailty Index, hallmark is neuromuscular weakness, every 1 pt increase equal to 3X increased risk of 6 month mortality, 82% of older ICU survivors qualify as frail
Kress JP, Hall JB (2014) Puthucheary ZA et al (2013) Baldwin MR et al: (2014).
Bringing the fragmented self together phase
• Fear anxiety and needing to learn the bed is not home and safety
• Upright is normal adaption
• Activity creates cognitive dissonance
• Integrating lost time, considering the future
• Support work of breathing, dyspnea
• Standing activity prior to extubation, finding midline and COG, repeated isometric holds
• Family support, palliative care to process loss and grief
This Photo by Unknown Author is licensed under CC BY-SA-NC
Not Even COVID-19 Will Weigh Us Down
• Photos and family and Zoom
• Humanity and touch
• Consistent familiar providers
• Music
• Treating pain, providing comfort
• Celebrating milestones
• Preparing for transitions
The marathon training phase begins
Transitions of self-awareness, Borg RPE, HIIT
Muscle recruitment, postural integrity, core strength, balance, endurance, shoulders- rotator cuff and gastric soleus muscles
Peripheral nerve injuries, musculoskeletal pain
PT activity forces reality of situation onto patient
Family education, windows, transition to greater autonomy and self-directed care
20 to 30 sessions of PT later, patients are walking and going home
References
Miller MA, Govindan S, Watson SR, Hyzy RC, Iwashyna TJ: ABCDE, but in That Order? A Cross-Sectional Survey of Michigan ICU Sedation, Delirium and Early Mobility Practices. Annals of the American Thoracic Society 2015.
Klompas M, Anderson D, Trick W, Babcock H, Kerlin MP, Li L, Sinkowitz-Cochran R, Ely EW, Jernigan J, Magill Set al: The Preventability of Ventilator-associated Events. The CDC Prevention Epicenters Wake Up and Breathe Collaborative. Am J Respir Crit Care Med 2015, 191(3):292-30
Kress JP, Hall JB: ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014, 370(17):1626-1635.
Baldwin MR, Reid MC, Westlake AA, Rowe JW, Granieri EC, Wunsch H, Dam TT, Rabinowitz D, Goldstein NE, Maurer MS et al: The feasibility of measuring frailty to predict disability and mortality in older medical intensive care unit survivors. J Crit Care 2014, 29(3):401-408.
Puthucheary ZA, Astin R, McPhail MJW, Saeed S, Pasha Y, Bear DE, Constantin D, Velloso C, Manning S, Calvert Let al: Metabolic phenotype of skeletal muscle in early critical illness. Thorax 2018, 73(10):926-935.
5/16/2020
6
From ICU to Home: Leveraging Rehabilitation
Paul Ricard, PT, DPT, CCS
Rehabilitation Team Coordinator: Cardiac Service
Johns Hopkins Medicine
@HopkinsAMP @RehabHopkins @ICUrehab
Pre-COVID-19: Bedrest is Bad
Hospital-acquired physical impairment is
associated with INCREASED:
• Hospital-acquired complications
• Hospital length of stay
• 30-Day readmissions
• Nursing home and rehab stays
• Long-term impaired physical function
Covinsky et al. J Am Geriatr Soc. 2003; 51: 451-458. Brown et al. J Am Geriatr Soc. 2004; 52: 1263-1270. Brown et al. JAMA. 2013; 310: 1168-1177.Hoyer et al. J. Hosp. Med. 2014; May;9(5):277-82
Disease
DebilityCo-morbidity
Leverage Our Models of Care:
Activity and Mobility Promotion (AMP), Adult
ICURehab, and Pediatric ICU (PICU Up!)
Essential concepts:
• Early and frequent mobilization
• Systematic measurement of function – “Common Language”
• Interdisciplinary team:
– nursing, rehabilitation team, respiratory team and medical team
• Normalize the 24 hour clock
– Sleep, Rest, Active
– ADLs: mobility with purpose
– Orientation to day and night
Critical Care Rehabilitation
Interdisciplinary Activity Mobility Program (AMP)
Rehabilitation
Consultation
Inpatient
Rehabilitation
Facilities
Homecare
Outpatient
Rehabilitation
Pre-COVID-19: Rehabilitation Continuum
Critical Care Rehabilitation
Interdisciplinary Activity and Mobility Program
(AMP)
Rehabilitation
Intervention
Inpatient
Rehabilitation
Facilities
HomecareOutpatient
Rehabilitation
COVID-19: Altered Health System
Critical Care Rehabilitation
Interdisciplinary Activity and Mobility Program
(AMP)
Rehabilitation
InterventionHomecare
Tele-
outpatient
COVID-19: Leveraged Health System
No further
Rehabilitation
Needs
5/16/2020
7
4 Rights
• Right patient– Functional and cognitive
screening
• Right time– Early, often
• Right intervention– Activity, Mobility, Impairment-
based
• Right provider– Define scope of practice not
roles
“Hospital Direct Home” Framework
1. “Common Language” of function
a. Capacity: AM-PAC Inpatient Mobility and Activity Scales (6 Clicks)
b. Performance: Johns Hopkins – Highest Level of Mobility (JH-HLM)
2. Utilize established ICU rehab criteria
3. Stratify patients
4. Establish formal interdisciplinary activity and mobility plans
5. Communicate variance from plans
COVID-19 Functional
Recovery Model
Low function
AM-PAC ≤ 12
> LOS
Moderate Function
AM-PAC (13-17)
IRF
Higher function
AM-PAC (18-23)
Home/Homecare
Nurse led AMP
AM-PAC=24
Home
Critical Care
- PRONE team
- Respiratory Therapy
-Rehabilitation
Diane U. Jette, et al. AM-PAC "6-Clicks" functional assessment scores predict acute care hospital discharge destination. Phys Ther. 2014 Sep; 94(9):
1252–1261.
COVID-19 Functional Recovery Model
RN/RT Led
Swallow: Unable to maintain alertness
Trach: Unable to tolerate cuff deflation
Low Function
Swallow: NPO, pureed solids; thickened liquids
Cognition: Eval for new deficits (not delirium)
Moderate Function
Swallow: Minced -Moist diet or Soft -bite sized diet
Cognitive interventions
Trach: Speaking valve
High Function
Swallow: Regular diet and thin liquids
Cognition: Baseline cognitive deficits
Critical Care
- PRONE team
- Respiratory Therapy
-Rehabilitation
Institutional Scope of Practice
Provider
• OT
• PT
• SLP
• Physiatry
Problem
• Cognition
• ADLs
• Positioning
• Ventilation
• Functional task
• Swallowing
Outcome
• Leaving ICU
• Leaving Hospital
• Needing ongoing care
Rehabilitation TEAM
• Multidisciplinary
• Daily Discussion
• Consistent
application
• Patient focused
Rehabilitation
(PT, OT, SLP, Rehab Psych)
Nursing
Respiratory Therapy
Physicians
(Critical Care,
Physiatry,
Hospitlaists)
PATIENT
5/16/2020
8
Patient Case
Patient
• 45 year old
• Admitted OSH 3d SOB
• Dx COVID 19 and
transferred JHH on HFNC
• Intubation 2d later,
sedated, prone, paralyzed
Response
• Prone team activated
– Some teams included
therapy
• RT involved
– Some rehab staff assisting
RT with care
• OT consulted for splinting
and positioning
• RN splinting, positioning
Patient Case
Patient
• Failing ventilation and
oxygenation in prone
subsequent
– ECMO
– Supine
– Tracheostomy
Response
• OT evaluation
– Splinting
– ROM
– Education
• OT or RT daily
communication with PT
• RN for splinting and
positioning
Patient Case
Patient
• Sedation intermittently
weaned
• Remained on ECMO
Response
• OT following
– Cognitive assessment and
intervention
– ROM
– Splinting
• OT increased frequency
of sessions
• RN for splinting,
positioning and activity
Patient Case
Patient
• ECMO decannulation
• Mechanical ventilation
weaning
– Trach collar trials
• Low AMPAC score during
therapy and RN scoring
Response
• OT: ADLs, splinting, activity,
communication
• SLP: EMST, communication
• PT: IMST/EMST, ADLs,
mobility
• Coordination of therapy
(Activity and mobility) with
RN
Patient Case
Patient
• AMPAC score during
therapy session >=12/24
• Off mechanical ventilation
Response
• ARISE
– Physiatry consulted
– OT and PT increased
frequency
– SLP progressed to
speaking valve
• Coordination of therapy
with routine RN cares
Patient Case
Patient
• AMPAC score 18/24
• Patient walking with
supervision but SOB
• Persistent cognitive
impairments
• Discharge planning
initiated
Response
• OT following for cognition
with tele-health
• SLP for swallowing
• PT for IMST/EMST and
interval training
• RN providing activity and
mobility opportunities
5/16/2020
9
Patient Case
Patient
• AMPAC 24/24
• Walking modified
independent using walker
• No longer SOB with home
mobility
• Decannulated, full diet
• Cognition slightly impaired
• Transition home
Response
• D/c’d with individualized
home exercise program
• Activity and mobility with
RN
• Communication with
home therapy
Once Home….
Coming soon to a theater near you:
COVID-19 Multi-Disciplinary Service: Addressing Post-Intensive
Care Syndrome.
The Pulmonary Critical Care Medicine, Physical Medicine &
Rehabilitation and Homecare Collaborative.
Resources
• PACER series: Free webinar through APTA
https://learningcenter.apta.org/student/Catalogue/CatalogueCategory.aspx?id=dcbae4dc-
1a13-42ff-b9da-7ba7a62162e9
• APTA endorsed Australian-based guideline for practice guidelines for PT in the Acute
Care Setting with COVID- patients
http://www.apta.org/uploadedFiles/APTAorg/News_and_Publications/Latest_News/News_
Items/2020/Physiotherapy_Guideline_COVID-19.pdf
• Comprehensive living document with links to up to date guidelines, webinars,
resources for both COVID and general critical care therapy by Kyle Ridgway, PT
https://docs.google.com/document/d/16UrBoE0YLikWaXgdUpmO01oO2NTo5fr-
_qkN3EyDvr0/mobilebasic
@ICUrehab
Learn more: hopkinsmedicine.org/pmr/amp
Newsletter and Training: [email protected]
The Show Must Go ON! Live or Virtual@Hopkins AMP, @icurehab, @PICU_Up
5/16/2020
10
Care Transitions After COVID-19 Infection
Jason R. Falvey, PT, DPT, PhD
Board Certified Geriatric Clinical Specialist
Post-Doctoral Fellow
Yale University School of Medicine
From Hospital to Home After COVID-19 Infection
How can we set patients up for successful transitions into the community?
Maximizing in hospital physical function
Reducing unmet needs for ADL assistance
Facilitating rehabilitation continuity over the next 30 days
@JRayFalvey
Impaired Physical Function as a Biomarker
Measures of physical function (ADLs) and capacity (i.e. walking ability) consistently have been associated with readmission risk
Importantly, physical function may be a modifiable risk factor for readmissions
Trajectories of functional change AFTER hospitalization also prognostic
@JRayFalvey
Impaired Post-Hospitalization Function and Readmission
@JRayFalvey
Discharge Physical Function and Readmission Risk
Journal of Hospital MedicineVolume 9, Issue 5, pages 277-282, 26 FEB 2014 DOI: 10.1002/jhm.2152http://onlinelibrary.wiley.com/doi/10.1002/jhm.2152/full#jhm2152-fig-0002
@JRayFalvey
Function and Readmission After Serious Illness
TUG >25 seconds at hospital discharge increases odds for readmission 86% AFTER myocardial infarction
Dobson et al, 2019
5/16/2020
11
Unmet Needs for ADL Assistance
Ensuring patient needs for ADL assistance are met during transitions home is critical
Unmet ADL needs are associated with a 37% increase in readmission risk (DePalma et al, 2013)
Trajectories of Recovery And Readmissions
Once older adults go home from hospitals or post-acute care settings, what happens in the early post-hospitalization period is critical
@JRayFalvey
Trajectories of Recovery And Readmissions
In –Hospital SPPB Score and 30 Day Change
Rate of decline after hospitalization
Re-hospitalization Rate Mortality
Medicare Priority Diagnoses (i.e. pneumonia and heart failure)
Volpato, 2011@JRayFalvey
Trajectories of Recovery And Readmissions
Any decline in physical function within 30 days AFTER hospital discharge is associated with a 250% increase in risk for hospital readmission or death
@JRayFalvey Volpato, 2011
Steve R. Fisher et al. J Gerontol A Biol Sci Med Sci
2012;gerona.gls252
Steps per day in older adults
NOT readmitted to hospital
Trajectories of Recovery And Readmissions
@JRayFalveySteve R. Fisher et al. J Gerontol A Biol Sci Med Sci
2012;gerona.gls252
Steps per day in older
adults readmitted to
hospital
Steps per day in older adults
NOT readmitted to hospital
Trajectories of Recovery And Readmissions
@JRayFalvey
5/16/2020
12
Role of Home Health in Successful Transitions
Using Medicare home health care improves transitions to the community after acute medical illnesses
9% reduction in readmission rates when going to home care, despite higher medical complexity (Weerahandi et al, 2019)
Yet only 20% get referrals!
More days at home despite higher medical complexity (Simning et al, 2020)
Rehab Use and Readmissions
For patients receiving care at home following hospitalization, higher doses of physical therapy are associated with up to 82% lower odds for readmission (Wang et al, 2019)
• Doses of 1 visits per week minimum
Evidence that rehab meaningfully impacts readmission risk
@JRayFalvey
Summary
@JRayFalvey
References:
• Dodson, J. A., Hajduk, A. M., Murphy, T. E., Geda, M., Krumholz, H. M., Tsang, S., ... & Alexander, K. P. (2019). Thirty-day readmission risk model for older adults hospitalized with acute myocardial infarction: the SILVER-AMI study. Circulation: Cardiovascular Quality and Outcomes, 12(5), e005320.
• DePalma, G., Xu, H., Covinsky, K. E., Craig, B. A., Stallard, E., Thomas III, J., & Sands, L. P. (2013). Hospital readmission among older adults who return home with unmet need for ADL disability. The Gerontologist, 53(3), 454-461.
• Volpato, S., Cavalieri, M., Sioulis, F., Guerra, G., Maraldi, C., Zuliani, G., ... & Guralnik, J. M. (2011). Predictive value of the Short Physical Performance Battery following hospitalization in older patients. Journals of gerontology series a: biomedical sciences and medical sciences, 66(1), 89-96.
• Fisher, S. R., Kuo, Y. F., Sharma, G., Raji, M. A., Kumar, A., Goodwin, J. S., ... & Ottenbacher, K. J. (2013). Mobility after hospital discharge as a marker for 30-day readmission. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 68(7), 805-810.
• Hoyer, E. H., Needham, D. M., Miller, J., Deutschendorf, A., Friedman, M., & Brotman, D. J. (2013). Functional status impairment is associated with unplanned readmissions. Archives of physical medicine and rehabilitation, 94(10), 1951-1958.
• Weerahandi, H., Bao, H., Herrin, J., Dharmarajan, K., Ross, J. S., Jones, S., & Horwitz, L. I. (2020). Home Health Care After Skilled Nursing Facility Discharge Following Heart Failure Hospitalization. Journal of the American Geriatrics Society, 68(1), 96-102.
• Simning, A., Orth, J., Wang, J., Caprio, T. V., Li, Y., & Temkin‐Greener, H. (2020). Skilled Nursing Facility Patients Discharged to Home Health Agency Services Spend More Days at Home. Journal of the American Geriatrics Society.
• Wang, J., Liebel, D. V., Yu, F., Caprio, T. V., & Shang, J. (2019). Inverse dose-response relationship between home health care services and rehospitalization in older adults. Journal of the American Medical Directors Association, 20(6), 736-742.
COVID-19: ICU to Home Transition
Leonard D. Arguelles, PT, DPT, CCS
Kirby P. Mayer, DPT, PhD
Heidi Engel, PT, DPT
Paul Ricard, PT, DPT, CCS
Jason R. Falvey, PT, DPT, PhD