Real-World Therapy Practice of Cognitive Screening and Assessment in Post-Acute Care

Research Objectives: 1) To describe current practice of cognitive screening and assessment in post-acute care
2) To discuss the clinical implications of study results on post-acute care quality and outcomes
3) To articulate the value of examining electronic health record documentation in understanding current practice

Design: We conducted a cross-sectional observational study using Medicare claims and electronic health record data from one large health system. We included older adults admitted to the acute hospital between September 1, 2016 to October 31, 2018 with one of the top ten CMS diagnoses who were discharged to a post-acute setting (i.e., inpatient rehabilitation, home health, skilled nursing).

Setting: Continuum of acute hospitalization to post-acute care (PAC)

Participants: The final sample included 2,535 patients, most commonly admitted for total hip or knee joint replacement (41.7%) and stroke (15.3%). Following acute hospitalization, 22.6% were discharged to an IRF (n=13 facilities), 9.3% were discharged to a SNF (n=9 facilities), and 68.1% were discharged to HH (n=12 locations).

Interventions: Cognitive screening was defined by any documentation of discrete cognitive behavioral fields (e.g., memory) by an occupational, physcial, or speech therapy provider.

Main Outcome Measures: Frequency of cognitive screening and assessment was stratified by therapy discipline and PAC setting.

Results: Thirty-eight percent had documentation of cognitive screening by any therapy discipline. Patterns of documentation varied across disciplines and PAC settings. Documentation of standardized cognitive assessments in designated locations was rare, occurring for less than two percent of patients.

Conclusions: The IMPACT Act of 2014 facilitated heightened awareness for creating data standardization across PAC settings to measure and improve care. We found inconsistent documentation of cognitive screening and assessment across PAC settings. It is unclear if documentation differences were driven by variation in care delivery approaches, documentation practices, or a combination of both. Future work can seek to understand facilitators and barriers for documenting cognitive screening and assessment in PAC to support implementation of standardized data elements.

Author(s) Disclosures: Authors have no disclosures to report.