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Rusk RehabilitationRehabilitation, Value BasedCare and Horticultural TherapyJohn R. Corcoran, PT, DPT, MSSite Director of RehabilitationClinical Assistant ProfessorOctober 2018
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John Muir – “Keep close tonature’s heart . and break clearaway, once in awhile, and climba mountain or spend a week inthe woods. Wash your spiritclean.”3Rusk Rehabilitation
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Vermont Wildflowers5Rusk Rehabilitation
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The History of Rehabilitation –8Rusk Rehabilitation
History of Rehabilitation In the ancient world, people with disabilities were summarily excluded fromeveryday life (Conti 2014) The notion that disabilities were punishments from the gods and deitieswas widely accepted Disabilities were assumed to be the direct result of one’s moral failings,sins, or acts against the gods People with disabilities were thus prescribed complete removal fromsociety9Rusk Rehabilitation
History of Rehabilitation Ancient Egypt– Edwin Smith Surgical Papyrus 2000 BCE Ancient Greece – father of modern medicine– Hippocrates 460 – 370 BCE– Olympic Games Rome – famed physician Galen– 130 – 200 CE Soldiers10Rusk Rehabilitation
History of Rehabilitation People were treated by their families or religious establishments until thelater part of the 20th century Penicillin – Alexander Fleming 1928, first treatment 194211Rusk Rehabilitation
History of Rehabilitation Howard A. Rusk, MD– Father of Rehabilitation Medicine12Rusk Rehabilitation
Rusk: The Foundation of Rehabilitation Medicine (1948)13Rusk Rehabilitation
Howard A. Rusk, MD –wounded and disabledservicemen were left to “simplylie around getting custodial care,with nothing to do, bored todistraction, helpless, hopeless,waiting for some kind of infectionor disease to carry them off.”14Rusk Rehabilitation
Howard A. Rusk, MD –“Gradually the concept of rehabilitationcame to me as I found out how muchreally could be done for these men. In thebeginning, I knew only that everythingpossible should be done to return them tophysical and mental health. This meantfinding ways for them to function despitetheir disabilities.”15Rusk Rehabilitation
Howard A. Rusk World War II Academic Class Work Early Mobilization– Improve outcomes, decrease readmissions Interdisciplinary Teams Psychosocial Functioning Physical and Vocational Rehabilitation Horticulture16Rusk Rehabilitation
Howard A. RuskHorticulture at Rusk – The Garden of Enid – The Glass Garden 1959“Hundreds of patients through the years have not only found joy and solace in theprogram but many have gone on to follow careers in horticulture . Distressedfamilies have found peace in this atmosphere.”“The idea has been copied throughout the entire country and has spread like wildflower seeds scattered by kindly winds.”17Rusk Rehabilitation
Glass Garden -18Rusk Rehabilitation
Rusk Without Walls – Dr. Lee19Rusk Rehabilitation
20Rusk RehabilitationPhoto credit: www.iasc.mcn.org
History of Horticultural Therapy Ancient Egypt21Rusk Rehabilitation
Why is HT offered in the hospital environment? Patient satisfaction Decrease pain Decrease anxiety Decrease stress Improved sleep Best practice22Rusk Rehabilitation
What are the drawbacks of horticultural therapy? Need for space, light, soil, water can be a challenge in an urban environment– Roof top gardens, green roofs, creative use of space Not reimbursed (in the US) by insurance– Value Based Care, Triple Aim Dependent on grant funding– Research23Rusk Rehabilitation
Why do you support HT for clients and patients? Personal experience– Family– Patient letters and photos Best rehabilitation is when the patients don’t realize it is rehabilitation Payment related to patient satisfaction It works! Need more research and QI studies24Rusk Rehabilitation
New Hospitals Kimmel Pavilion Hassenfeld Children’s Hospital Tisch Hospital25Rusk Rehabilitation
Patient CareAdvanced Comprehensive Stroke CenterCertified VAD CenterHeart, Lung, Face Transplant Center26Rusk Rehabilitation
Specialty Programs Brain Injury Stroke Pediatrics Limb Loss CIIRPo Comprehensive Integrated Inpatient Rehabilitation Program
AccoladesRusk Rehabilitation has been rankedamong the top ten in the country sinceU.S. News started its rankings in 1989 and#1 in New York StateThis year, NYU Langone Health Systemsranks among the top ten hospitalsnationally, its highest ranking to date28Rusk Rehabilitation
Rusk Rehabilitation: One of 16 National TBI Model Systems The Traumatic Brain Injury Model System grant is a collaborative endeavor involvingRusk Rehabilitation and Bellevue Hospital, several trauma and medical centersthroughout New York City, and a nationally renowned rehabilitation outcomes researchcenter at the University of Michigan. Cultural disparities and culturally-accessible knowledge in rehabilitationhealthcare among patients with TBI.29Rusk Rehabilitation
𝑄𝑢𝑎𝑙𝑖𝑡𝑦𝑉𝑎𝑙𝑢𝑒 𝐶𝑜𝑠𝑡Value Based CareMichael Porter
Rusk Rehabilitation InitiativesValue Based MedicineValue Quality/CostBundled Payment InitiativeCMS PilotsTriple AimImproving pt experienceImproving outcomesReducing cost(Institute for Healthcare Improvement)31Rusk Rehabilitation
Value Based Care - Bundled Payment Initiativesthe risks for embracing new paymentmodels as they evolve is worth theopportunity to identify what works andinfluence future policyPresentation Title Goes Here32
Value Based Care - Bundled Payment InitiativesPresentation Title Goes Here33
Value Based Care - ICU Early MobilizationEarly Rehabilitation in the Medical andSurgical Intensive Care Units for PatientsWith and Without Mechanical Ventilation:An Inter-professional PerformanceImprovement ProjectJohn R. Corcoran, PT, DPT, MS, Jodi M. Herbsman, PT, DPT, MS, Tamara Bushnik, PhD,Steve Van Lew, MS, OTR/L, Angela Stolfi, PT, DPT, Kate Parkin, PT, DPT, MA, AlisonMcKenzie, MA, RN, NE-BC, CCRN, Geoffrey W. Hall, MBA, MSW, FACHE, LCSW,Waveney Joseph, MBA, Jonathan Whiteson, MD, FAAPMR, Steven R. Flanagan, MDPM&R. Feb 2017Presentation Title Goes Here34
Early Mobilization Study Results: Rehabilitation therapy services increased by 60 minutes ICU LOS decreased by 20% from 4.6 to 3.7 days (P .05) Floor bed LOS decreased 40% from 6.0 to 3.4 days 40.5% vs 18.2% discharged home without services Annualized net cost savings of 1.5 millionPresentation Title Goes Here35
Value Based Care - ICU Early Mobilization Reduced ICU length of stay by 0.93 days –20%LOS Reduced Med-Surg bed length of stay by 1.9days – 30%LOS Reduced average direct cost per day by 12%Presentation Title Goes Here36
Value Based Care - ICU Early MobilizationAnnual Net CostSavings of 1.5M 2.2M saved with an annual increase in salaries of 740KPresentation Title Goes Here37
Performance ImprovementGreen Satisfaction Team38Rusk Rehabilitation
Performance ImprovementProject goal: The aim of this studyis to explore whether adding nature-basedelements in the hospital room may improvethe patient experience. Patient perceptionsof their room, pain control, quality of sleep,quality of room, and quality of care will beassessed.Matthew Wichrowski, MSW, HTR39Rusk Rehabilitation
The Rehabilitation Therapy Team Value: Improving the patient experience Horticultural Therapy Improving patient outcomes Horticultural Therapy Decreasing hospital length of stay Reducing hospital costs Decreasing the need for post acute services Preventing readmissionsPresentation Title Goes Here40
Lifelong Rehabilitation Did your program provide the foundation
Bottom Line!From fitness to health, location-aware medical wearables are about totransform our lives . Embedded –computing.com ; Sept 2015.42
Reaching the Nation43Rusk Rehabilitation
Spreading the Word: Using Podcasting to AdvanceScientific Knowledge Across the Spectrum of PM&RGeoff Hall, Doug Elwood, Joanna FelizRusk Insights on Rehabilitation MedicineWhat is it?Leaders in the field discussing key topicsin rehabilitationWho is Involved?Over 85 leaders from the field withweekly episodes44Rusk RehabilitationWhat is the Reach?Over 25,000 downloadsin 15 monthsDownloads inall 50 states inthe US plus 14countries
Matt Wichrowski, MSW, HTR45Rusk Rehabilitation
Events, Contests, Patient/Family and Staff Education46Rusk Rehabilitation
John Muir – “The clearest wayinto the universe is through aforest wilderness.”47Rusk Rehabilitation
References: Early rehabilitation in the medical and surgical intensive care units for patients with andwithout mechanical ventilation: an inter-professional performance improvement project:Corcoran, Herbsman, Bushnik, Parkin, McKenzie, Van Lew, Stolfi, Hall, Joseph,Flanagan (PM&R Volume 9, Issue 2, February 2017, pg. 113-119). Medical Aspects of Disability – 5th edition. Editors: Flanagan, Zaretsky, Moroz.Introduction Chapter 1 Parkin, Corcoran, Stolfi (pg. 1 – 18). Copyright, SpringerPublishing 2016. Conti, A. A. (2014). Western medical rehabilitation through time: A historical andepistemological review. The Scientific World Journal, 2014, 1–5. View through a window may influence recovery from surgery: Ulrich (Science, Vol. 224,April 1984, pg. 420-421). The Strategy that will fix health care: Porter, Lee (Harvard Business Review, Vol. 91,Oct. 2013 pg. 50- 70).48Rusk Rehabilitation
References: The Triple Aim: Care, health, and cost. Berwick DM, Nolan TW, Whittington J. HealthAffairs. 2008 May/June;27(3):759-769. The Glass Garden – a Therapeutic Oasis in New York City. Chambers, Fried andWichrowski. Copyright, Arena Books Associates, LLC. 2014. Rusk, H. A. (1977). A world to care for–the autobiography of Howard A. Rusk, MD. NewYork, NY: Random House/Reader’s Digest Association.49Rusk Rehabilitation
Questions?50Rusk Rehabilitation
THANK YOU
29 Rusk Rehabilitation The Traumatic Brain Injury Model System grant is a collaborative endeavor involving Rusk Rehabilitation and Bellevue Hospital, several trauma and medical centers throughout New York City, and a nationally renowned rehabilitation outcomes research center at the University of Michigan.
