Earlier this year, Mark Realmuto, rehabilitation coordinator, and Vivien Osuorah, MD, GEC service chief, cut the ribbon officially opening the Short-Stay Rehabilitation Unit at the Salem, VA, VAMC. The 10-bed unit also features a dining area, common room and fitness/rehabilitation exercise equipment.
SAN DIEGO — After a serious illness, veterans who received medical care via the Post-Acute Recovery Center (PARC) model experienced fewer deaths and more days outside of the hospital compared to those not treated with PARC, according to a recent study.
A presentation at the recent American Thoracic Society (ATS) 2024 International Conference in San Diego described the early outcomes of the new PARC model at the VA Pittsburgh Healthcare System. Using telehealth, PARC is administered by nurse practitioners to address the complex needs of intensive care unit (ICU) survivors as they transition from hospital to home and improve access to post-ICU care for high-risk veterans, the authors explained.1
The abstract, which also was published in the American Journal of Respiratory and Critical Care Medicine, was funded by the National Institutes of Health. The study included researchers from VAMCs in Augusta, ME, and Pittsburgh.
Each year, “more than 100,000 veterans transition from ICUs to their home after treatment for life-threatening illnesses, but this transition presents many challenges, including unresolved acute medical issues and the lingering effects of acute organ dysfunction,” according to the study authors, who were quoted in an ATS press release. “Our healthcare system’s current structure compromises the continuity of care and contributes to care fragmentation following critical illness.”
The retrospective analysis, which involved 195 veterans at the VA Pittsburgh Healthcare System, assessed mortality and nonhospital days up to 90 days after discharge. The study classified veterans using the PREDICT score, with veterans scoring above 15 being considered high-risk.
“Our findings, though preliminary, suggest that the PARC model could significantly improve transitional care, potentially lowering mortality rates and increasing hospital-free days for veterans,” Hiam Naiditch, MD, MHS, a pulmonary and critical-care fellow at University of Pittsburgh Medical Center, explained.
The study found that “high-risk veterans who received PARC care showed a median increase of four additional days at home compared to matched controls within the same period,” the researchers noted.
At VAMCs nationwide in 2020, nearly half (46.9% or 32,060) of the veterans discharged after critical illnesses such as sepsis and acute organ failure met this study’s high-risk criteria. As a result, they faced a potentially significant increase in post-discharge care complexity, according to the report.
High-risk participants in the study had a median age of 74 and were predominantly white (67.6%) and male (95.8%) with a median van Walraven Elixhauser score of 27.
“Compared to low-risk veterans, high-risk veterans had two less home days and were more likely to die within 90 days (18.2% vs. 4.8%, p <0.01). Also, compared to 130 matched controls, 65 high-risk veterans who received post-ICU care through PARC had a median of four more days at home within 90 days and were less likely to die within 90 days (23.1% vs. 39.2%, ARR 16.1),” study authors explained.
“The PARC model aims to alleviate the burden of these challenges by improving continuity of care and reducing the burden of follow-up care for patients,” Naiditch said in the press release.
In the future, the research team plans to study the PARC model in a randomized trial across several VA facilities in the northeastern U.S. to further evaluate its effectiveness and scalability, according to the authors.
Improving Post-Acute Care
Improving post-acute care for veterans has been a priority across the VA. An article in the quarterly publication In Progress, which highlights ongoing VA Health Services Research and Development (HSR&D) research on various topics, describes an ongoing study that aims “to identify “high-value” skilled nursing facilities across VA and non-VA facilities and understand how much matching a veteran with specific needs to specific skilled nursing facilities improves value.”
Each year, “more than 200,000 veterans are discharged from the hospital to skilled nursing facilities, but more than 25% are readmitted to the hospital. By 100 days after hospital discharge, less than half have returned to the community. Veterans who don’t successfully recuperate are often placed in long-term care facilities—a significant cost to both them and the VA, which spends more than $7 billion each year on institutional care,” In Progress explained.
The authors pointed out that it is sometimes difficult to identify “high-value” skilled nursing facilities, meaning those that deliver the best community discharge rates at the lowest cost for veterans.
The VA’s goal is to “develop two tools (one for use at the bedside and another for use nationally) to help optimize the choice of a skilled nursing facility to maximize value for veterans who need rehabilitation after being discharged from the hospital. The study’s results will be shared with VA Community Care leadership and VISN and VA facility leaders,” according to the article.
- H. Naiditch, M.F. Brucato, V. Talisa, Z. Hahn, J.R. Hotchkiss, J.M. Young, B. Tyler, and F.B. Mayr. The Post-acute Recovery Center: A Telehealth Care Model to Improve Patient-centered Outcomes for High-risk Survivors of Critical Illness (abstract). Am J Respir Crit Care Med 2024;209:A3036.