There is wide variation across post-acute care settings in the documentation of cognitive screening and assessments, a new study has found. The industry could improve care coordination with standardized methods for recording evaluations of cognitive health, researchers say.
The authors examined documentation by post-acute therapy providers who care for patients in skilled nursing, home health and inpatient rehabilitation settings. Data came from Medicare claims and electronic health records from a single, large health system. The most common patient diagnoses were total hip or knee replacement (42%) and stroke (15%).
Across therapy disciplines and settings, there was a 38% rate of documented cognitive screening. Perhaps not surprisingly, patients with stroke received significantly more screenings and assessments than patients with other diagnoses, the researchers reported. Notably, patients who received occupational therapy were more likely to have documentation of cognitive screening or assessment in skilled nursing (85%) and home health (72%) when compared to inpatient rehabilitation.
Rare documentation
Across all disciplines, standardized cognitive assessments were rarely documented, at only 2% overall. There was no significant relationship between cognitive screening and 30-day readmissions.
It’s hard to tell whether provider behaviors or the structure of documentation is behind the varied findings, according to Natalie E. Leland, PhD, OTR/L, of the University of Pittsburgh, and colleagues. But the inconsistency is likely connected to the variation in electronic health record platforms, they theorized. For example, there is no field for physical therapy to document cognitive screening in home health, they reported.
Evidence-based care
Cognitive impairments occur for 30% to 60% of older adults receiving post-acute care, and can co-occur across a broad range of conditions. Once these impairments are identified, therapy providers can use evidence-based guidelines in daily treatments, caregiver training and care transition planning, the researchers noted.
“Standardized assessment and documentation of cognitive impairments aligns with national post-acute policy priorities to promote improved care coordination and understanding of practice,” the authors concluded.
The study was published in JAMDA.
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