Research Focus Overview

Research Focus Overview

Those in the Rehabilitation and Related Outcomes Learning Lab (RROLL) aim to be a nationally-recognized source of new knowledge pertaining to rehabilitation practice patterns and their associated outcomes. Our primary mission is to use data from patient interactions in the Cleveland Clinic system to scientifically examine and improve rehabilitation practice and outcomes. To do so, we are continuously building and improving a learning health system infrastructure to transform practice to data, data to knowledge, and knowledge to practice. That work is facilitated by the RROLL Data Registry, partnerships with operational leaders in the health system, and collaborations with like-minded researchers both within and outside the Cleveland Clinic.

Rehabilitation practice is vast. It is also poorly understood, especially as it pertains to the value provided for patients across the continuum of care. There are over 1,000 rehabilitation clinicians employed by or affiliated with Cleveland Clinic. Collectively, these clinicians provide care for more nearly 300,000 unique patients each year. Those episodes of rehabilitation care represent opportunities to learn and improve. In the RROLL, we capture the data from these episodes to systematically examine relationships between care patterns and patient outcomes in order to identify opportunities for improved care. Among others, specific topics of interest include optimizing the frequency of rehabilitation visits for patients who are hospitalized, improving rehabilitation planning and provision before and after surgery, and implementing and examining innovative models of home-based rehabilitation. As part of a learning health system research lab, members of the RROLL incorporate health services research, implementation and dissemination science, and quality improvement.

Contact Information:

Joshua Johnson PT, DPT, PhD
johnsoj8@ccf.org

Funding Sources:

  • Implementation of the PT-PENCIL Tool to Facilitate Discharging Home
  • Learning Health Systems Rehabilitation Research Network (LeaRRn) Pilot Award
  • Evaluating the implementation of high intensity home-based rehabilitation following stroke
  • K01 from the Agency for Healthcare Research and Quality
  • Evaluating the implementation of high intensity home-based rehabilitation following stroke
  • Loan Repayment Program Award from the National Institute of Child Health and Human Development
  • Evaluating the implementation of high intensity home-based rehabilitation following stroke
  • Neurological Institute Clinician Scientist Career Development Award
  • Examining the effectiveness of a ‘Home Care Plus’ program on patient-important outcomes
  • Center on Health Services Training and Research (CoHSTAR)
Publications

Publications

Short-term functional recovery after total joint arthroplasty is unaffected by bundled payment participation. Johnson JK, Erickson JA, Miller CJ, Fritz JM, Marcus RL, Pelt CE. Arthroplasty Today. 2019 Mar;5(1):119-25. doi: 10.1016/j.artd2018.12.003. Epub 2019 Feb 7.

Short-term clinical and quality outcomes have inconsistent changes from a quality improvement initiative to increase access to physical therapy in the cardiovascular and surgical ICU. Tonna JE, Johnson J, Presson A, Zhang C, Noren C, Lohse B, Bento H, Barton RG, Nirula R, Mone M, Marcus R. Critical Care Explorations. 2019 Oct;1(10):e0055. doi: 1097/CCE.0000000000000055.
The association between patients' physical function in the hospital and their outcomes in skilled nursing facilities. Johnson JK, Fritz JM, Brooke BS, LaStayo P, Thackery A, Stoddard G, Marcus R.Physical Therapy Journal of Policy Administration and Leadership. 2019 Nov;19(4):5-16.

Characteristics of usual physical therapy post-total knee replacement and their associations with functional outcomes. Oatis C, Johnson J, DeWan T, Donahue K, Li W, Franklin P. Arthritis Care & Research. 2019. Sep;71(1):1171-77. doi: 10.1002/acr.23761.

Improving outcomes for critically ill cardiovascular patients through increased physical therapy staffing. Johnson JK, Lohse B, Bento HA, Noren CS, Marcus RL, Tonna JE. Archives of Physical Medicine and Rehabilitation. 2019 Feb;100(2):270-77. doi: 10.1016/j.apmr.2018.07.437.

Use of the activity measure for post-acute care “6 clicks” basic mobility inpatient short form and national institutes of health stroke scale to predict hospital discharge disposition after stroke. Covert S, Johnson J, Stilphen M, Passek S, Thompson N, Katzan I. Physical Therapy. 2020 Aug 31;100(9):1423-33. doi: 10.1093/ptj/pzaa102.

Physical function in the hospital is associated with patient-centered outcomes in an inpatient rehabilitation facility. Johnson JK, Fritz JM, Brooke BS, LaStayo PC, Thackeray A, Stoddard G, Marcus RL. Physical Therapy. 2020 Aug;100(8):1237-48. doi: 10.1093/ptj/pzaa073. Epub 2020 Apr 20.

Advancing rehabilitation practice using embedded learning health system researchers. Johnson KK, Stiphen M, Young DL, Friedman M, Marcus RL, Noren CS, Zeleznik H, Freburger JK. PTJ: Physical Therapy & Rehabilitation Journal: Physical Therapy. 2021 June;101(6). doi: 10.1093/ptj/pzab029. Epub 2021 Jan 29.

Reframing hospital to home discharge from “should we?” to “how can we?”: covidÔÇÉ19 and beyond. Gustavson AM, Toonstra A, Johnson JK, Ensrud KE. Journal of the American Geriatrics Society. 2021 Mar;69(3):608-9. doi: 10.1111/jgs.17036. Epub 2021 Feb 6.

High-intensity postacute care at home. Johnson JK, Hohman JA, Vakharia N, Zafirau W, Stilphen M, Pamer S, Marzulli J, Zimbroff R, Rotheberg MB. NEJM Catalyst. 2021 May;2(6). doi: 10.1056/CAT.21.0125.
An explanatory model for the relationship between physical therapists' self-perceptions of value and care prioritization decisions in the acute hospital. Johnson JK, Toung DL, Marcus RL. Journal of Acute Care Physical Therpy. 2021 Oct;12(4):165-64. doi: 10.1097/JAT.0000000000000157.

Functional recovery rate: a feasible method for evaluating and comparing rehabilitation outcomes between skilled nursing facilities. Johnson J, Hohman J, Stilphen M, Bethoux F, Rotherg M. Journal of the American Medical Directors Association. 2021 Aug;22(8):1633-39. doi: 10.1016/j.jamda.2020.09.037.

Frequency of physical therapist intervention is associated with mobility status and disposition at hospital discharge for patients with covid-19. Johnson JK, Lapin B, Green Karen, Stilphen M. Physical Therapy. 2021 Jan 4;101(1):pzaa181. doi: 10.1093/ptj/pzaa181.

Patient versus clinician proxy reliability of the am-pac "6-clicks" basic mobility and daily activity short forms. Johnson JK, Lapin B, Bethoux F, Skolaris A, Katzan I, Stilphen M. PTJ: Physical Therapy & Rehabilitation Journal: Physical Therapy. 2022 Jun 3;102(6):pzac035. doi: 10.1093/ptj/pzac035.

Association of physical therapy treatment frequency in the acute care hospital with improving functional status and discharging home. Johnson JK, Rothberg MB, Adams K, Lapin B, Keeney T, Stilphen M, Bethoux F, Freburger JK. Medical Care. 2022 Jun 1;60(6):444-52. doi: 10.1097/MLR.0000000000001708.

Key data elements for longitudinal tracking of physical function: modified Delphi consensus study. Young DL, Fritz JM, Kean J, Thackeray A, Johnson JK, Drummer D, Passek S, Stilphen M, Beck D, Havrilla S, Hoyer E, Friedman M, Daley K, Marcus RL. Physical Therapy and Rehabilitation Journal. 2022 Apr 1;102(4):pzab279. doi: 10.1093/ptj/pzab279.

PLAN and AM-PAC "6-clicks" scores to predict discharge disposition after primary total hip and knee arthroplasty. Hadad MJ, Emara A, Orr MN, Klika AK, Johnson JK, Piuzzi NS. J Bone Joint Surg Am. 2022 Feb 16;104(4):326-335. doi: 10.2106/JBJS.21.00503.

Members & Collaborations

Members & Collaborations

Members

Gabrielle Jones, BS – Research Coordinator II
Email: jonesg14@ccf.org

External Relationships & Collaborations

Cleveland Clinic Center for Value-Based Care Research (CVCR)

  • Michael Rothberg, MD, MPH (Center Director, Professor, Cleveland Clinic Lerner College of Medicine)
  • Jessica Hohman, MD, MSc, MSc (President, Cleveland Clinic Medicare Accountable Care Organization & Associate Staff, Cleveland Clinic Community Care)
  • Jarrod Dalton, PhD (Associate Staff, Department of Quantitative Health Science, Cleveland Clinic)

LeaRRn | Learning Health Systems Rehabilitation Research Network (brown.edu)

  • Mi Jung Lee, OT, PhD (Research Assistant Professor, Dept. of Nutrition, Metabolism, and Rehabilitation at University of Texas Medical Branch)
  • Matt Briggs PT, DPT, PhD, AT (Clinical Assistant Professor, Dept. of Orthopedics and  Researcher in Sports Medicine Institute at The Ohio State University Wexner Medical Center)