VIRTUAL REALITY FEEDBACK FOR GAIT IMPROVEMENT IN PATIENTS WITH IDIOPATHIC SENILE GAIT DISORDERS AND PATIENTS WITH HISTORY OF STROKE

condition of the patient) in patients after discharge from the hospital and unplanned rehospitalizations in the United States. For example, the rehospitalization rate of 20% in Medicare patients within 30 days after discharge from the hospital that was recently reported is close to the unplanned rehospitalization rate of 24% in medical patients suffering a postdischarge adverse event within approximately 30 days after hospital discharge to home in a previous study. Although the previous study examined only medical (not surgical) patients and had a significantly younger population (mean patient age 57, with only half of patients covered by Medicare), other patient characteristics such as common discharge diagnoses (e.g., heart failure, pneumonia, and obstructive lung disease) were similar to those reported in recent study. A direct relationship between postdischarge adverse events and unplanned rehospitalizations may exist in the Medicare population. Postdischarge adverse events most commonly occur because of discontinuities in care. Our generally fragmented healthcare system may be most vulnerable during transitions in care, with discontinuities in care arising mainly from poor information transfer and faulty communication. The most common types of adverse events identified in the previous study within 30 days after hospital discharge were due to medications, nonsurgical procedures, nosocomial infections, and falls. Most of these events were preventable (an adverse event injury that could have been avoided as a result of an error or a system design flaw) or ameliorable (an injury whose severity could have been substantially reduced if different actions or procedures had been performed or followed). A strong relationship between postdischarge adverse events and unplanned rehospitalizations may exist. Therefore, future research on rehospitalizations should include specific investigation on the number of patients who are rehospitalized as a result of postdischarge adverse events. If a significant number of such patients are identified, then current efforts should focus on minimizing postdischarge adverse events, especially in Medicare patients. Systemic approaches that may minimize these events and prevent rehospitalizations include the adoption of health information technology, improvement of transitional care, medication reconciliation, and improvement of follow-up of test results after hospital discharge.