Wake County Clinical Outreach Improves Continuum of Care

As part of a partnership between UNC and Rex, Tanya Zinner, MD, and Paul Thananopavarn, MD, provide patient evaluation, monitoring, and follow-up in Wake County. Thanks to home-like features, patients feel comfortable while at the same time they receive an array of rehabilitation services.

Wake County Clinical Outreach Improves Continuum of Care click to enlarge Dr. Zinner (second from right) and the rehabilitation team in Raleigh blend with the facility's natural surroundings.

• Dr. Zinner oversees sub-acute rehabilitation management in Raleigh. She also serves as medical director for Rex Outpatient Rehabilitation.
• Dr. Thananopavarn is the medical director for UNC Rex Rehabilitation and Nursing Care Center of Apex.

On a sunny afternoon, several patients are finishing therapy sessions and looking out at a glistening pond, where a recreational therapy dog, named Bella, walks gingerly around the flowers.

Thanks to Bella and other home-like features, patients at the UNC-Rex Rehabilitation Center of Raleigh feel comfortable while at the same time they receive an array of rehabilitation services.

The Raleigh facility is accredited by the International Commission on Accreditation of Rehabilitation Facilities (CARF), an independent, international nonprofit organization focused on advancing the quality of services for best possible outcomes.

“We are the only sub-acute rehabilitation facility in North Carolina with CARF accreditation,” notes Dr. Zinner. “Additionally, we participate in monthly performance-improvement meetings, to continually increase quality in all areas of the facilities.”

As medical director for Rex Outpatient Rehabilitation, Dr. Zinner also oversees three different outpatient therapy sites in Raleigh, Cary and Garner for medical direction, questions and support.

A sister facility, UNC-Rex Rehabilitation Center in Apex, helps sub-acute patients transition to home with fish, birds, a library and garden areas.

Most importantly, however, patients receive interdisciplinary therapy and care.

Similar to an acute rehabilitation setting, sub-acute patients receive physical therapy, occupational therapy, speech therapy, recreational therapy, and may attend family meetings as needed to discuss the plan for returning home.

“Sub-acute rehabilitation is for patients who may not be able to tolerate a full three hours a day of therapy, but would still benefit from an interdisciplinary setting,” Dr. Zinner explains. “Our patients vary, and include those recovering from a stroke, surgery or other debilitating medical illness. We work with patients to improve their function and endurance to allow discharge home.”

“Patients are being discharged sooner and sicker from the hospital,” Dr. Zinner continues. “We are able to help with their transition back to functioning as independently as possible. I set up the rehab plan taking into account each patient’s medical issues and functional limitations. We can provide not only intensive therapy services but close medical monitoring as well – by the MD, physician extenders and nursing staff – to review medications, monitor blood pressure and glucose, look at pain management, and assess skin care and nutrition, for example.”

Dr. Thananopavarn (“Dr. Than”) directs an interdisciplinary rehabilitation strategy for each patient in the Apex facility.

“We can provide more support than a patient might receive at home, for example, immediately after joint replacement surgery,” Dr. Than notes.

In addition to coordinating critical rehabilitation services from a variety of experts, Dr. Than has the unique qualifications of being double-boarded in Physical Medicine and Rehabilitation as well as Internal Medicine. As a specialist in internal medicine, Dr. Than is well-suited to treat patients with chronic and complex disabilities. Long-term patients, therefore, also benefit from Dr. Than and his team at the adjoining nursing care facility in Apex.

“The nursing care facility provides a warm, cozy atmosphere where patients can socialize in a variety of settings,” Dr. Than observes.

At the long-term care facility, the team keeps patients as active as possible. “We also keep secondary conditions at bay by maintaining function and restoring independence through various techniques, equipment and modalities,” Dr. Than says.

Growing the Continuum of Care

Dr. Than plans to further coordinate care by bringing together residents in PM&R, geriatrics, internal medicine, surgery and emergency medicine to create a core geriatrics curriculum. “This evidence-based curriculum is sponsored by a grant from the Reynolds Foundation and will improve residents’ abilities to care for older patients,” Dr. Than says.

Part of this curriculum will involve practicum at the sub-acute and long-term facilities in Apex. Additionally, Dr. Zinner will oversee Rex-UNC outpatient rehabilitation therapy services, which complete the continuum for rehabilitation patients in the Wake County area.

The next generation of physiatrists will continue to benefit from unique and valuable opportunities in the surrounding community.

“It’s a great experience for residents to work in a community setting, outside of the main, academic medical campus,” Dr. Zinner adds. “Residents are exposed to a wide variety of patients not always seen in acute rehabilitation. Residents also learn to collaborate with physicians in the private sector to ensure quality of care.”

Dr. Than agrees that collaboration across disciplines is key to better health outcomes.

“The focus on restoring function is something that physiatrists can bring to other disciplines, to improve overall disease management in a variety of clinical settings,” he says. “We can suggest different approaches for maximum quality of life.”

Further growth also includes developing satellite specialty clinics. “There is a significant need for physiatry services in the Rex system,” Dr. Zinner concludes, “and we are looking at opening an outpatient PM&R clinic in Raleigh for both follow-up of appropriate inpatients and for new patient evaluations. This will allow me to work closely with the treating therapists in select cases to give patients optimum care.”

Dr. Than Wins Award from PM&R Residency Program

Dr. Than won the “teaching module of the year” award in 2010 for his teaching of case scenarios to PM&R residents, the next generation of physiatrists.

“The case-based approach allows our residents to use critical thinking skills and to be interactive, while accumulating basic knowledge required for passing their board exams,” Dr. Than notes. “They evaluate and discuss each diagnosis and treatment decision with their peers. This is particularly important for patients with multiple issues.”

Dr. Than also is expanding resident education in ultrasound techniques and musculoskeletal rehabilitation.