Functional cognition is a critical domain of concern for occupational therapy practice. As the health care system moves to assessing value through achievement of quality outcomes, the field of occupational therapy must address the inclusion of functional cognition in evaluation and treatment. Evidence indicates that impaired cognition contributes to risk of hospital readmission and poor overall health outcomes across diagnostic groups. Moreover, expenditure on occupational therapy services that address functional cognition has been shown to lower hospital readmission rates. To improve client outcomes, occupational therapists must consistently screen for and, when appropriate, evaluate and treat functional cognition impairments and consider functional cognition in the discharge planning process. Occupational therapy professionals must make a proactive, coordinated effort to establish the profession’s role in evaluating and treating clients’ limitations in functional cognition as a means to achieving improved quality care and client outcomes.

Healthcare services and the production of healthcare knowledge are increasingly dependent on highly functioning, multidisciplinary teams, requiring greater awareness of individuals' readiness to collaborate in translational science teams. Yet, there is no comprehensive tool of individual motivations and threats to collaboration that can guide preparation of individuals for work on well-functioning teams. This prospective pilot study evaluated the preliminary psychometric properties of the Motivation Assessment for Team Readiness, Integration, and Collaboration (MATRICx). We examined 55 items of the MATRICx in a sample of 125 faculty, students and researchers, using contemporary psychometric methods (Rasch analysis). We found that the motivator and threat items formed separate constructs relative to collaboration readiness. Further, respondents who identified themselves as inexperienced at working on collaborative projects defined the motivation construct differently from experienced respondents. These results are consistent with differences in strategic alliances described in the literature-for example, inexperienced respondents reflected features of cooperation and coordination, such as concern with sharing information and compatibility of goals. In contrast, the more experienced respondents were concerned with issues that reflected a collective purpose, more typical of collaborative alliances. While these different types of alliances are usually described as representing varying aspects along a continuum, our findings suggest that collaboration might be better thought of as a qualitatively different state than cooperation or coordination. These results need to be replicated in larger samples, but the findings have implications for the development and design of educational interventions that aim to ready scientists and clinicians for greater interdisciplinary work.

As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection.

Health care systems are prioritizing the quality of outcomes over the quantity of services provided, and health care payers and other stakeholders are focusing on preventing hospital readmissions. This priority supports the effort to reduce the cost of health care by avoiding the most expensive care type and improving the quality of health care by promoting sustained return to the community and remaining in the community. Occupational therapy practitioners have expertise that is critically important in this effort. Occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmissions if they are not addressed. By addressing activities of daily living, instrumental activities of daily living, functional cognition, psychosocial needs, vision, fear of falling, and safety, occupational therapy practitioners can be a valuable addition to the effort to keep people out of the hospital and participating in their lives. This article reviews the literature supporting the role of occupational therapy in each of these key areas. T he Quadruple Aim is the new normal in health and health care. Organizations across the country now support the four noble goals of reducing health care costs, improving the patient experience, improving the health of people, and preventing practitioner burnout (Rathert et al., 2018). Addressing the first three of these goals (known collectively as the Triple Aim) is challenging, especially given the fragmented systems and payers in the United States. Although no single way to measure progress exists in these areas, hospital readmission rates are often used as a proxy for overall care. Occupational therapy has an extremely important role to play in preventing readmissions to hospitals and promoting optimal participation in the community. National Trends and Policies Influencing Quality Measure Reporting The Patient Protection and Affordable Care Act (ACA; Pub. L. 111-148) has moved Medicare providers to a world of accountability and quality (Lowell & Bertko, 2010). One provision affecting acute care hospitals is § 3025, the Hospital Readmission Reduction program, which was implemented initially as part of the fiscal year 2012 inpatient prospective payment system final rule (Centers for Medicare and Medicaid Services, 2011). In addition, § 3026 of the ACA describes the Community Care Transitions program, which provides funds for implementation of evidence-based care transition interventions for adults at risk for readmissions. More recently, quality measures for readmissions have been added through the value-based purchasing program in postacute care settings. These quality measures compare facilities on the basis of the risk-adjusted number of readmissions to the hospital after discharge. The best performing facilities receive bonus (upward adjusted) payments that are balanced by worst performing facilities receiving penalty (downward adjusted) payments. Skilled nursing facilities saw the first bonus and penalty payments in ...