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Purpose. Clinical practice guidelines establish that occupational therapy (OT) services are indicated for people with early Parkinson’s disease (PD). However, OT is uncommon compared to other rehabilitation services. This study describes the development and evaluation of a proactive, consultative OT program for people with early PD as a part of an integrated care approach. Materials and Methods. The program was developed by an occupational therapist adapting practice guidelines for people with early PD. Retrospective program evaluation occurred at an outpatient rehabilitation clinic. The consultative OT program for early PD includes a 90-minute evaluation with instruction in self-management techniques, individually tailored exercises, and follow-up recommendations. The program was evaluated with the RE-AIM framework. Postprogram semistructured interviews provided patient-reported program effectiveness and satisfaction. Results. In 2018, 23 individuals used OT out of 77 people with early PD who attended the proactive rehabilitation program. Most individuals (n = 16, 69.6%) were within Hoehn and Yahr stages 1-2 and were seen within 3 years of PD diagnosis. Participants presented with deficits in hand strength (60.0 ± 23.4 pounds) and dexterity (right hand 30.0 ± 8.0 seconds) and reported complaints about basic and/or instrumental activities of daily living (n = 15, 65.2%). Semistructured interviews (n = 16) revealed that most individuals (75%) reported high satisfaction. Of the 10 who recalled a home exercise program, 60% reported continued adherence. Consultative OT was delivered with fidelity in 22/23 individuals (96%). After one year, only two occupational therapists at one clinic had adopted the program, and the program is maintained in the organization. Conclusion. Occupational therapists reached people in the early stages of PD when a specific program was tailored to evaluate and target their specific needs. Motor activity deficits noted in individuals with early PD support future scaling and sustainability efforts of OT within this population. Quality improvement suggestions are discussed for future implementation and clinical trials.

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nism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial showed that tolvaptan, combined with standard therapy, improved many heart failure signs and symptoms without serious adverse events. This study evaluated the hospital resource utilization associated with tolvaptan usage among heart failure (HF) patients with hyponatremia based on the EVEREST trial. METHODS: A cost offset model was constructed to evaluate the impact of tolvaptan on hospital resource utilization among HF patients. The Healthcare Cost and Utilization Project (HCUP) 2008 Nationwide Inpatient Sample (NIS) database was used to estimate hospitalization length of stay (LOS) and hospital cost, for HF-associated diagnosis related group hospitalizations (DRG) of adult patients (age Ն18 years). EVEREST trial data for patients with hyponatremia were used to estimate the reduction of LOS associated with tolvaptan vs. placebo. RESULTS: Among EVEREST trial HF patients with hyponatremia (Ͻ135 mEq/L), tolvaptan patients had a shorter hospitalization LOS than placebo patients (9.72 vs. 11.44 days, respectively), with a relative LOS reduction of 15%. 933,189 HF-associated DRG hospitalizations were identified from the HCUP NIS database. The mean LOS was 4.8 days with mean total hospital costs of $7,545, and mean daily hospital costs of $1,562. Using an inpatient tolvaptan treatment duration of 3 days with a daily wholesale acquisition cost of $250, the cost offset model estimated a LOS reduction among US HF hospitalizations of 0.73 days with a hospital cost reduction averaging $1,134 per HF admission. The cost neutral breakeven mean duration of tolvaptan inpatient therapy is 4.54 days. CONCLUSIONS: Based on the EVEREST trial, tolvaptan is associated with a shorter hospitalization LOS than placebo among hyponatremic HF patients, resulting in an estimated mean hospital cost reduction of $1,134 per admission in the US. PCV38