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Inpatient Geriatric Rehabilitation: Definitions and Appropriate Admission Criteria, as Established by Maltese National Experts. J Clin Med 2022; 11:jcm11237230. [PMID: 36498804 PMCID: PMC9736396 DOI: 10.3390/jcm11237230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/30/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Background: The importance of having an appropriate admissions system for geriatric rehabilitation is on the increase. However, the process of admitting patients to inpatient rehabilitation is a complex process. This is yet to be standardised across the European Union, as the approach to geriatric rehabilitation tends to vary from one Member State to another. (2) Objective: To discuss evidence-based practice with clinical experts, in order to define geriatric rehabilitation and admission criteria based on the Maltese population. (3) Method: The study entailed conducting four panel sessions using a purposive sample of thirteen local clinicians with extensive knowledge in clinical rehabilitation and healthcare management. A total of 48 items, based on the literature and clinical experience, were presented to the panel. Data analysis was done quantitatively and qualitatively, using IBM SPSS Statistics Version 24 and thematic analysis. (4) Results: The panel formulated a definition of rehabilitation, which shared common elements with the definition provided by the World Health Organization (WHO) and other sources/literature. The panel agreed on a list of eight criteria for appropriate inpatient geriatric rehabilitation admission in Malta. Consensus was also reached on: the need for a consultant-led multidisciplinary approach to assessment; the adoption of a standardised assessment processes for an equitable chance for all older adults assessed; the benefit of digital health in assessments; and the consideration that most patients would have some form of rehabilitation potential, depending on availability of resources. (5) Conclusion: Inpatient geriatric rehabilitation hospitals should have a unified strategy for rehabilitation services. The conclusions reached by the panel, could be useful in supporting the clinical evidence and establishing future rehabilitation guidelines and standards for inpatient rehabilitation.
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Merlo A, Rodà F, Carnevali D, Principi N, Grimoldi L, Auxilia F, Lombardi F, Maini M, Brianti R, Castaldi S. Appropriateness of admission to rehabilitation: definition of a set of criteria and rules through the application of the Delphi method. Eur J Phys Rehabil Med 2020; 56:537-546. [PMID: 32667147 DOI: 10.23736/s1973-9087.20.06148-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Controlling inappropriateness of care is an essential issue, especially in rehabilitation medicine. In fact, admitting a patient to a rehabilitation hospital or unit is a complex decision also due to the absence of shared and objective admission criteria. AIM The aim was to define clinical admission criteria and rules in rehabilitation medicine. DESIGN Survey based on the application of the Delphi method on a sample of rehabilitation medicine experts. SETTING Administration of electronic online questionnaires concerning appropriateness of admission to intensive rehabilitation. POPULATION Volunteer sample of 53 experts with the following inclusion criteria: being members of the Italian Society of Physical and Rehabilitation Medicine, having practical experience in the research field, agreeing to the confidentiality of the information and being skilled in both rehabilitation and healthcare organization. METHODS A three-round Delphi survey was conducted according to international guidelines. The two initial rounds consisted of an electronic online questionnaire while in the third one a report of the results was provided to the participants. The experts had to score their agreement with each item in the questionnaires, based on either a Likert scale or a dichotomous statement. Consensus between the experts was assessed. RESULTS A total of 53 health professionals completed the Delphi survey. 19 out of 20 Italian regions were represented. The first round consisted of 8 multiple-choice questions. The second round was designed according to the suggestions provided by the panelists in the previous one and consisted of a twelve items questionnaire. At the end of the survey, seven criteria of appropriateness of admission to rehabilitation were identified and five rules defining an appropriate admission to a rehabilitation facility were elaborated. CONCLUSIONS This study represents an attempt to create a worthwhile and reliable tool for a more conscious clinical practice in admission to rehabilitation, based on a set of shared criteria and rules. CLINICAL REHABILITATION IMPACT To increase appropriateness of admission to rehabilitation. Improving appropriateness in healthcare delivery must be a primary goal in order to improve healthcare quality, save money and ensure system sustainability.
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Affiliation(s)
- Andrea Merlo
- LAM-Motion Analysis Laboratory, Department of Neuromotor and Rehabilitation, San Sebastiano di Correggio Hospital, USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy.,Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy.,Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Rimini, Italy
| | - Francesca Rodà
- Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Italy
| | - Davide Carnevali
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy -
| | - Niccolò Principi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Ludovico Grimoldi
- Postgraduate School in Public Health, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Francesco Auxilia
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
| | - Francesco Lombardi
- Unit of Neurorehabilitation, Department of Neuromotor and Rehabilitation, San Sebastiano di Correggio Hospital, USL-IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Rodolfo Brianti
- Rehabilitation Medicine Service, Department of Rehabilitation Geriatrics, NHS-University Hospital of Parma, Parma, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.,Maggiore Polyclinic Hospital, IRCCS Ca' Granda Foundation, Milan, Italy
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Gledhill K, Hanna L, Nicks R, Lannin NA. Defining discharge-readiness from subacute care from all stakeholders' perspectives: a systematic review. Disabil Rehabil 2020; 43:3127-3134. [PMID: 32126189 DOI: 10.1080/09638288.2020.1733107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Research to date has focused on clinicians' views on patients' discharge readiness from acute hospital settings.This study aims to synthesise the literature on discharge readiness from sub-acute (rehabilitation) hospital settings from all stakeholders' perspectives.Methods: Electronic databases (MEDLINE, CINAHL, Ageline, AMED and Global Health) were systematically searched for post-2000 publications on discharge readiness of adult inpatients in sub-acute settings. After screening, quantitative and qualitative studies were assessed for bias using the Downs and Black checklist and McMaster critical assessment tool respectively, and narrative analysis conducted.Results: From the 3516 papers identified, 23 were included in the review. Overall quality of articles was rated as adequate. Narrative synthesis identified three main themes: the importance of functional outcomes; confounding factors impact on discharge destination and length of stay and barriers and facilitators to discharge.Conclusion: Despite limited literature defining sub-acute patients' discharge-readiness from all stakeholders' perspectives, synthesis of available findings identified major themes for consideration when determining when a patient is ready to leave hospital. Limitations include the heterogeneity of the studies located impacted on data extraction and quality appraisal.IMPLICATIONS FOR REHABILITATIONDischarging patients from hospital is complex, discharge too early may lead to poor medical outcomes or readmission, while discharge too late may increase the risk of hospital-based adverse events.Multiple factors need to be considered when considering the discharge readiness of an inpatient.Ensuring adequate social support is key to maximising transition from hospital to home.Combining the use of functional outcome measures with clinical decision-making allows for quantifying readiness for discharge.
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Affiliation(s)
- Kate Gledhill
- School of Health and Social Development, Deakin University, Melbourne, Australia.,Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Lisa Hanna
- School of Health and Social Development, Deakin University, Melbourne, Australia
| | | | - Natasha A Lannin
- Department of Clinical Neuroscience, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health, Melbourne, Australia
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Hall AJ, Fullam J, Lang IA, Endacott R, Goodwin VA. Community physiotherapy for people with dementia following hip fracture: Fact or fiction? A qualitative study. DEMENTIA 2019; 19:2750-2760. [DOI: 10.1177/1471301219857027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Physiotherapy is a core component of rehabilitation following a hip fracture. Approximately 40% of people sustaining a hip fracture will have dementia, but there is little evidence to guide physiotherapy interventions in this population. Objective This study forms part of a process evaluation seeking to explore reasons why people with dementia were not referred for physiotherapy following a hip fracture and challenges that are faced treating these people in the community. Methods We undertook a series of structured focus groups and interviews with physiotherapists based in community-rehabilitation services in the South West of England. Qualitative data sought to explain reasons why people with dementia were not being referred for onward physiotherapy following discharge from the acute setting after hip fracture. Framework analysis was used to make sense of the data. Results Four focus groups and interviews were undertaken with physiotherapists and assistants working in community settings. Three main themes were determined – beliefs, the importance of pathways of care and the effect of resources on decision making. Discussion Out data suggest that people with dementia were often labelled as having ‘no rehabilitation potential’ in the acute setting and this excluded them from receiving ongoing therapy in the community setting. It was also suggested that physiotherapists were judging this potential using biomedical measures of outcome which fails to recognise the importance of person centred care for this population. Conclusion There was suggestion of therapeutic nihilism when considering rehabilitation for this population, whereby it is assumed that people with dementia cannot be rehabilitated, so they are not given the opportunity. It is unsurprising that outcomes for this population are poor considering the reluctance to provide physiotherapy to people with dementia following hip fracture.
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Affiliation(s)
| | | | - Iain A Lang
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Ruth Endacott
- School of Nursing and Midwifery, Faculty of Health & Human Sciences, Plymouth University, Plymouth, UK
| | - Victoria A Goodwin
- NIHR CLAHRC South West Peninsula, University of Exeter Medical School, Exeter, UK
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Sheehan KJ, Smith TO, Martin FC, Johansen A, Drummond A, Beaupre L, Magaziner J, Whitney J, Hommel A, Cameron ID, Price I, Sackley C. Conceptual Framework for an Episode of Rehabilitative Care After Surgical Repair of Hip Fracture. Phys Ther 2019; 99:276-285. [PMID: 30690532 PMCID: PMC8055063 DOI: 10.1093/ptj/pzy145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 08/24/2018] [Indexed: 12/23/2022]
Abstract
Researchers face a challenge when evaluating the effectiveness of rehabilitation after a surgical procedure for hip fracture. Reported outcomes of rehabilitation will vary depending on the end point of the episode of care. Evaluation at an inappropriate end point might suggest a lack of effectiveness leading to the underuse of rehabilitation that could improve outcomes. The purpose of this article is to describe a conceptual framework for a continuum-care episode of rehabilitation after a surgical procedure for hip fracture. Definitions are proposed for the index event, end point, and service scope of the episode. Challenges in defining the episode of care and operationalizing the episode, and next steps for researchers are discussed. The episode described is intended to apply to all patients eligible for entry to rehabilitation after hip fracture and includes most functional recovery end points. This framework will provide a guide for rehabilitation researchers when designing and interpreting evaluations of the effectiveness of rehabilitation after hip fracture. Evaluation of all potential care episodes facilitates transparency in reporting of outcomes, enabling researchers to determine the true effectiveness of rehabilitation after a surgical procedure for hip fracture.
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Affiliation(s)
- Katie J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London, London SE1 1UL, United Kingdom,Please address all correspondence to Dr Sheehan at:
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Antony Johansen
- Trauma Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Lauren Beaupre
- Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Edmonton, Canada
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Julie Whitney
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London
| | - Ami Hommel
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Iona Price
- Royal College of Physicians Patient and Carer Network, London, United Kingdom
| | - Catherine Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King's College London
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Sarkies MN, White J, Henderson K, Haas R, Bowles J. Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. J Physiother 2018; 64:142-158. [PMID: 29929739 DOI: 10.1016/j.jphys.2018.05.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/01/2018] [Accepted: 05/11/2018] [Indexed: 12/29/2022] Open
Abstract
QUESTION Are additional weekend allied health services effective and cost-effective for acute general medical and surgical wards, and subacute rehabilitation hospital wards? DESIGN Systematic review and meta-analysis of studies published between January 2000 and May 2017. Two reviewers independently screened studies for inclusion, extracted data, and assessed methodological quality. Meta-analyses were conducted for relative measures of effect estimates. PARTICIPANTS Patients admitted to acute general medical and surgical wards, and subacute rehabilitation wards. INTERVENTION All services delivered by allied health professionals during weekends (Saturday and/or Sunday). This study limited allied health professions to: occupational therapy, physiotherapy, social work, speech pathology, dietetics, art therapy, chiropractic, exercise physiology, music therapy, oral health (not dentistry), osteopathy, podiatry, psychology, and allied health assistants. OUTCOME MEASURES Hospital length of stay, hospital re-admission, adverse events, discharge destination, functional independence, health-related quality of life, and cost of hospital care. RESULTS Nineteen articles (20 studies) were identified, comprising 10 randomised and 10 non-randomised trials. Physiotherapy was the most commonly investigated profession. A meta-analysis of randomised, controlled trials showed that providing additional weekend allied health services in subacute rehabilitation wards reduced hospital length of stay by 2.35days (95% CI 0.45 to 4.24, I2=0%), and may be a cost-effective way to improve function (SMD 0.09, 95% CI -0.01 to 0.19, I2=0%), and health-related quality of life (SMD 0.10, 95% CI -0.01 to 0.20, I2=0%). For acute general medical and surgical hospital wards, it was unclear whether the weekend allied health service model provided in the two identified randomised trials led to significant changes in measured outcomes. CONCLUSION The benefit of providing additional allied health services is clearer in subacute rehabilitation settings than for acute general medical and surgical wards in hospitals. REGISTRATION PROSPERO CRD76771. [Sarkies MN, White J, Henderson K, Haas R, Bowles J, Evidence Translation in Allied Health (EviTAH) Group (2018) Additional weekend allied health services reduce length of stay in subacute rehabilitation wards but their effectiveness and cost-effectiveness are unclear in acute general medical and surgical hospital wards: a systematic review. Journal of Physiotherapy 64: 142-158].
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Affiliation(s)
| | | | | | - Romi Haas
- Department of Physiotherapy, Monash University
| | - John Bowles
- Allied Health Research Unit, Monash University, Melbourne, Australia
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Kimmel LA, Holland AE, Hart MJ, Edwards ER, Page RS, Hau R, Bucknill A, Gabbe BJ. Discharge from the acute hospital: trauma patients' perceptions of care. AUST HEALTH REV 2018; 40:625-632. [PMID: 26910554 DOI: 10.1071/ah15148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/12/2016] [Indexed: 11/23/2022]
Abstract
Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.
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Affiliation(s)
- Lara A Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Anne E Holland
- The Alfred, Commercial Road, Melbourne, Vic. 3004, Australia. Email
| | - Melissa J Hart
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Richard S Page
- Barwon Health and St John of God, Geelong, Vic. 3220, Australia
| | - Raphael Hau
- Northern Hospital, 185 Cooper Street, Epping,Melbourne, Vic. 3076, Australia. Email
| | - Andrew Bucknill
- Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia. Email
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
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Kimmel LA, Holland AE, Lannin N, Edwards ER, Page RS, Bucknill A, Hau R, Gabbe BJ. Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma. AUST HEALTH REV 2017; 41:192-200. [PMID: 27144728 DOI: 10.1071/ah16031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.
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Affiliation(s)
- Lara A Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
| | - Anne E Holland
- School of Allied Health, La Trobe University, Vic. 3086, Australia.
| | - Natasha Lannin
- School of Allied Health, La Trobe University, Vic. 3086, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
| | - Richard S Page
- Department of Orthopaedics, Barwon Health and St John of God, Geelong, Vic. 3220, Australia. Email
| | - Andrew Bucknill
- Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia. Email
| | - Raphael Hau
- Department of Orthopaedics, Northern Hospital, Epping, Vic. 3076, Australia. Email
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
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Roda F, Agosti M, Merlo A, Maini M, Lombardi F, Tedeschi C, Benedetti MG, Basaglia N, Contini M, Nicolotti D, Brianti R. Psychometric validation of the Italian Rehabilitation Complexity Scale-Extended version 13. PLoS One 2017; 12:e0178453. [PMID: 29045409 PMCID: PMC5646770 DOI: 10.1371/journal.pone.0178453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/12/2017] [Indexed: 11/18/2022] Open
Abstract
In Italy, at present, a well-known problem is inhomogeneous provision of rehabilitative services, as stressed by MoH, requiring appropriate criteria and parameters to plan rehabilitation actions. According to the Italian National Rehabilitation Plan, Comorbidity, Disability and Clinical Complexity should be assessed to define the patient's real needs. However, to date, clinical complexity is still difficult to measure with shared and validated tools. The study aims to psychometrically validate the Italian Rehabilitation Complexity Scale-Extended v13 (RCS-E v13), in order to meet the guidelines requirements. An observational multicentre prospective cohort study, involving 8 intensive rehabilitation facilities of the Emilia-Romagna Region and 1712 in-patients, [823 male (48%) and 889 female (52%), mean age 68.34 years (95% CI 67.69-69.00 years)] showing neurological, orthopaedic and cardiological problems, was carried out. The construct and concurrent validity of the RCS-E v13 was confirmed through its correlation to Barthel Index (disability) and Cumulative Illness Rating Scale (comorbidity) and appropriate admission criteria (not yet published), respectively. Furthermore, the factor analysis indicated two different components ("Basic Care or Risk-Equipment" and "Medical-Nursing Needs and Therapy Disciplines") of the RCS-E v13. In conclusion, the Italian RCS-E v13 appears to be a useful tool to assess clinical complexity in the Italian rehab scenario case-mix and its psychometric validation may have an important clinical rehabilitation impact allowing the assessment of the rehabilitation needs considering all three dimensions (disability, comorbidity and clinical complexity) as required by the Guidelines and the inhomogeneity could be reduced.
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Affiliation(s)
- Francesca Roda
- Department of Medicine and Surgery, Unit of Neuroscience, University of Parma, Parma, Italy
| | - Maurizio Agosti
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS-University Hospital of Parma, Parma, Italy
| | - Andrea Merlo
- Motion Analysis Laboratory, Department of Rehabilitation, "S. Sebastiano" Hospital of Correggio, NHS Local Agency of Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Maini
- “San Giacomo” Hospital, Ponte dell’Olio, Piacenza, Italy
| | - Francesco Lombardi
- Neurorehabilitation Service, "S. Sebastiano" Hospital of Correggio, NHS Local Agency of Reggio Emilia, Reggio Emilia, Italy
| | - Claudio Tedeschi
- Physical medicine and Rehabilitation Unit – Neuromotor Department, IRCCS "Arcispedale Santa Maria Nuova" of Reggio Emilia, Reggio Emilia, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, “Rizzoli” Orthopaedics Hospital, Bologna, Italy
| | - Nino Basaglia
- Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Mara Contini
- Extensive Orthopaedic Rehabilitation Unit, Department of Medicine, Borgo Val Di Taro Hospital, NHS Local Agency of Parma, Parma, Italy
| | - Domenico Nicolotti
- Intensive Rehabilitation Medicine Spinal Unit, Emergency Medicine Department, Villanova d’Arda Hospital, NHS Local Agency of Piacenza, Piacenza, Italy
| | - Rodolfo Brianti
- Rehabilitation Medicine Service, Rehabilitation Geriatrics Department of the NHS-University Hospital of Parma, Parma, Italy
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Qureshi AZ, Jenkins RM, Williamson LF. The Broken Link: Admission Criteria for Inpatient Rehabilitation and Some Common Misconceptions. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2016; 4:233-237. [PMID: 30787738 PMCID: PMC6298344 DOI: 10.4103/1658-631x.188257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Ahmad Z Qureshi
- Departments of Physical Medicine and Rehabilitation, Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, North Carolina 27157, USA
| | - Randolph M Jenkins
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA
| | - Laneita F Williamson
- Wake Forest Baptist Medical Center, Wake Forest University, Winston-Salem, North Carolina 27157, USA
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Earl BJ, Lazzarini PA, Kinnear EM, Cornwell PL. Prevalence of active foot disease and foot disease risk factors in a subacute inpatient rehabilitation facility: a cross-sectional prevalence study. J Foot Ankle Res 2014; 7:41. [PMID: 25328541 PMCID: PMC4200129 DOI: 10.1186/s13047-014-0041-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 10/02/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Australian subacute inpatient rehabilitation facilities face significant challenges from the ageing population and the increasing burden of chronic disease. Foot disease complications are a negative consequence of many chronic diseases. With the rapid expansion of subacute rehabilitation inpatient services, it seems imperative to investigate the prevalence of foot disease and foot disease risk factors in this population. The primary aim of this cross-sectional study was to determine the prevalence of active foot disease and foot disease risk factors in a subacute inpatient rehabilitation facility. METHODS Eligible participants were all adults admitted at least overnight into a large Australian subacute inpatient rehabilitation facility over two different four week periods. Consenting participants underwent a short non-invasive foot examination by a podiatrist utilising the validated Queensland Health High Risk Foot Form to collect data on age, sex, medical co-morbidity history, foot disease risk factor history and clinically diagnosed foot disease complications and foot disease risk factors. Descriptive statistics were used to determine the prevalence of clinically diagnosed foot disease complications, foot disease risk factors and groups of foot disease risk factors. Logistic regression analyses were used to investigate any associations between defined explanatory variables and appropriate foot disease outcome variables. RESULTS Overall, 85 (88%) of 97 people admitted to the facility during the study periods consented; mean age 80 (±9) years and 71% were female. The prevalence (95% confidence interval) of participants with active foot disease was 11.8% (6.3 - 20.5), 32.9% (23.9 - 43.5) had multiple foot disease risk factors, and overall, 56.5% (45.9 - 66.5) had at least one foot disease risk factor. A self-reported history of peripheral neuropathy diagnosis was independently associated with having multiple foot disease risk factors (OR 13.504, p = 0.001). CONCLUSION This study highlights the potential significance of the burden of foot disease in subacute inpatient rehabilitation facilities. One in eight subacute inpatients were admitted with active foot disease and one in two with at least one foot disease risk factor in this study. It is recommended that further multi-site studies and management guidelines are required to address the foot disease burden in subacute inpatient rehabilitation facilities.
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Affiliation(s)
- Brenton J Earl
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
- />School of Medicine, Flinders University, Adelaide, South Australia 5001 Australia
| | - Peter A Lazzarini
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
- />Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland 4032 Australia
- />School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland 4059 Australia
| | - Ewan M Kinnear
- />Department of Podiatry, Metro North Hospital and Health Service, Queensland Health, Brisbane, Queensland 4032 Australia
| | - Petrea L Cornwell
- />Allied Health Research Collaborative, Metro North Hospital and Health Service, Queensland Health, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Queensland 4032 Australia
- />Griffith Health Institute, Behavioural Basis of Health, Griffith University, Brisbane, Queensland 4122 Australia
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Considine J, Mohr M, Lourenco R, Cooke R, Aitken M. Characteristics and outcomes of patients requiring unplanned transfer from subacute to acute care. Int J Nurs Pract 2013; 19:186-96. [DOI: 10.1111/ijn.12056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Julie Considine
- School of Nursing and MidwiferyDeakin University Victoria Australia
| | - Marie Mohr
- Broadmeadows Health ServiceNorthern Health Victoria Australia
| | | | - Robynne Cooke
- Medical and Continuing Care ServicesNorthern Health Victoria Australia
| | - Mark Aitken
- Bundoora Extended Care CentreNorthern Health Victoria Australia
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New PW, Cameron PA, Olver JH, Stoelwinder JU. Defining Barriers to Discharge From Inpatient Rehabilitation, Classifying Their Causes, and Proposed Performance Indicators for Rehabilitation Patient Flow. Arch Phys Med Rehabil 2013; 94:201-8. [DOI: 10.1016/j.apmr.2012.07.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/30/2012] [Accepted: 07/30/2012] [Indexed: 10/28/2022]
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Determining level of care appropriateness in the patient journey from acute care to rehabilitation. BMC Health Serv Res 2011; 11:291. [PMID: 22040281 PMCID: PMC3212985 DOI: 10.1186/1472-6963-11-291] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022] Open
Abstract
Background The selection of patients for rehabilitation, and the timing of transfer from acute care, are important clinical decisions that impact on care quality and patient flow. This paper reports utilization review data on inpatients in acute care with stroke, hip fracture or elective joint replacement, and other inpatients referred for rehabilitation. It examines reasons why acute level of care criteria are not met and explores differences in decision making between acute care and rehabilitation teams around patient appropriateness and readiness for transfer. Methods Cohort study of patients in a large acute referral hospital in Australia followed with the InterQual utilization review tool, modified to also include reasons why utilization criteria are not met. Additional data on team decision making about appropriateness for rehabilitation, and readiness for transfer, were collected on a subset of patients. Results There were 696 episodes of care (7189 bed days). Days meeting acute level of care criteria were 56% (stroke, hip fracture and joint replacement patients) and 33% (other patients, from the time of referral). Most inappropriate days in acute care were due to delays in processes/scheduling (45%) or being more appropriate for rehabilitation or lower level of care (30%). On the subset of patients, the acute care team and the utilization review tool deemed patients ready for rehabilitation transfer earlier than the rehabilitation team (means of 1.4, 1.3 and 4.0 days from the date of referral, respectively). From when deemed medically stable for transfer by the acute care team, 28% of patients became unstable. From when deemed stable by the rehabilitation team or utilization review, 9% and 11%, respectively, became unstable. Conclusions A high proportion of patient days did not meet acute level of care criteria, due predominantly to inefficiencies in care processes, or to patients being more appropriate for an alternative level of care, including rehabilitation. The rehabilitation team was the most accurate in determining ongoing medical stability, but at the cost of a longer acute stay. To avoid inpatients remaining in acute care in a state of 'terra nullius', clinical models which provide rehabilitation within acute care, and more efficient movement to a rehabilitation setting, is required. Utilization review could have a decision support role in the determination of medical stability.
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Wong ELY, Yam CHK, Chan FWK, Cheung AWL, Wong FYY, Griffiths S, Yeoh EK. Perspective from health professionals on delivery of sub-acute care in Hong Kong: a qualitative study in a health system. Health Policy 2010; 100:211-8. [PMID: 21109327 DOI: 10.1016/j.healthpol.2010.10.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2010] [Revised: 10/29/2010] [Accepted: 10/31/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The perception and understanding of health professionals of the role of sub-acute care in the health system will have an impact on the potential effectiveness in preventing unnecessary hospitalization. This study aims to explore the perceived role and quality of sub-acute care services in the context of Hong Kong from the perspective of health service providers and to identify barriers to effectiveness. METHODS Seven focus groups were conducted and the discussion was led by a guide covering three main areas: definition/component/role of sub-acute, difficulties in the sub-acute care services provision, and suggestion for further improvement in the provision of sub-acute care. RESULTS The participants highlighted the positive role of sub-acute to promote patient's health and quality of life so as to reduce unnecessary hospitalization. The potential barriers in the sub-acute care identified were interrelated and focused mainly on systemic issues including lack of service coordination, specialist input and resources. The participants also suggested a number of practical ways to improve the quality of sub-acute care services. CONCLUSIONS The findings showed a need for further improvement in the process of sub-acute care by developing operation guideline and re-evaluating the allocation of resources to support the sub-acute care provision.
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Affiliation(s)
- Eliza L Y Wong
- Division of Health Systems, Policy and Management, School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Bérard É, Chougrani M, Tasseau F. An evaluation of a post-acute rehabilitation unit after five years of operations. Ann Phys Rehabil Med 2010; 53:457-73. [DOI: 10.1016/j.rehab.2010.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 07/08/2010] [Indexed: 11/16/2022]
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Hammond CL, Pinnington LL, Phillips MF. A qualitative examination of inappropriate hospital admissions and lengths of stay. BMC Health Serv Res 2009; 9:44. [PMID: 19265547 PMCID: PMC2655293 DOI: 10.1186/1472-6963-9-44] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 03/05/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. METHODS Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. RESULTS The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. CONCLUSION Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed.
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Affiliation(s)
- Christina L Hammond
- Rehabilitation Research and Education Group, School of Community Health Sciences, University of Nottingham, Derby, UK
| | - Lorraine L Pinnington
- Rehabilitation Research and Education Group, School of Graduate Entry Medicine & Health, University of Nottingham, Derby, UK
| | - Margaret F Phillips
- Rehabilitation Research and Education Group, School of Graduate Entry Medicine & Health, University of Nottingham, Derby, UK
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New PW, Poulos CJ. Functional improvement of the Australian health care system - can rehabilitation assist? Med J Aust 2008; 189:340-3. [PMID: 18803542 DOI: 10.5694/j.1326-5377.2008.tb02058.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Accepted: 05/27/2008] [Indexed: 11/17/2022]
Abstract
Strategies for managing increasing health system demand have focused on the acute sector and chronic disease management in the community, with little attention on the role of rehabilitation. There were over 53 000 inpatient rehabilitation episodes in Australia in 2006. We argue that rehabilitation can improve patient flow and outcomes in acute care if engaged early. The effectiveness of rehabilitation can be enhanced by increasing the intensity of therapy and developing models of rehabilitation that provide alternatives to inpatient care. Factors that reduce the efficiency of rehabilitation services include the location of many services in small, stand-alone hospitals without acute support; the lack of options for managing younger people with acquired disability in the community; and deficiencies in government programs for the supply of aids, equipment and home modifications. Improving the organisation of rehabilitation services should improve access to acute and rehabilitation inpatient beds, improve patient outcomes and reduce costs.
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Affiliation(s)
- Peter W New
- Continuing Care Program, Southern Health, Melbourne, VIC, Australia.
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