Rehabilitation

Improving recovery, rehabilitation and reablement services – NHS Improving Quality – 11 July 2014

Posted on July 15, 2014. Filed under: Rehabilitation |

Improving recovery, rehabilitation and reablement services – NHS Improving Quality – 11 July 2014

More detail

“Working in partnership with Col John Etherington, National Clinical Director for Rehabilitation and Recovery in the Community and Shelagh Morris, Acting Chief Allied Health Professions Officer, NHS Improving Quality has supported NHS England in developing its programme of work to improve rehabilitation services.

This builds on an earlier review of adult rehabilitation services by NHS England which found that, while there are areas of good practice, there is variation in service provision and a lack of understanding amongst referrers, clinicians and people using the services of what is actually available to them.

NHS Improving Quality undertook a scoping exercise of rehabilitation services, which included:

Identification of the different practice models illustrated through case studies looking at integrated models of adult rehabilitation service provision
A high level baseline mapping exercise of the current availability of adult rehabilitation services across England.

NHS Improving Quality also assisted in capturing the views from key stakeholders by supporting and facilitating a series of stakeholder engagement events hosted by NHS England.These events aimed to develop and agree principles and expectations to underpin high quality rehabilitation services.

The work undertaken by NHS Improving Quality will inform NHS England’s ongoing work programme to improve rehabilitation services across England.

Publications and resources

Improving Adult Rehabilitation Services in England: Sharing best practice in acute and community care

Improving Adult Rehabilitation Services Communities of Practice NHS Networks

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New Zealand Spinal Cord Impairment Action Plan 2014–2019 – Ministry of Health – 3 July 2014

Posted on July 11, 2014. Filed under: Rehabilitation |

New Zealand Spinal Cord Impairment Action Plan 2014–2019 – Ministry of Health – 3 July 2014

“Summary

The Action Plan outlines a vision, purpose, priorities and eight overarching objectives to help ensure the best possible health and wellbeing outcomes for people with spinal cord impairment (SCI), enhancing their quality of life and ability to participate in society.

Each year there are around 130 to 180 people diagnosed with SCI in New Zealand, with 80 to 130 receiving specialist acute SCI services in both ACC and health settings. There are currently around 1500 people with SCI resulting from an injury that are managed by ACC and less than 1000 people with a medical or congenital diagnosis of SCI who may be receiving supports from Disability Support Services.

SCI affects the lives of those who are diagnosed with it, but also many others, especially their families and whānau. It can happen at any age and, due to medical advancements, most people living with SCI now have a near normal life expectancy, but this brings with it progressive complexity for people and their lifelong self-management.

In March 2012, ACC and the Ministry of Health jointly led a project to review New Zealand’s SCI services and develop a national implementation plan for improving them.

ACC and the Ministry of Health worked collaboratively with a wide range of stakeholders, including clinicians, management, community representatives and people with SCI across the service continuum to develop the SCI Action Plan. A high level of engagement and support was received through the process.”

 

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Examining the effectiveness and cost-effectiveness of rehabilitation-care models for frail seniors – McMaster University Health Forum Issue Brief – 30 September 2013

Posted on January 30, 2014. Filed under: Aged Care / Geriatrics, Health Economics, Rehabilitation |

Examining the effectiveness and cost-effectiveness of rehabilitation-care models for frail seniors – McMaster University Health Forum Issue Brief – 30 September 2013

Wilson MG. Rapid Synthesis: Examining the Effectiveness and Cost-Effectiveness of Rehabilitationcare Models for Frail Seniors. Hamilton, Canada: McMaster Health Forum, 30 September 2013.

Extract from the key messages

“Question
How effective and cost-effective are different models of physical and occupational rehabilitation for frail seniors?

Why the issue is important
Functional difficulties significantly compromise quality of life and are associated with depression, increased frailty, long-term care home (LTCH) placement, and mortality.
Rehabilitation services to improve functional abilities are generally understood to be essential components of the bundle of services that should be made available to seniors to help them live in their own homes for as long as possible.
It has been recommended that Ontario adopt an ‘assess and restore’ approach to the care of all seniors that emphasizes timely access to rehabilitation and other ‘restorative care’ services as a means of avoiding or delaying LTCH placement, emergency department visits, and admissions to hospital.

What we found”

… continues on the site

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Rehabilitation Services at Hospitals – Office of the Auditor General of Ontario Value for Money Audit – 10 December 2013

Posted on December 13, 2013. Filed under: Rehabilitation |

 

Rehabilitation Services at Hospitals – Office of the Auditor General of Ontario Value for Money Audit – 10 December 2013

 

Media release: Lack of co-ordinated hospital rehab system, Auditor General says

 

“The lack of a provincially co-ordinated system for rehabilitation services means that patients may be treated differently depending on where they live in Ontario, Auditor General Bonnie Lysyk says in her 2013 Annual Report.

 

“Individual hospitals generally determine which inpatient and outpatient rehab services they will offer,” Lysyk said today after the release of the Report. “Each hospital also establishes its own policies for determining whether a patient is eligible for its services. A patient deemed eligible for services at one hospital might not be eligible for similar services at another,” she added.”

 

 

 

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The needs of stroke survivors in Australia – Stroke Foundation – 1 October 2013

Posted on October 1, 2013. Filed under: Neurology, Rehabilitation | Tags: |

The needs of stroke survivors in Australia – Stroke Foundation – 1 October 2013

“The increasing number of people surviving strokes is leading to a crisis in service provision as the health and community support systems struggle to keep pace with demand.

Decades-long lack of investment in stroke services and community support mechanisms mean more than 300,000 Australians are struggling to access the help they need for day-today activities such as dressing themselves, using the bathroom and communicating.

Meanwhile, the number of people living following a stroke is expected to almost double to more than 700,000 within the next two decades.

A new report, released today by the National Stroke Foundation, shows Australians are struggling every day due to a lack of access to essential support – a situation that is set to worsen as the number of stroke survivors grows. The report shows services are fragmented and access is dependent on where survivors live.

National Stroke Foundation Chief Executive Officer Dr Erin Lalor said the gaps in Australian stroke care, right across the stroke patient journey, were causing unnecessary pain and suffering.”

… continues on the site

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Making the case for cardiac rehabilitation: modelling potential impact on readmissions – NHS Improvement – March 2013

Posted on April 9, 2013. Filed under: Cardiol / Cardiothor Surg, Health Economics, Rehabilitation | Tags: |

Making the case for cardiac rehabilitation: modelling potential impact on readmissions – NHS Improvement – March 2013

“This report summarises the findings of a short study, commissioned by NHS Improvement, which models the relationship between uptake of CR and unplanned cardiac readmission rates both nationally and at commissioner level.

The primary purpose of the study was to examine the Quality, Innovation, Productivity and Prevention (QIPP) potential of CR and to establish whether the benefits of CR outweigh the costs in terms of the potential impact on readmissions alone.

Over and above the well-documented, positive effects of rehabilitation on mortality, morbidity and quality of life, the results suggest that increasing the uptake of ’gold standard’ CR has the potential to reduce cardiac-related readmissions and deliver significant financial savings.”

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Making the case for cardiac rehabilitation: modelling potential impact on readmissions – NHS Improvement – March 2013

Posted on March 20, 2013. Filed under: Cardiol / Cardiothor Surg, Rehabilitation | Tags: |

Making the case for cardiac rehabilitation: modelling potential impact on readmissions – NHS Improvement – March 2013

Extract

“The primary purpose of the study was to examine the Quality, Innovation, Productivity and Prevention (QIPP) potential of CR and to establish whether the benefits of CR outweigh the costs in terms of the potential impact on readmissions alone.

Over and above the well-documented, positive effects of rehabilitation on mortality, morbidity and quality of life, the results suggest that increasing the uptake of ’gold standard’ CR has the potential to reduce cardiac-related readmissions and deliver significant financial savings.”

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Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

Posted on August 2, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Rehabilitation | Tags: |

Provider-Level Risk-Adjusted Quality Measurement for Inpatient Rehabilitation Facilities – RAND – 2012

by  Andrew W. Dick,  Peter J. Huckfeldt,  Hangsheng Liu,  Hao Yu,  Ateev Mehrotra,  Susan L. Lovejoy,  J. Scott Ashwood

“Quality metrics play an increasingly important role in the evaluation and reimbursement of post-acute providers. Currently, it is difficult to ascertain whether changes in inpatient rehabilitation facility (IRF) patient outcomes are due to changes in treatment or the case mix of patients seen in IRFs. Risk adjustment, however, has the potential to improve the comparability of quality metrics both across providers and over time. This report (1) develops risk-adjusted quality metrics at the provider level for IRFs, (2) develops methods to address low case volume, and (3) uses these metrics to estimate national trends in IRF quality from 2004 to 2009. It presents the results for five IRF outcomes: (1) functional gain, (2) discharge to the community, (3) 30-day readmission to acute care given discharge to the community, (4) 30-day readmission to skilled nursing facility (SNF), given discharge to the community, and (5) discharge directly to acute care.”

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Reablement: a guide for families and carers – Social Care Institute for Excellence [UK] – March 2012

Posted on March 30, 2012. Filed under: Rehabilitation | Tags: |

Reablement: a guide for families and carers – Social Care Institute for Excellence [UK] – March 2012

“Key messages

Reablement is a short and intensive service, usually delivered in the home, which is offered to people with disabilities and those who are frail or recovering from an illness or injury.
The purpose of reablement is to help people who have experienced deterioration in their health and/or have increased support needs to relearn the skills required to keep them safe and independent at home.
People using reablement experience greater improvements in physical functioning and improved quality of life compared with using standard home care.
Reablement is usually free for the first six weeks.
To find out more about reablement services in your area, contact your local social services department.”

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After the event: getting care right for patients after a heart attack – Heart UK – 16 January 2012

Posted on January 17, 2012. Filed under: Cardiol / Cardiothor Surg, Rehabilitation | Tags: |

After the event: getting care right for patients after a heart attack – Heart UK – 16 January 2012

Full text of the report 

“HEART UK, the Cholesterol Charity, has today called on all NHS Trusts to offer cardiac rehabilitation services to patients more vigorously following the launch of a report highlighting the shocking inequalities in treatment after a heart attack in England.

The cardiac rehabilitation report, entitled ‘After the event: getting care right for patients after a heart attack’, found that 2,100 patients across England are not being offered cardiac rehabilitation despite the clear benefits of the service in improving patient experience and outcomes from the disease.

HEART UK Chief Executive Jules Payne said: “It is encouraging that many patients are offered cardiac rehabilitation after they have had a heart attack but the variation in uptake across the country is unacceptable. Action is needed on both a national and local level to ensure that all patients are offered this service to help them to recover and return to normal life as soon as possible after their heart attack.”

… continues on the site

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IMPRESS Guide to Pulmonary Rehabilitation – Improving and Integrating Respiratory Services – December 2011

Posted on December 19, 2011. Filed under: Rehabilitation, Respiratory Medicine | Tags: |

IMPRESS Guide to Pulmonary Rehabilitation – Improving and Integrating Respiratory Services – December 2011

“IMPRESS was set up in 2007 as a joint initiative between the British Thoracic Society (BTS) and the Primary Care Respiratory Society-UK (PCRS-UK) to provide clinical leadership to the NHS to stimulate improvement and integration in respiratory services. The IMPRESS team now works closely with representatives from  primary and secondary care, nursing and medicine, public health, social care, providing and commissioning and the public.”

“Executive Summary

• Pulmonary rehabilitation (PR) reduces morbidity, mortality and hospital attendances in people with COPD disabled by their disease.
• PR should receive commissioning priority given its proven clinical and cost effectiveness and relative value compared to many of our other interventions
for COPD.
• The more components of the COPD pathway working together in an integrated multi-faceted programme, including an interface with self-management support, quit smoking support and oxygen assessment, the more likely there is to be a positive effect.
• This paper reviews the evidence, explains what PR is, how it works, its value and why it should be commissioned.
• It supplements the Commissioning Pack for COPD to be issued by the DH England, including a section on PR (due early 2012).
• It answers the questions asked by commissioners who may have no current service, a service with insufficient capacity, one that does not meet patient’s expectations, or one that is failing to achieve acceptable completion rates.”

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Mind the gap: ways to enhance therapy provision in stroke rehabilitation – NHS Improvement – 2011

Posted on December 13, 2011. Filed under: Neurology, Rehabilitation | Tags: , |

Mind the gap: ways to enhance therapy provision in stroke rehabilitation – NHS Improvement – 2011

“Ways to enhance therapy provision in stroke rehabilitation This document explores some of the different models adopted by therapy services to deliver more rehabilitation and provides further detail about 45 minutes, process and outcomes.”
 
Contents
Introduction
National guidelines
Who can deliver more rehabilitation?
When – a seven day service?
How long – getting more out of the whole week?
Where can more therapy make a difference?
How – bridging the gap?
Conclusions
References
Case studies

Practical principles for improving stroke care 

1 – Improving psychological care after stroke 

2 – Developing an early supported discharge service 

 3 – Improving access to CT scanning 

4 – Transient Ischaemic Attack (TIA) 

5 – How to establish joint care planning 

6 – How to manage reviews for stroke survivors 

7 – Being the best in acute stroke 

8 – Developing a community stroke service

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Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

Posted on November 11, 2011. Filed under: Cardiol / Cardiothor Surg, Neurology, Preventive Healthcare, Rehabilitation | Tags: |

Transition of Care for Acute Stroke and Myocardial Infarction Patients: From Hospitalization to Rehabilitation, Recovery, and Secondary Prevention – AHRQ – October 2011

AHRQ = US Agency for Healthcare Research and Quality

“Structured Abstract

Objectives: To review the available published literature to assess whether evidence supports a beneficial role for coordinated transition of care services for the postacute care of patients hospitalized with first or recurrent stroke or myocardial infarction (MI). This review was framed around five areas of investigation:

1.Key components of transition of care services.
2.Evidence for improvement in functional outcomes, morbidity, mortality, and quality of life.
3.Associated risks or potential harms.
4.Evidence for improvement in systems of care.
5.Evidence that benefits and harms vary by patient-based or system-based characteristics.

Data Sources: MEDLINE®, CINAHL®, Cochrane Database of Systematic Reviews, and Embase®.

Review Methods: We included studies published in English from 2000 to 2011 that specified postacute hospitalization transition of care services as well as prevention of recurrent stroke or MI.

Results: A total of 62 articles representing 44 studies were included for data abstraction. Transition of care interventions were grouped into four categories:

1.Hospital-initiated support for discharge was the initial stage in the transition of care process.
2.Patient and family education interventions were started during hospitalization but were continued at the community level.
3.Community-based models of support followed hospital discharge.
4.Chronic disease management models of care assumed the responsibility for long-term care.

Early supported discharge after stroke was associated with reduced total hospital length of stay without adverse effects on functional recovery, and specialty care after MI was associated with reduced mortality. Because of several methodological shortcomings, most studies did not consistently demonstrate that any specific intervention resulted in improved patient- or system-based outcomes. Some studies included more than one intervention, which made it difficult to determine the effect of individual components on clinical outcomes. There was inconsistency in the definition of what constituted a component of transition of care compared to “standard care.” Standard care was poorly defined, and nearly all studies were underpowered to demonstrate a statistical benefit. The endpoints varied greatly from study to study. Nearly all the studies were single-site based, and most (26 of 44) were conducted in countries with national health care systems quite different from that of the U.S., therefore limiting their generalizability.

Conclusions: Although a basis for the definition of transition of care exists, more consensus is needed on the definition of the interventions and the outcomes appropriate to those interventions. There was limited evidence that two components of hospital-initiated support for discharge (early supported discharge after stroke and specialty care followup after MI) were associated with beneficial effects. No other interventions had sufficient evidence of benefit based on the findings of this systematic review. The adoption of a standard set of definitions, a refinement in the methodology used to study transition of care, and appropriate selection of patient-centered and policy-relevant outcomes should be employed to draw valid conclusions pertaining to specific components of transition of care.”

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Reablement: a cost-effective route to better outcomes – Social Care Institute for Excellence – April 2011

Posted on April 29, 2011. Filed under: Disability, Rehabilitation | Tags: |

Reablement: a cost-effective route to better outcomes – Social Care Institute for Excellence – April 2011

By Jennifer Francis, Mike Fisher and Deborah Rutter

“This is one in a series of research briefings about preventive care and support for adults.

Reablement is generally designed to help people learn or relearn the skills necessary for daily living which may have been lost through deterioration in health and/or increased support needs. A focus on regaining physical ability is central, as is active reassessment. “

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NICE improves rehabilitation for people after critical illness UK National Institute for Health and Clinical Excellence

Posted on April 29, 2009. Filed under: Rehabilitation | Tags: , |

2009/025 NICE improves rehabilitation for people after critical illness UK National Institute for Health and Clinical Excellence

NICE guidance published today (25 March 2009) sets out to improve the quality of care patients receive during their recovery and rehabilitation after critical illness
.

Approximately 110,000 [1] people spend time in critical care units in England and Wales each year, the majority survive to be discharged home. For many patients recovery after critical illness is relatively straightforward but for others, discharge from critical care is the start of an uncertain journey to recovery characterised by problems such as, weakness, loss of energy and physical difficulties, anxiety, depression, post-traumatic stress (PTS) phenomena and, for some, a loss of mental faculty. Family members become informal caregivers, and this itself can exert an additional toll of ill-health and a strain on family relationships and financial security.

This guideline outlines the assessments and care patients should receive in hospital following a critical illness and the rehabilitation goals that will help patients recover to take part in usual daily activities as much and as rapidly as possible following discharge.

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AskSARA – website link

Posted on April 29, 2009. Filed under: Occupational Therapy, Rehabilitation |

AskSARA is an award-winning guided advice tool developed by national charity the Disabled Living Foundation (DLF) to help people find solutions to their daily living problems.

AskSARA is very simple to use. Just choose the topic you wish to complete, respond to the questions and then go to your report. The report contains useful advice written by the DLF’s team of occupational therapists as well as details of products that might help you. This information is drawn from the DLF’s impartial database of equipment that aims to include details of every product on the market.

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Vocational Rehabilitation: what is it, who can deliver it and who pays? – UK report Dec 2008

Posted on April 8, 2009. Filed under: Mental Health Psychi Psychol, Occupational Therapy, Rehabilitation |

Vocational Rehabilitation: what is it, who can deliver it and who pays?

The Government wants to help millions of people with mental health problems to work, shown by its response to Dame Carol Black’s review of the health of the working population and welfare reform.

Vocational rehabilitation is whatever helps someone with a health problem to stay at, return to and remain in work. We need to develop a vocational rehabilitation workforce that is capable of delivering evidence-based services and we need to find the resources to invest in changing the system.

As a contribution to this debate, in 2008 Sainsbury Centre and the College of Occupational Therapists joined forces to host expert roundtable discussions which addressed the thorny, practical issues about vocational rehabilitation – what is it, who can deliver it, who pays? This paper is the result.

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Rehabilitation measures [for cancer services – UK]

Posted on April 7, 2009. Filed under: Oncology, Rehabilitation |

This revised Manual of Cancer Services is an integral part of the NHS Cancer Plan, Cancer Reform Strategy and modernisation of cancer services. It will support quality assurance of cancer services and enable quality improvement. (Department of Health – publications)   17 Dec 2008

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