A model of rehabilitation service delivery for moderate to severe traumatic brain injury in New Zealand: its development and implementation
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1 A model of rehabilitation service delivery for moderate to severe traumatic brain injury in New Zealand: its development and implementation Allison Foster, PhD Max Cavit ABI Rehabilitation New Zealand, Ltd.
2 Summary of Integrated Rehabilitation Services for traumatic brain injury Contract with ACC began March 2008 Identify ALL adult moderate-to-severe TBI clients in Auckland, Northland, and Hamilton/Waikato Acute, inpatient, and community/outpatient integrated inter-disciplinary assessments and rehabilitation Including neurobehavioural and transitional rehabilitation services, and residential / long-term support Client-centred and focused on personally-relevant goals; family-whānau have key role Efficient management of rehabilitation process Transitions Across multi-disciplinary team Electronic data management; research programme Evolving
3 IRS-TBI Development People Places Processes Client-centred
4 Development Align with best-practice recommendations Acute medical management Sensory function Discharge management Rehabilitation programme design Characteristics of a rehabilitation service Vocational rehabilitation Managing the impact on the family Strategies and goals The rehabilitation team Leisure and recreation Medications Communication The case worker Sleep and fatigue Substance abuse Matching needs to services The phases and locations of rehabilitation Sexuality Mental health Cultural considerations The focus of rehabilitation Rehabilitation aids Pain management Transition management Involving the family in rehabilitation Early rehabilitation Activities of daily living Cognition Measurement tools Long term TBI management Motor function New Zealand: New Zealand: USA: USA: UK: UK: Canada: Canada: Australia: New Zealand Guidelines Group: Traumatic Brain Injury: Diagnosis, Acute Management and Rehabilitation. New Zealand Guidelines Group TBI Tools review. TBI Model Systems (TBIMS) AHRQ evidence report. Rehabilitation following acquired brain injury: National Clinical guidelines. NICE head injury guidelines. Toronto Acquired Brain Injury Network: Development of a Comprehensive Best Practice Brain Injury Model, Phases I-III. ABIKUS guidelines. Brain injury outcomes study (BIOS) Develop through action research and partnerships
5 People The client is the heart of the IRS-TBI Service The client s family is both a recipient of services and a member of the rehab team Multi-disciplinary team: Disciplines Clinical psychology Cultural advisor Exercise science General practice Massage therapy Neurological specialist Nursing Occupational therapy Physiotherapy Psychology (health, clinical, general) Psychiatry or neuropsychiatry Rehabilitation medicine specialist Social work Speech and language therapy Functions Acute rehabilitation coordination Admission/discharge coordination Managers (team, nursing) Rehabilitation programme coordination Rehabilitation programme worker
6 Places Acute rehabilitation coordinators embedded in DHBs: clients are identified in hospital and enrolled in the rehabilitation programme shortly after injury (70% within 1 day) Intensive assessment and rehabilitation in inpatient facility in West Auckland Outpatient services, community-based services (concussion clinic) : post-acute rehabilitation coordinators in the community
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12 Processes Client s experience Client s TBI Acute Phase: Hospital Residential Phase: ABIRM Residential Facility Community Phase: Home / Outpatient Client s resumption of pre-injury status IRS-TBI contribution Identification, enrolment Education: client and family Rehab services/ support Transition management Transition Plan Support health and safety Needs assessment Clinical recommendations Education: client and family Goal-setting MDT services and therapies Improve functional capacity Transition management Transition Plan Ongoing clinical review Needs assessment Clinical recommendations to ACC and outside providers Support return to work/social productivity
13 Length of stay (days) IRS vs. Pre-IRS ( ) Mean Median 47 Acute NOW (n=319) THEN (n=133) NOW THEN Residential NOW (n=173) THEN (n=133) NOW THEN
14 Processes: Data and Research Contribute to AROC Academic research population: ~10 ongoing studies Internal database for research, publications, and quality improvement: demographics, injury details, outcomes (28 core variables per client; n>1000) Pursuing NZ and overseas clinical research collaborations
15 Next steps Continual quality improvement CARF accreditation
16 Data were gathered incidental to standard service delivery through ABI Rehabilitation New Zealand, Ltd. Views and/or conclusions in this report are those of the author(s) and may not reflect the position of funding or governmental agencies.
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