Developing Community Stroke Rehabilitation Pathways in Lothian. This presentation. Evidence for Therapy-based Community Stroke Rehabilitation

Transcription

1 Developing Community Stroke Rehabilitation Pathways in Lothian Mark Smith Consultant Physiotherapist Stroke Rehabilitation NHS Lothian This presentation The Rationale The Process A Pilot Service Evidence for Therapy-based Community Stroke Rehabilitation Early Supported Discharge 2005 Cochrane 11 trials, 1597 patients, 8 days LOS Therapy-based Stroke Rehabilitation Services for Patients at Home 2003 Cochrane 14 trials, 1617 patients, sig OT Services after Stroke 2006 Cochrane - 64 trials, 1258 patients, sig

2 The Strategies National Framework - Kerr Delivering for Health Changing Lives Better Lives, Better Care CHD & Stroke Framework for Adult Rehabilitation Pan Lothian Review of Older Peoples Services Joint Physical & Complex Disability in Lothian The Strategy /2004 Lothian Managed Clinical Network for Stroke Multidisciplinary Clinical Governance Agenda Research Governance Framework Networking Scottish Executive Health Dept Health Boards NACS HEIs NHS Education Scotland NHS QIS Professional Bodies Working Sub-groups Consultant AHP post amongst others Job description

3 Framework for Adult Rehabilitation - Target Groups Older People People with Long Term Conditions People returning from work absence and/or aiming to stay in employment (vocational rehabilitation) Adult Rehabilitation Framework - Aims and Objectives Access to services Local Service Provision community based Enablement and Self-Managed Care Comprehensive and Evidence-based Services Sustainable Multi-professional Teams Capacity Better Health, Better Care 2007 Improve long term condition management Locally involve service users and their carers in primary care and community settings Best use of clinical skills to maximise outcomes for patients Meet highest standards Improve transport infrastructure

4 Better Health, Better Care 2007 Best value eliminate unnecessary expenditure Develop new NMAHP Consultant roles Sharing service provision ie.. Health & Social Care Engaging with the voluntary sector Shifting the balance from hospital to community-based services Better Health, Better Care 2007 Addressing quality of life and barriers to employment Care for people with disabilities Self-care/condition management strategy with the support of NMAHPs Cognitive/psychological therapies Methodology Consultant AHP - Feb 2006 Lothian stroke MCN Community Service Development Subgroup Semi-structured interviews key stakeholders Service Directory standard proforma Consultation Paper Nov feedback

5 Methodology CIHR Small Project Grant Researcher P/T 6 months Data sources: ISD, SSCAS, LSR, CHSS Follow-up interviews/clarification Final Report May 2007 Stakeholder Event 6 June 2007 Stroke MCN Steering Group 22 June 2007 CHSS Stroke Liaison Nurse 05/06 Authority Under 65 / Total / % Over 65/Total/% Edinburgh 83 / % East Lothian 21 / % Midlothian 26 / % West Lothian 50 / % TOTAL 180 / % 182 / % 35 / % 38 / % 67 / % 320 / % Pathways Stroke Services: Acute & Rehabilitation Medicine of Old Age geriatricians/stroke physicians Older people established pathway 5 day hospitals in Lothian Under 65 short-term, term, disorganised, highly selective, undefined

6 The Pilot Edinburgh Local Authority Service redesign & developing ethos no added cost Premises - Firrhill and Craighall Centres Management Medicine Occupational Therapy Speech & Language Therapy Clinical Neuropsychology Rehabilitation Officers Transport and Drivers The Pilot Lothian Stroke MCN 90k 84,818 from slippage funds non recurring Physiotherapist Band WTE 2 years - 70,239 Rehabilitation Equipment Lifestyle Management Courses Thistle Foundation Evaluation Training, Uniform, Travel The Pilot Edinburgh Community Stroke Service ECSS - 2 year pilot Something different! Joint funded by City of Edinburgh Council & Lothian Stroke MCN Firrhill & Craighall Centres Stroke Days - One per week at each Centre with ongoing rehabilitation input on other days Lifestyle Management Programme Thistle Foundation courses Jan 2008, Jan 2009 open to all age groups pan Lothian

7 The Pilot Under 65 around 40 patients per annum in Edinburgh Referral sources: Hospital Discharges - MDTs Community Rehabilitation Service CHSS Stroke Nurses Up to one year Transport Training CHSS involvement Two day course for the teams from both Centre sites Designed specifically for ECSS Service launched following this referrals from 1 April 2008 The Pilot Provisional Objectives: 1. To develop an ongoing MDT rehabilitation and management service for any younger stroke patients (referral criteria) within Edinburgh area 2. To allow ESD where appropriate 3. To prevent hospital admission where appropriate 4. To provide specialist, non time-limited multidisciplinary intervention

8 The Pilot Provisional Objectives: 5. To hold regular MDT meetings 6. To set client-centred centred goals within the team 7. To measure baseline consumer satisfaction 8. To collect and process service outcome data 9. To work in partnership with other service providers, patients, carers and the voluntary sector The Process Assessment baseline Battery of outcome measures: physical, functional, mood, cognition and satisfaction Data storage and retrieval Intervention Evaluation Exit strategy Recommendations The Way Forward Improve data collection Consent to follow up Consumer satisfaction Evaluate pilots Develop late stage pathway lifestyle management, access to leisure facilities, health promotion

9 The Way Forward Further address pan Lothian inequity standardisation of rehabilitation services under the three CHPs Working in partnership with regional vocational rehabilitation services for young stroke patients Older people strengthening and developing services Research in practice The use of mixed research methods can help to more quantitatively evaluate care pathways This can facilitate more robust strategic service redesign Allows service users, carers, health and local authority staff to work together to think creatively about how services should look challenging outdated models