Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia

BMC Health Services Research

Research

Jacquelin T Capell¹  Tara Alexander¹  Fey-Ching Un²  Friedbert Kohler³  Roslyn G Poulos³  Andrew M Cole³  Claire MC O’Connor³  Kerry N Warner³  Christopher J Poulos³  Dan R Hilvert⁴  Steven G Faux⁵  Tuan-Anh Nguyen⁶ 

[1] Australasian Rehabilitation Outcomes Centre, University of Wollongong, Wollongong, Australia;HammondCare, Sydney, Australia;HammondCare, Sydney, Australia;School of Population Health, UNSW, Sydney, Australia;Hilvert Advisory, Sydney, Australia;School of Population Health, UNSW, Sydney, Australia;St Vincent’s Hospital, Sydney, Australia;South Western Sydney Local Health District, Sydney, Australia;

关键词: Rehabilitation;    Rehabilitation in the home;    Reconditioning;    Delphi study;    Allied health;    Community rehabilitation;    Post-acute rehabilitation;   

DOI  :  10.1186/s12913-023-09068-5

 received in 2022-07-19, accepted in 2023-01-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundReconditioning for patients who have experienced functional decline following medical illness, surgery or treatment for cancer accounts for approximately 26% of all reported inpatient rehabilitation episodes in Australia. Rehabilitation in the home (RITH) has the potential to offer a cost-effective, high-quality alternative for appropriate patients, helping to reduce pressure on the acute care sector. This study sought to gain consensus on a model for RITH as hospital substitution for patients requiring reconditioning.MethodsA multidisciplinary group of health professionals working in the rehabilitation field was identified from across Australia and invited to participate in a three-round online Delphi survey. Survey items followed the patient journey, and also included items on practitioner roles, clinical governance, and budgetary considerations. Survey items mostly comprised statements seeking agreement on 5-point Likert scales (strongly agree to strongly disagree). Free text boxes allowed participants to qualify item answers or make comments. Analysis of quantitative data used descriptive statistics; qualitative data informed question content in subsequent survey rounds or were used in understanding item responses.ResultsOne-hundred and ninety-eight health professionals received an invitation to participate. Of these, 131/198 (66%) completed round 1, 101/131 (77%) completed round 2, and 78/101 (77%) completed round 3. Consensus (defined as ≥ 70% agreement or disagreement) was achieved on over 130 statements. These related to the RITH patient journey (including patient assessment and development of the care plan, case management and program provision, and patient and program outcomes); clinical governance and budgetary considerations; and included items for initial patient screening, patient eligibility and case manager roles. A consensus-based model for RITH was developed, comprising five key steps and the actions within each.ConclusionsStrong support amongst survey participants was found for RITH as hospital substitution to be widely available for appropriate patients needing reconditioning. Supportive legislative and payment systems, mechanisms that allow for the integration of primary care, and appropriate clinical governance frameworks for RITH are required, if broad implementation is to be achieved. Studies comparing clinical outcomes and cost–benefit of RITH to inpatient rehabilitation for patients requiring reconditioning are also needed.

【 授权许可】

CC BY   
© The Author(s) 2023

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