[State of practice: national and international practices in the organization of rehabilitative care for adults with permanent or temporary motor disabilities]

Laflamme H, Valade S
Record ID 32018000978
Original Title: État des pratiques: les pratiques organisationnelles en réadaptation à l’échelle nationale et internationale pour la clientèle adulte présentant une incapacité motrice permanente ou temporaire
Authors' objectives: This project is in keeping with the work planned for 2018-2019 by the Direction des services en déficience et en réadaptation physique (DSDRP) of the Ministère de la Santé et des Services sociaux (MSSS) to determine rehabilitative care organization parameters for adults with motor disabilities. Directors of physical disability programs/services in Québec’s integrated health and social services centres (CISSS) and integrated university health and social services centres (CIUSSS) have expressed a need to clarify services to be offered specifically to adults with motor disabilities. The MSSS thus mandated the Institut national d’excellence en santé et en services sociaux (INESSS) to conduct a literature review with the primary goal of describing international and national models for service organization and organizational practices that can improve the accessibility, continuity and complementarity of rehabilitative services for adults with permanent motor disabilities resulting from accident or illness (stroke, traumatic brain injury (TBI), amputation, spinal cord injury, degenerative disease) or temporary motor disabilities resulting from a fracture (frailty with comorbidities) or surgery (total hip replacement (THR), total knee replacement (TKR)).
Authors' results and conclusions: RESULTS: In Australia two sets of standards for provision of rehabilitation services have been developed, one for inpatient services and one for outpatient services. These standards pertain to six aspects of service provision: governance; staffing; facilities and equipment; policies and procedures; quality improvement and risk management; and education and research. During this same period, a national rehabilitation stroke services framework was developed and a non-hierarchical services organization model was introduced for stroke victims, including a wide range of outpatient services. In Ontario, a work plan focusing on key priorities was developed, including establishing a common terminology, supporting a standardized approach to service evaluation, and evaluating and planning outpatient rehabilitation care. To meet these objectives, different tools and frameworks are suggested, notably a framework for reorganization of bedded rehabilitative care. As part of a wide-ranging national undertaking, the Government of Ireland reviewed its organization of rehabilitative services. Based on the Turner-Stoke principle of service that ranges from the most simple to the most complex, the new service delivery model calls for four levels of care with pathways across care levels. Depending on the complexity of needs and volume of patients, the different levels of care are offered: outpatient primary care rehabilitation services, outpatient community-based rehabilitation services, regional rehabilitation services (inpatient and outpatient) and national rehabilitation services (inpatient and outpatient). Alberta developed a conceptual framework in order to promote a shared understanding of rehabilitation, provide definitions and serve as a guide for planning, managing and delivering consistent rehabilitation services that meet patient and community needs. The framework outlines five rehabilitation services sectors: acute care, rehabilitation facility/unit, ambulatory community, home care and long-term care facility. New Zealand developed a national rehabilitation strategy to ensure a more coordinated focus on developing structures and processes. Key objectives of the strategy include ensuring rehabilitation is an integral component of health and social services strategies and improved integration of services. With respect to cross-organizational practices (second question), the literature review showed four practices in particular appear repeatedly in the diverse sources consulted: adoption by care providers of a common terminology and a shared vision of rehabilitative care; service integration together with delivery of a comprehensive and wide range of services; presence of an interdisciplinary team with targeted expertise; inclusion of patients and family members in the interdisciplinary team. The literature review also highlighted elements specific to each of the themes investigated. Regarding bed management (third question), certain practices seem essential: promotion of early and intensive inpatient rehabilitation services; selection of the type of inpatient unit depending on the circumstances of the patient and his/her family, their needs and preferences (dedicated unit, combined unit, mixed unit, orthogeriatric rehabilitation unit, etc.) Transition management (fourth question) is the series of actions to ensure coordination and continuity of care when a patient is transferred from one establishment to another or from one level of service to another within the same establishment. Based on the organizational practices reviewed, planning and coordination of transitions seems to be indispensable. Early planning of hospital discharge facilitates the patient’s return home, maximizes his/her autonomy, reduces isolation and makes it possible to better meet his/her needs and those of the family. In addition, designating a particular individual responsible for coordinating all transitions facilitates continuity of care and encourages effective communication between the care providers concerned. Lastly, in response to the fifth question, the literature review indicates that delivery of a range of outpatient services adapted to the needs of patients and their families is a central element. In fact, the impact of outpatient services is made very clear in the literature, and many jurisdictions have made such services a key part of their rehabilitation services organization models. Availability of center-based or home-based outpatient rehabilitation services, early supported discharge and telerehabilitation, when pertinent, seem to be essential to improving the continuum of care. CONCLUSION: This report highlights organizational practices that can improve accessibility, continuity and complementarity of care. In Québec, the rehabilitative care continuum seems to breakdown into several phases: the phase closest to the event, when care is provided in an acute care unit in hospital; the “rehabilitation” phase, when inpatient and outpatient rehabilitation services are delivered as center or home-based services; and the last phase, when support services are provided for integrating and remaining in the community. Most of the organizational practices analyzed and presented in this report could be applicable to the organization of services in Québec. Though the concepts are not new, they highlight practices whose implementation in pertinent Québec establishment would be worth evaluating, so that needed adjustments could be made in the rehabilitative services offer for adults with temporary or permanent motor disabilities.
Authors' methods: Five questions were formulated to meet the main objective of this state of practice. The first was about models of rehabilitation services organization in place in other jurisdictions. The second was about cross-organizational practices in bed management, transition management and outpatient services delivery. The last three were about specific organization practices with respect to each of these three themes (bed management, transition management and outpatient services delivery). The literature search was conducted by consulting the websites of organizations, professional associations, learned societies and government agencies in Australia, the United States, Ireland, New Zealand, the United Kingdom and other Canadian provinces and territories. In addition, the PubMed database and the Cochrane Database of Systematic Reviews (OvidSP) were queried. Google and Google Scholar searches were also conducted using key words for the themes of interest. Selected for review were studies published in peer-reviewed journals, practice guides, guidances, assessment reports, government reports and reports by committees of experts. In addition, INESSS consulted managers from different regions of Québec to get an understanding of the real situation with respect to services offered and their organization, interestablishment practices, partnership agreements, problems encountered and solutions implemented. Lastly, a 13-member working committee worked closely with INESSS to ensure that the project met the needs expressed by the health and social services network, was clinically relevant and had practical applications.
Project Status: Completed
Year Published: 2018
Requestor: Minister of Health
English language abstract: An English language summary is available
Publication Type: Other
Country: Canada
Province: Quebec
MeSH Terms
  • Recovery of Function
  • Rehabilitation
  • Stroke Rehabilitation
  • Disabled Persons
  • Exercise Therapy
  • Physical Therapy Modalities
  • Occupational Therapy
  • Adult
Organisation Name: Institut national d'excellence en sante et en services sociaux
Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369
Contact Name: demande@inesss.qc.ca
Contact Email: demande@inesss.qc.ca
Copyright: Gouvernement du Québec
This is a bibliographic record of a published health technology assessment from a member of INAHTA or other HTA producer. No evaluation of the quality of this assessment has been made for the HTA database.