Page 99 - HA Convention 2015

Special Topics

ST6.2 Rehabilitation – Future Trend and Development 14:30 Theatre 2

Improving the Rehabilitation Patient Journey Monday, 18 May
Poulos C
School of Public Health and Community Medicine, The University of New South Wales, Australia

Rehabilitation services are a critical component of any healthcare system, improving outcomes for patients with disabling
conditions resulting from illness or injury, freeing-up acute hospital capacity and decreasing the burden of disability.
Improving the effectiveness and efficiency of the patient journey through the acute hospital, and into and through the
rehabilitation episode, has the potential to enhance patient outcomes and increase hospital capacity.

Research suggests that a high proportion of patient days do not meet level of care appropriateness in either acute or
rehabilitation settings. There may also be variability between the acute care and rehabilitation teams in the determination of
patient appropriateness for rehabilitation, and readiness for transfer.

Strategies that improve patient selection and the transfer process to rehabilitation will aid patient flow. Strategies include
improved information and logistical management of patients, and support for clinical decision making. Care and funding
models that encourage rehabilitation in the acute setting may also offer benefit, including the more effective use of resources
and the prevention of avoidable functional decline.

Providing sufficient therapy “dose” in inpatient rehabilitation, overcoming barriers to discharge, and the availability of
ambulatory rehabilitation options, have the potential to improve the efficiency and effectiveness of the rehabilitation episode.

ST6.3 Rehabilitation – Future Trend and Development 14:30 Theatre 2

Rehabilitation in Hospital Authority – Challenges and the Way Ahead HOSPITAL AUTHORITY CONVENTION 2015
Li LSW
Division of Rehabilitation, Department of Medicine, Tung Wah Hospital, Hong Kong

Before the establishment of Hospital Authority (HA), rehabilitation services in public hospital system in Hong Kong were
limited. In each cluster of HA, there are now facilities and staff responsible to provide in-hospital or outpatient rehabilitation
for patients with functional limitations. Patients with diseases resulted in permanent impairments and functional limitations
have good opportunity to receive rehabilitation services in the public hospital system in Hong Kong now. However,
comprehensive rehabilitation programme is a dynamic process which could be expensive and requires good organisational
approach in terms of expertise, manpower, facilities and outcome assessment to achieve a cost-effective service. As
rehabilitation treatment is aiming at enhancing functional status, assessing and monitoring its effectiveness are very different
from the treatment for diseases which could be easily measured by reduction of mortality and morbidity. Lack of standard
assessment across hospitals in Hong Kong in provision of rehabilitation services hinders the development of a cost-effective
service with unified standard.

Recent survey on cardiac and stroke rehabilitation services revealed marked variations among clusters in terms of outcomes.
To improve rehabilitation services, appropriate performance indicators or outcome measurements which are different from
those routinely collected for acute medical services would be needed. Appropriate funding for rehabilitation services is a
challenge in a fixed cluster budgeting approach. Competition of funding between acute and rehabilitation service has a
tendency to put rehabilitation service as an inferior competitor. To alleviate the situation, healthy life expectancy rather than
just life expectancy should be a paramount issue to address in health policy and funding. Organisation of rehabilitation
services are influenced by many factors including funding model, manpower, expertise, culture and geographical issues.
The science to facilitate organisation is through an evidence-based practice, whilst the art of administrative coordination
is needed to establish the best model. Expertise is essential for comprehensive rehabilitation services but credentialing for
provision of such services is needed if high standard of rehabilitation services is the ultimate goal. Lastly, evidence-based
practice requires good researches to establish clinical guidelines for service organisation; funding and support for local
research on cost-effectiveness of rehabilitation services and organisational models are needed.

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