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

BACKGROUND: Reconditioning 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 cos...

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Autores principales: Poulos, Roslyn G, Cole, Andrew M, Warner, Kerry N, Faux, Steven G, Nguyen, Tuan-Anh, Kohler, Friedbert, Un, Fey-Ching, Alexander, Tara, Capell, Jacquelin T, Hilvert, Dan R, O’Connor, Claire MC, Poulos, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895972/
https://www.ncbi.nlm.nih.gov/pubmed/36737750
http://dx.doi.org/10.1186/s12913-023-09068-5
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author Poulos, Roslyn G
Cole, Andrew M
Warner, Kerry N
Faux, Steven G
Nguyen, Tuan-Anh
Kohler, Friedbert
Un, Fey-Ching
Alexander, Tara
Capell, Jacquelin T
Hilvert, Dan R
O’Connor, Claire MC
Poulos, Christopher J
author_facet Poulos, Roslyn G
Cole, Andrew M
Warner, Kerry N
Faux, Steven G
Nguyen, Tuan-Anh
Kohler, Friedbert
Un, Fey-Ching
Alexander, Tara
Capell, Jacquelin T
Hilvert, Dan R
O’Connor, Claire MC
Poulos, Christopher J
author_sort Poulos, Roslyn G
collection PubMed
description BACKGROUND: Reconditioning 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. METHODS: A 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. RESULTS: One-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. CONCLUSIONS: Strong 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09068-5.
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spelling pubmed-98959722023-02-04 Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia Poulos, Roslyn G Cole, Andrew M Warner, Kerry N Faux, Steven G Nguyen, Tuan-Anh Kohler, Friedbert Un, Fey-Ching Alexander, Tara Capell, Jacquelin T Hilvert, Dan R O’Connor, Claire MC Poulos, Christopher J BMC Health Serv Res Research BACKGROUND: Reconditioning 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. METHODS: A 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. RESULTS: One-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. CONCLUSIONS: Strong 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09068-5. BioMed Central 2023-02-03 /pmc/articles/PMC9895972/ /pubmed/36737750 http://dx.doi.org/10.1186/s12913-023-09068-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Poulos, Roslyn G
Cole, Andrew M
Warner, Kerry N
Faux, Steven G
Nguyen, Tuan-Anh
Kohler, Friedbert
Un, Fey-Ching
Alexander, Tara
Capell, Jacquelin T
Hilvert, Dan R
O’Connor, Claire MC
Poulos, Christopher J
Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title_full Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title_fullStr Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title_full_unstemmed Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title_short Developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a Delphi survey in Australia
title_sort developing a model for rehabilitation in the home as hospital substitution for patients requiring reconditioning: a delphi survey in australia
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9895972/
https://www.ncbi.nlm.nih.gov/pubmed/36737750
http://dx.doi.org/10.1186/s12913-023-09068-5
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