Complete Care Pathways

The goal in any rehabilitation stream is to provide seamless care from the onset of injury to the ultimate recovery. As this chapter has demonstrated, the continuum of ABI care involves acute interventions with a transition to some combination of rehabilitation therapies. This section aims to identify studies which have compared pathways of care combining several rehabilitation strategies. 

Individual Studies 

Table: Complete Care Pathways for ABI

Discussion

These studies re-affirm many of the concerns already noted in this chapter.  There is significant heterogeneity in caring for individuals with ABI and direct comparison of complete systems is difficult. Unfortunately, no matter what health care system is assessed, budgetary concerns play a role in the accessibility of care. As a result, difficult decisions need to be made regarding resource allocation. Despite financial concerns, Khan et al. (2002) provide encouraging news regarding decreases in LOS and fiscal savings brought on by an integrated ABI system in Canada. The authors state that care needs to be taken to ensure that savings do not arise from sacrifices in quality of care but rather from the improvement of systematic inefficiencies. Moreover, Andelic et al. (2014) report that a continuous chain of treatment and interventions worked out to be more cost-effective than the ‘broken chain’ format of rehabilitation with patients’ receiving inconsistent interventions.  Thus, patients transitioning smoothly through the continuum of care not only benefit in terms of functional and cognitive gains, but approximately $6,075.5 USD per patient was saved (Andelic et al. 2014). Finally, Harradine et al. (2004) note that co-ordination of regional facilities resulted in an equal availability of resources despite geographic challenges in New South Wales, Australia.

Continuity and accessibility of services is crucial to allow a patient the greatest opportunities for rehabilitation.  Regional differences in resource availability need to be taken into consideration, along with patient demographics, so that the correct pathway decisions can be made. An alternative model of care is a comprehensive rehabilitation case management approach; this was implemented within a brain injury rehabilitation service and evaluated by Kennedy et al. (2012). A series of interviews with case managers and brain injury staff revealed that the new model provided a consistent and continuous transition through the rehabilitation continuum. Similarly, Talbot et al. (2014) conducted interviews with patients and focus groups with clinicians, and reported that a new Collaborative Care model resulted in improved continuity of care and communication among clinicians and patients. The increased communication allowed clinicians to better monitor and facilitate patient progress. 

Conclusions

There is Level 2 evidence that individuals living in both rural and urban settings benefited from an integrated network of inpatient, outpatient and community services.

Although continuity of care has been shown to be beneficial in optimizing recovery, there is insufficient evidence to draw any conclusions regarding the ideal structure of a complete model of ABI care.

 

 

Further research is required in determining the ideal structure of a complete model of ABI care.