3.8 Complete Care Pathways

The ultimate 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.

These studies re-affirm many of the concerns already noted in this chapter. Brain injury displays significant heterogeneity and direct comparison of complete systems is difficult. All three papers identify similar foci for model of care design. Continuity and accessibility of services is crucial to allow a patient the greatest opportunities for rehabilitation while a multidisciplinary approach to rehabilitation with communication between stages is ideal. Also, regional differences in resource availability need to be taken into consideration along with patient demographics so that the correct pathway decisions can be made.

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. Mellick et al. 110list those being female, older, severely injured and not a member of a minority group as less likely to receive rehabilitation.  While this is clearly the product of larger social issues, these facts need to be addressed when decisions regarding ABI care systems are being made. In a similar fashion, Khan et al. 3provide encouraging news regarding decreases in LOS and fiscal savings brought on by an integrated ABI system in Canada. The author points out 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. Finally, Harradine et al. 111note that co-ordination of regional facilities resulted in an equal availability of resources despite geographic challenges in New South Wales, Australia.