Model Of Care For Patients Research Articles

Survey of direct patient care and payment models among pharmacy practice faculty

AbstractIntroductionThe scope of pharmacy practice continues to expand into comprehensive medication management and direct patient care models, where practice‐based faculty play a central role. The extent to which schools/colleges of pharmacy have faculty embedded in health systems, physician practices, and other value‐based care settings involving practice plans is largely unknown.ObjectivesThe objectives of this project were to: (1) elucidate the perceptions, barriers, and implementation strategies related to direct patient care models, and (2) to further our understanding of how practice departments are employing practice plans, within schools/colleges of pharmacy.MethodsA 25‐item survey was distributed via email. Eligible respondents were pharmacy practice department chairs at United States‐based colleges/schools of pharmacy. Descriptive statistics were used to characterize workload allocations, direct patient care activities, and billing/reimbursement trends among practice faculty.Measurements and Main ResultsSurvey respondents included 43 institutions (32.6% institutional response rate) representing 1241 practice faculty and nearly 800 faculty involved in direct patient care activities. Faculty at private institutions tended to have a higher degree of effort in direct patient care (26.3% vs 4.3%) and were more involved in billing for services in the clinic setting, when compared with public institutions. Although Collaborative Practice Agreements were widely utilized, very few institutions employed practice revenue plans.ConclusionThe findings of our study indicate that pharmacy practice faculty provide significant effort in direct patient care that is critical to advancing the profession. These faculty practicing in primary and ambulatory care settings serve as role models to our student trainees, particularly in value‐based care settings. However, practice plan payment models appear to be rarely utilized. Failure to account for and recognize these valuable direct patient care activities may adversely impact the financial sustainability of schools and colleges of pharmacy in the future.

Patient Service Utilization Among Individuals with Co-occurring Disorders: A Comparison of Two Models of Care Coordination.

Healthcare systems have increasingly adopted integrated care models with demonstrated effectiveness. However, few studies examine integrated care for individuals with co-morbid mental illness and medical conditions. This quasi-experimental study compared service use for two integrated care models for patients with co-occurring conditions. We used hierarchical negative binomial and logistic regressions with random effects to test the relationship between integration and service use. Patients treated at co-located agencies had significantly higher odds of inpatient hospitalization compared to those in fully integrated settings. Additionally, some comorbidities had significantly different levels of service use. Patients at co-located agencies had more outpatient and emergency visits, but was not statistically significant. Our findings provide evidence that the model of care may impact service use for patients experiencing co-occurring conditions, however, variations in service use for specific co-morbid conditions highlight the need to examine the specific needs and characteristics of this population.

Use of Telemedicine in Care of Hematologic Malignancy Patients: Challenges and Opportunities.

Purpose of ReviewFor nearly 20 years, oncology specialty practices have been working to integrate telemedicine technologies into standard patient care models. However, hematology practices have been slower to adopt telemedicine due to traditional care models that rely on interdisciplinary regional care centers and their ability to provide comprehensive and centralized services. Patients have traditionally been able to access high-quality medical care, diagnostics, supportive care, and clinical trials from these regional care centers, but they are required to attend frequent in-person visits to access these services. Rural and underserved patients experience more barriers than their urban counterparts to access the same level of care.Recent FindingsThe COVID-19 pandemic has elevated telemedicine into the forefront of care, highlighting both promise and limitations to incorporating telemedicine into specialty hematology care.SummaryHematologists should consider the benefits of incorporating telemedicine technologies into standard-of-care practices to promote patient-centered care and provide equal access to all patient populations.

Pharmacists' role in buprenorphine management for opioid use disorder: A narrative review

AbstractThe continued rise in patients treated for opioid use disorder (OUD) has called for an increase in access to OUD therapies. Pharmacists, who have previously demonstrated their value in various disease states, have begun to address gaps in OUD care by facilitating buprenorphine treatment. The objective was to review current literature and characterize the pharmacists' role in buprenorphine collaborative care models for patients with OUD. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were queried through May 2021. Studies were included if a pharmacist was part of a care model in which buprenorphine was prescribed for OUD and excluded if there was a pain management indication, a limited pharmacist role, or a survey methodology was used. Eight care models were included in this review. Key characteristics identified were (1) pharmacist role, (2) collaborating prescriber type, (3) clinic setting, (4) pharmacist practice type, and (5) outcomes. All models were located within a variety of outpatient settings. No collaborative practice model involved autonomous buprenorphine prescriptive authority by pharmacists. The majority utilized a psychiatrist as a collaborating prescriber, alongside a psychiatry‐trained pharmacist. Less than half utilized pharmacists to make dosing recommendations. Outcomes evaluating treatment retention and relapse rates were most reported. Most outcomes identified across each model were either improved or unchanged by pharmacist involvement. Pharmacists are valued members of buprenorphine care teams across a variety of settings, collaborate with various clinicians, and have a positive impact on patient outcomes such as treatment retention and relapse. Few published collaborative care models exist, suggesting pharmacists may be underutilized in caring for this growing patient population. The role of the pharmacist in buprenorphine management is not currently well‐defined; however, pharmacists are well prepared to take a more active role to help address the opioid crisis.

REASONING OF THE IMPROVED MODEL OF SURGICAL CARE FOR PATIENTS WITH THYROID PATHOLOGY

The aim of the study was to substantiate the improved functional and organizational model of surgical care for patients with thyroid pathology based on a multidisciplinary approach. Materials and methods. A systematic analysis of the incidence of thyroid pathology in the population, recommendations of international experts, data from international and domestic scientific sources on the topic, results of own research on the basis of the Municipal non-profit enterprise "Kyiv City Clinical Endocrinology Center" in 2019-2021 was carried out; conceptual modeling; graphic.Results. The high incidence of oncological diseases in the population, in particular, of the thyroid gland, and the risks of postoperative complications during surgical treatment led to the introduction of a multidisciplinary approach, which involves the integration of knowledge and skills of specialists of various disciplines through close cooperation and communication. In Ukraine, a multidisciplinary approach has not been implemented. An improved functional-organizational model of surgical care for patients with thyroid gland pathology was substantiated, the innovative elements of which were: patient-orientation; a multidisciplinary team of specialists as a freelance functional and structural unit of a health care institution; strengthening of interaction between secondary and primary health care institutions, outpatient and inpatient stages; improvement of regulatory and legal regulation of the interdisciplinary approach at the sectoral, regional and local levels, involvement of specialized associations of doctors and public organizations of patients in its introduction.Conclusions. The introduction of a multidisciplinary approach as an innovative organizational technology of clinical activity at the system level is substantiated.

Intestinal ultrasound as first-line investigation in low-risk gastrointestinal symptoms: a new model of care.

Functional gut disorders (FGD) are common. Diagnosis is symptom based, although symptoms may be indistinguishable from inflammatory bowel disease. As a result of this, investigations are common, diagnostic yield is low. A streamlined novel model of care may reduce costly investigations. To compare a new model of care for patients with low-risk gastrointestinal symptoms to a matched historical cohort. Data were prospectively collected over 12 months. General practitioner referrals for low-risk abdominal symptoms were triaged to a new multidisciplinary clinic structure utilising intestinal ultrasound. Outcomes were compared to the historical model in the preceding 12 months. Duration of care (time from referral to discharge), number of contact episodes and investigations ordered were reviewed. Thirty-seven patients meeting strict inclusion criteria completed their care. Compared with the historical cohort, colonoscopies reduced from 0.7 to 0.05 per patient (P < 0.0001). Gastroenterology consults reduced from 1.5 to 1.2 (P = 0.303) and dietitian review increased from 0.8 to 1.5 (P < 0.0001). Total contact episodes reduced from 3.2 to 1.8 (P < 0.0001). Duration of care reduced from a median of 252 days to 130 days (interquartile ranges (IQR) 287 and 69, respectively; P < 0.0001). Time from first consultation to discharge reduced from 125 to 42 days (IQR 188 and 63; P < 0.0001). This multidisciplinary approach to care of low-risk abdominal symptoms significantly reduced contact episodes, time in care and invasive investigations. It decreased costly gastroenterology consultation and increased allied health exposure. It demonstrates improved health service outcomes.

Australian general practitioners’ perceptions of the barriers and opportunities for community-based care of patients with viral hepatitis: a mixed methods study.

Introduction Engagement of general practitioners (GPs) is essential to improving rates of diagnosis and treatment of viral hepatitis, as traditional tertiary hospital-based models of care often face challenges. Aim We investigated Australian general practitioners' perceptions of a community-based model of care for patients with viral hepatitis. Methods We conducted a mixed methods study using survey questionnaires (23 GPs) and an open-ended interview guide (10 GPs) at primary care clinics in Brisbane, Queensland, Australia. Quantitative data were analysed using descriptive statistics in Stata 15.1 and qualitative data were analysed using thematic analysis following an inductive approach. Results Patient loss to follow up and high cost of diagnostic tests were identified as the biggest challenges to providing care for patients with viral hepatitis. Most GPs interviewed believe a more community-based model of care with support to GPs may improve uptake of care and increase both GP and patient engagement. General practitioners felt a community-based model of care could also improve viral hepatitis testing and follow-up rates. Discussion For Australian GPs, improving patient retention and diagnostics access were key pressure points in the viral hepatitis care pathway. A broader and more profound capacity-building allows community-based viral hepatitis care to be sustainable.

Systematic Review and Meta-Analysis Program Based on Effectiveness of a Multidisciplinary Model of Care for Patients with Chronic Kidney Disease.

The effectiveness of the multidisciplinary nursing model in the nursing of chronic kidney disease (CKD) by using meta-analysis is explored. Relevant literatures that are in line with the multidisciplinary nursing model for CKD intervention are searched and screened from domestic and foreign literature databases such as Wanfang Medical Center, CNKNET, VIP, and PubMed, and Meta-analysis is conducted with RevMan 5.2 software. A total of 6 literatures are included, and the publication bias of the included literatures is low. Meta-analysis shows that the multidisciplinary group had a better Hb compliance rate, Hb level, Scr, eGFR, SBP, and DBP than the traditional group. The experimental results show that multidisciplinary nursing intervention can improve the nursing effect of patients with CKD and help to improve Hb, Scr, blood pressure, and glomerular filtration function of patients.

Clinical Effect of Intelligent Emergency Nursing Mode in Patients with Severe Traumatic Brain Injury

Objective: Severe traumatic brain injury (sTBI) is one of the common acute and critical diseases in neurosurgery. So we aim to explore the clinical effectiveness of an intelligent emergency care model in patients with severe traumatic brain injury. Methods: Eighty patients with severe traumatic brain injury (sTBI) who were treated in Zhuji People’s Hospital of Zhejiang Province from January 2019 to December 2021 were selected as the study subjects. The patients were divided into an observation group and a control group with 40 patients in each group according to the random number table method. Patients in the control group received conventional first-aid nursing mode intervention, and the intelligent emergency nursing mode was used for the observation group based on the control group. Comparisons were conducted between the two groups on the time of arrival to the emergency room, the time from the emergency room to the operating room, Glasgow Coma Scale (GCS) score before surgery, GCS score when leaving the Intensive Care Unit (ICU), the average length of ICU stay, the average length of hospital stay, the total hospital costs. Results: The time of arrival to the emergency room, the time from the emergency room to the operating room, the average length of ICU stay, the average length of hospital stay, and the total hospital costs in the observation group were significantly lower than those in the control group, and the differences were statistically significant (All P < 0.05). At the same time, the GCS score before surgery and the GCS score when leaving the ICU of the observation group was better than the control group, and the difference was statistically significant (P < 0.05). Conclusion: Intelligent emergency nursing mode can shorten the time of sTBI rescue, the length of ICU stay, and the average length of hospital stay, reduce the total hospitalization cost, improve the prognosis, with good efficacy, reduce the total cost of hospitalization, and improve the prognosis with better efficacy.

Secondary Data Analysis of Tuberculosis Deaths in Bulawayo Province, Zimbabwe, 2016-2019

Background: Tuberculosis is a leading cause of death globally, and the third leading cause of death in Zimbabwe. Death from any cause following a diag-nosis of tuberculosis is classified as a tuberculosis death. Bulawayo Province reported high tuberculosis death rates from 15.3% in 2016 to 14.2% in 2019 against a threshold of 5%. We analyzed tuberculosis deaths for Bulawayo Province to characterize patients dying and to make recommendations for im-proving treatment outcomes for susceptible tuberculosis cases. Methods: A descriptive cross-sectional study was conducted. We analyzed all (N = 469) records of tuberculosis deaths from 19/19 Bulawayo tuberculosis diagnosing centers from 01 January 2016 to 31 December 2019. Microsoft® Excel 2007 was used to generate graphs and Stata® version 17 was used to conduct chi-square tests for trends. Results: Males accounted for 278/469 (59.3%) of the deaths. The median age of death was 40 years (Q1 = 33: Q3 = 51). The proportion of TB deaths increased from 63/114 (55%) in 2016 to 57/90 (63%) in 2019 for males (p < 0.01). The majority of deaths 278/469 (59.3%) occurred in the intensive phase of treatment and anemia was a co-morbid condition in only 44/469 (9.4%) of the tuberculosis deaths. Testing for anemia was not rou-tinely done. Conclusion: High death rates particularly in the intensive phase, could be attributed to sub-optimal clinical care. Tuberculosis programs should work towards adopting differentiated care models for tuberculosis patients and developing algorithms for patients at high risk of death.

A Blockchain Based System for Healthcare Digital Twin

Digital Twin (DT) is an emerging technology that replicates any physical phenomenon from a physical space to a digital space in congruence with the physical state. However, devising a Healthcare DT model for patient care is seen as a challenging task as the lack of adequate data collection structure. There are also security and privacy concerns as healthcare data is very sensitive and can be used in malicious ways. Because of these current research gaps, the proper way of acquiring the structured data and managing them in a secure way is very important. In this article, we present a mathematical data model to accumulate the patient relevant data in a structured and predefined way with proper delineation. Additionally, the provided data model is described in harmony with real life contexts. Then, we have used the patient centric mathematical data model to formally define the semantic and scope of our proposed Healthcare Digital Twin ( <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">HDT</i> ) system based on Blockchain. Accordingly, the proposed system is described with all the key components as well as with detailed protocol flows and an analysis of its different aspects. Finally, the feasibility of the proposed model with a critical comparison with other relevant research works have been provided.

Predictive and prognostic impact of the different features of tumor budding in stage II colorectal cancer.

Tumor budding is a significant independent prognostic factor in colorectal cancer. Routine reporting of tumor budding is now advocated for in the colorectal cancer standard approach recommended by the International Tumor Budding Consensus Conference guidelines. However, the current tumor budding assessment system only emphasizes tumor budding quantity and ignores other features. Therefore, this study aimed to further determine the prognostic value of tumor budding based on a more comprehensive feature analysis. To this end, we conducted a retrospective pathology review of the different characteristics of tumor budding (that is quantity, structure, cell atypia, location, stromal reaction, and immunohistochemical phenotype) in 224 specimens of stage II colorectal cancer at our institution between 2009 and 2015. The mean age of the patients was 60.3±9.2 years (range, 39-84 years). Among various features of tumor budding, single-cell budding, anaplasia-like cell atypia, myxoid stroma, high tumor budding quantity, and loss of CDX2 expression were independent predictors of recurrence and mortality in patients with stage II colorectal cancer. Based on these results, we suggest that in addition to tumor-budding quantity, other tumor budding features play important biological roles in the development of colorectal cancer. Our findings provide prognostic information that could help with guiding clinical management and oncology care models for patients with stage II colorectal cancer.

Critical Care Resource Nurse Team: A Patient Safety and Quality Outcomes Model.

The Critical Care Resource Nurse Team (CCRNT) evolved from our traditional Rapid Response Team (RRT). The CCRNT is a unique paradigm created using the conceptual framework of the American Association of Critical Care Nursing Synergy Model for Patient Care. The goal of the CCRNT is to help align nurse competencies with patient needs. This team was seen as a much-needed strong clinical support by nursing leadership as large numbers of inexperienced new graduate registered nurses were hired and senior experienced nurses were leaving the workforce. The CCRNT supports 24/7 RRT, Code Blue, Code Stroke, Emergency Airway Response Team, Early Warning System, Medical Emergency Team, simulation team training, and bedside nurse support and mentoring. Coverage expanded from inpatient medical/surgical areas to all areas of the medical center and included hospital-wide initiatives. The focus for the CCRNT changed to a system-wide nursing and patient safety model to improve practice and intervene in near-miss events. This model improved communication between disciplines, provided critical surveillance of at-risk patients, supported patient safety with a significant decrease in patient mortality, and offered a 24/7 expert critical care nurse resource team for staff.

Improving Organizational Sustainability of an Urban Indian Health Clinic With an Innovative Pharmacy Model.

Introduction:To increase access to care for the urban American Indian population, a collaboration was developed between an Urban Indian Health Clinic (UIHC) and Federally Qualified Healthcare Center (FQHC) to reduce financial barriers, increase patient access to affordable medications, and augment the integrated model of care.Objective:To describe the design and implementation of an innovative pharmacy model through a partnership between an UIHC and a FQHC.Methods:A collaborative partnership between an UIHC and a FQHC was developed to spread scarce 340B federal resources as a method to enhance patient care. The innovative practice model included the development of processes to (1) increase medication access to all patients by providing access to affordable medications at clinic and the provision of mail order services, (2) minimize program expenses through cost-sharing of a pharmacist salary, (3) expand clinical pharmacy programs (collaborative drug therapy management) to augment integrated patient care, and (4) optimize 340B cost savings for the clinic by establishing contracts and implementing adjudication software to obtain medication reimbursement from Medicaid and other third party insurances.Results:Through the cost-sharing of a pharmacist salary and use of remote verification, the majority of prescription medications were available to patients at the UIHC through implementation and expansion of an other outlet. Collaborative drug therapy management (CDTM) protocols were successfully implemented which allowed clinical pharmacy services to collaboratively manage chronic conditions. All adult primary care providers adopted the integrated patient care model. Third-party pharmacy insurance contracts were obtained and computer software was installed to allow for the adjudication of pharmacy claims, resulting in cost savings from medication reimbursement.Conclusion:The innovative collaborative partnership between an UIHC and an FQHC demonstrated how scarce federal resources can be leveraged using the 340B program to increase patient access to affordable medications. This innovative model reduced financial barriers to the clinic, and allowed for expansion of pharmacist led CDTM programs and augmentation of integrated clinical services. The cost savings observed from this novel program additionally fueled programmatic sustainability through reinvestment into the pharmacy program and is expected to continue to fund the program in the future.

Results From the WAGR Syndrome Patient Registry: Characterization of WAGR Spectrum and Recommendations for Care Management.

WAGR syndrome is a rare genetic disorder characterized by Wilms tumor, Aniridia, Genitourinary anomalies, and Range of developmental delays. In addition to the classic features, patients affected by WAGR syndrome can develop obesity and kidney failure, and a wide variety of non-classical manifestations have also been described. This suggests that a broader phenotypic spectrum beyond the classic syndrome exists and here we demonstrate that spectrum using data from the WAGR Syndrome Patient Registry. In the present study, we collected information from 91 individuals enrolled in the registry to explore self-reported health issues in this patient population. A wide variety of common clinical issues not classically associated with the disorder were found, prompting the redefinition from WAGR syndrome to WAGR spectrum disorder to incorporate the phenotypic variations that occur. A comprehensive care management approach is needed to address the wide range of clinical issues and we propose a care model for patients affected by WAGR spectrum disorder. Further research is needed to solidify the breath of the phenotype and confirm the observations in this study to advance individualized patient care in this population.

COVID-19 triage in general adult in-patient psychiatry: perspectives from clinicians on a novel triage ward during the pandemic

SUMMARYIntra-hospital transmission of COVID-19 is a major concern. To mitigate this risk, ‘COVID-triage’ psychiatric wards were implemented by some in-patient service providers in the UK. Although the effectiveness of this model has not been investigated, there are questions about the benefits and detriments of this model of care for patients and staff. This reflection draws from the experiences of clinicians who were redeployed from their planned clinical posts (and training rotations, in the case of trainees) to staff a newly established COVID-triage ward at a large urban mental healthcare provider, between August 2020 and March 2021.

Evaluation of a novel pre-treatment model of nutrition care for patients with head and neck cancer receiving chemoradiotherapy.

Weight loss and malnutrition occur frequently in patients with head and neck cancer and are associated with reduced survival. This pragmatic study aimed to determine the effect of a novel pre-treatment model of nutrition care on nutrition outcomes for patients with head and neck cancer receiving chemoradiotherapy. This health service evaluation consisted of an evaluation of the new model of care implementation (Phase 1) and an evaluation of patient outcomes (Phase 2) in pre- and post-implementation cohorts (n=64 and n=47, respectively). All Phase 2 patients received a prophylactic gastrostomy. The new model of care consisted of dietary counselling and commencement of proactive supplementary enteral nutrition via a prophylactic gastrostomy, in addition to normal oral intake, prior to treatment commencement. Nutrition outcomes were collected at baseline (pre-treatment) and 3 months post-radiotherapy completion. The new model of care was successfully incorporated into practice with high referral (96.5%) and attendance (91.5%) rates to the counselling session, and high adherence rates to proactive tube feeding (80.9%). Patients in the post-implementation cohort had less weight-loss (1.2%; p=0.338) and saw less of a decline in nutritional status compared to patients in the pre-implementation cohort (23% vs. 30%, respectively; p=0.572), deemed clinically important. However, patients still experienced critical weight loss overall (mean 9.9%). Pre-treatment nutrition care was feasible in standard clinical practice and demonstrated clinically relevant outcome improvements for patients. Future high-quality research is warranted to investigate further multidisciplinary strategies to attenuate weight-loss further, inclusive of patient-reported barriers and enablers to nutrition interventions.

A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases

Brief Summary The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. Background Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). Objective To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. Design Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. Participants Five spanish centers including patients with AHLF at discharge or in out-patient clinics. Intervention Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. Main Measures Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. Results 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). Conclusions The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

Trauma-informed hospital security: a policy for intimate partner violence in a pediatric healthcare setting

Background: Increasing numbers of providers are adopting “trauma-informed approaches” in patient care models to address intimate partner violence (IPV), but most hospitals’ security policies and practices do not incorporate trauma-informed approaches. Pre-existing security culture and differing approaches to trauma-informed care necessitate policy-level interventions. To support the physical and emotional safety of IPV survivors within the hospital environment, the security leaders at our tertiary-care, inner-city pediatric hospital expressed the need for a trauma-informed IPV security policy.

67 A BLENDED MODEL OF CARE USED IN THE ROLLOUT OF AN EARLY SUPPORTED DISCHARGE FOR STROKE SERVICE DURING COVID-19

BackgroundThe Health and Social Care Professionals budget was augmented to develop rehabilitation services that facilitated hospital discharges. Early Supported discharge (ESD) for stroke is a proven model of best care for stroke patients with mild to moderate disability (Langhorne et al., 2005). A pilot was implemented with the team consisting of an Occupational Therapist, Speech and Language Therapist, Physiotherapist and Medical Social Worker.MethodsThe service facilitated an early discharge from the hospital with the delivery of specialist stroke rehabilitation in the home. Therapy is provided with the same intensity and expertise that would be received in hospital and is available for up to 8 weeks, it was provided using a blended model of domiciliary care and the introduction of telehealth in response to COVID 19.Data was recorded for 100 service users using an excel spreadsheet. Data was recorded to measure number of new referrals, length of stay, bed days released back into the hospital system, mode of service delivery and functional outcomes. A cost analysis was completed. Service user experience was captured using questionnaires.ResultsFrom September 2020 to July 2021, 100 patients accessed ESD with a reduction of 7.2 days in hospital stay per patient. Improvements in pre- and post- rehabilitation scores on the FIM/FAM were evident. Very positive feedback regarding the rehabilitation experience was captured within the patient satisfaction questionnaire. Therapy delivery was 60% face to face, 37% via telehealth and 3% outpatient appointments. Telehealth received good compliance but with varying reports of experience in comparison to face to face.ConclusionESD provided in the home environment facilitated earlier discharge from hospital with positive outcomes for the hospital and service users. Telehealth ensured that rehabilitation was maintained throughout the pandemic. Telehealth increased access for patients residing outside of the catchment area. However service user preference remains face to face.