September 3 (Wed.)
ORGANIZED CLINICAL MANAGEMENT SYSTEMS IN REHABILITATION
John L. Melvin, MD (Temple University, Philadelphia, USA)
Hospital based inpatient rehabilitation historically emphasized the care of individuals who experienced catastrophic events likely to result in long term disability. Their course led to new levels of function which tended to become stable approximately six months after onset. Often these episodes of rehabilitation care corresponded to the rehabilitation stays, but as pressure developed to reduce hospital costs, the stays became shorter. This suggests the need to have an organized system which assures expected outcomes after the episodes of care. These episodes of care may now include some combination of hospital rehabilitation, subacute nursing home rehabilitation, home care, day hospital, day care and outpatient care. The system must also function well enough to provide efficient and patient satisfying care.
Such a system requires several elements. (1) A patient based classification system which determines the needed site of care, and the appropriate care plan. (2) Clinical protocols which identify selected best practices for similar patients. (3) A database which contains sequential descriptions of the patients' status, and the major interventions they have received. (4) Predictions of resource use, and (5) Feedback which permits assessment of improvement expectations, and achievement of program goals.
The successful implementation of such plans will require significant development.