Rehabilitation for a Million Hospital as a Proactive Interface to Community Rehabilitation

Transcription

1 Rehabilitation for a Million Hospital as a Proactive Interface to Community Rehabilitation DrEddie SL CHOW MBBS(HK), MMED(Syd), MMED(NSW), MRCP(UK), FRCP(Edin), FHKCP, FHKAM(Medicine) Consultant Rehabilitation Physician Department of Medicine and Geriatrics, TuenMunHospital, Hospital Authority, HKSAR

2 The Work-Force Tuen Mun Hospital Rehabilitation Block (TMHRB) A designed capacity of 520 beds. Current M&G Beds : 319 beds

3 The Workforce Designated Rehabilitation Team with Specialists in rehabilitation A diverse spectrum of expertise collaboration: 1. Rehab Specialists with expertise in exercise physiology, acupuncture, osteoporosis, sex therapy & work rehab. 2. Collaboration with Geriatricians/ Cardiologist/Resp Physician/Renal Physician/Neurologist /Rheumatologist etc.. Neurosurgeons Orthopaedic Surgeons Paediatricians AH professionals

4 New Territories West Cluster

5 Service Demand in NTWC 新界西聯網服務需求 In Tuen Mun, Yuen Long & Tin Shui Wai Population ~1.1 million 服務屯門 元朗及天水圍 1,100,000 人口

6 A HUGE in-patient medical rehabilitation demand Requiring.. A close service linkage, and.. to sustain the high output.

7 The System Acute In-patient Rehab Community Rehab

8 Floor Based Rehabilitation 9/F Visceral Rehab 10/F Neuro Rehab 11/F Musculoskeletal Rehab

9 Service integration : Stroke/ NeuroReh NeuroSur R10 NeuroReh Floor Team 1 Team 2 Team 3 F1 F2 A5 C9 ASU A10 B10 C9 D9 C10 C10 C9 CCU/CCL GDH T10 MB - Acute GDH RB Subacute

10 Service integration : Visceral Rehab (Card/Resp/Renal) Team 1 Team 2 Team 3 F1 F2 Cardi C9 B6 A10 B10 C9 Resp Renal C10 C9 CCU/CCL GDH T10 MB - Acute GDH RB Subacute

11 In-patient programs Integrated patient care plans (IPCP) COPD care program (CCP) COPD rehabilitation program (PRP) Rehabilitation Stroke Unit (RSU) NeuroSurgical-Med-Rehab Collaboration (Pilot)

12 A HUGE in-patient medical rehabilitation demand Requiring.. A close service linkage, and an extensive community support network.. to sustain the high output.

13 The System Acute In-patient Rehab Community Rehab Community Rehab Community Rehab Community Rehab Community Rehab

14 The Hardware Day rooms and Integrated Rehab Areas at each RB floor

15 Day Activity Room 活動室 Integrated Rehab Area (PT & OT) 綜合治療室 ( 物理治療及職業治療 ) 17

16 The Hardware Day rooms and Integrated Rehab Areas at each RB floor For rehabilitation services catering both in-patient and out-patient rehab patients. As an interface activity centre for in-reaching community partners For multi-disciplinary training and patient meetings.

17 The Software As a Platform for Community Rehabilitation For In-patients to transit to the community.. To facilitate community partners to join in Community partners as a team member Multi-community partner collaboration TMH RB Comm unity Rehab Comm unity Rehab Comm unity Rehab Comm unity Rehab Comm unity Rehab

18 Our Community Rehabilitation Partners CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

19 Cardiac Rehabilitation Neuro-Rehabilitation

20 NTWC Cardiac Rehabilitation Program

21 Acute Hospital Heart Attack Emergency Dept Hospital In-Patient Rehab (CRP1) Commun Community Rehab CRP3/4 CRP3/4 Hospital Day-patient CRP2 24

22 Traditional Hospital-based Cardiac Rehabilitation Classical Simple Safe Control Treatment Compliance Established effectiveness Hospital Rehab CRP 2 26

23 Drawbacks Cost Hospital manpower Vs facilities Patient fees Priority Traditional Hospital-based Safety Issues: Infection Control Accessibility (time, place, person) Patient role Cardiac Rehabilitation Treatment Vs Habits/Hobbies/Enjoyment Post- treatment maintenance Hospital Rehab CRP 2 27

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25 TMH Cardiac Rehabilitation NTWC Cardiac Rehab Program CRP Phase 1 (CCU): Preventive education and rehabilitative services to hospitalized patients following an index CVD event, such as an MI/acute coronary syndrome; CRP 2 (Hospital-based Day-patient Supervised Training) Medically-supervised Exercise-based training and education. CRP 3 (Community-based Supervised Training) Professionally-supervised Exercise-based training in the community setting CRP 4 (Community-based Long-term Maintenance Unsupervised Training) The incorporation of exercise into daily lives with long-term maintenance 29

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27 OUR BIG FOUR NTWC Cardiac Rehab Program CRP Phase 1 (CCU): Preventive education and rehabilitative services to hospitalized patients following an index CVD event, such as an MI/acute coronary syndrome; CRP 2 (Hospital-based Day-patient Supervised Training) Medically-supervised Exercise-based training and education. CRP 3 (Community-based Supervised Training) Professionally-supervised Exercise-based training in the community setting CRP 4 (Community-based Long-term Maintenance Unsupervised Training) The incorporation of exercise into daily lives with long-term maintenance 31

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29 Drawbacks Cost Hospital-based rehabilitation Hospital manpower Vs facilities Patient fees Priority Safety Issues: Infection Control Accessibility (time, place, person) Patient role Treatment Vs Habits/Hobbies/Enjoyment Post- treatment maintenance The use of partial hospital resources to run the full service Patients pay the same fees and then lower fees afterwards 33

30 Drawbacks Cost Hospital-based rehabilitation Hospital manpower Vs facilities Patient fees Priority Safety Issues: Infection Control Accessibility (time, place, person) Patient role Hospital can maintain priority services without jeopardizing CRP services Treatment Vs Habits/Hobbies/Enjoyment Post- treatment maintenance Less infection risk in the community 34

31 Hospital-based rehabilitation Drawbacks Cost Hospital manpower Vs facilities Patient fees Priority Safety Issues: Infection Control Accessibility (time, place, person) Sick role Elimination Treatment Vs Habits/Hobbies/Enjoyment Post- treatment maintenance Enhanced accessibility: Opening hours (staff/gym) / locations (city centre) 35

32 Cardiac Rehabilitation Does it work? the medical parameters Leung KC, Chow E et al 2006 Chow E, Chung MC, Fong CH et al 2007 and

33 Summary (c/w other reports) SBP 6mmHg (Vs 3-4mmHg) Risk Factor control 2 DBP 1mmHg (NS) BP targets (140/90) achieved in 75%/91%. (Vs 2-3mmHg) Match (or exceed) international audit practice/ requirement / standards Quit Smoking 87% 96% (Vs 76% 92%) Mood and QoL Improved (inconsistent) 39

34 What afterwards The medical parameters seemed acceptable.. Can we do better? Patient Behaviour Parameters the incorporation of healthy life style into daily lives Exercise Habits / DM Mx/ BP Mx. 41

35 Psycho-Cardiac Rehabilitation 活出新 心 Collaboration with NGO (Community Rehabilitation Network) Cognitive-Behavioral Therapy Self-Disease Management (CDSMP) 42

36 Psycho-Cardiac Rehabilitation 活出新 心 44

37 What afterwards The medical parameters seemed acceptable.. Did we do better? Patient Behaviour Parameters the incorporation of healthy life style into daily lives Exercise Habits / DM Mx/ BP Mx. 45

38 Drug Survey (post CRP) 97.3% 97.3% 97.3% 100% UK-ben chmark NTWC UK 90% 96% 95% 94% 93% 85% 80% 80% 80% 60% antiplatelet agent lipid lowering agent Betablk or ACEI/A2R (IHD) (IHD) (CHF) 48

39 Expected Outcomes 1. Drug Therapy Better coverage 2. Exercise Capacity 3. BP Home BG Monitoring 4. Lipid Profile 5. DM HBGM / DM Screening 6. Body Weight 7. Smoking 8. Mood and QoL 9. Physical Activity Time More 54

40 NTWC Cardiac Rehabilitation Program A Multi-NGO Collaboration Model in Cardiac Rehabilitation Safe cost-effective good outcome quality. sustainable.

41 Acute Hospital Hobbies / Habit Emergency Dept Hospital In-Patient Rehab (CRP1) Commun Community Rehab CRP3/4 CRP3/4 Hospital Day-patient CRP2 58

42 Neuro-Rehabilitation

43 Neuro-rehabilitation Close Liaison and service flow with acute neurology units Community Rehab starts in in-patients Close & Extensive Community Rehab Support. Acute In-patient TMH RB Rehab Comm unity Comm unity Rehab Comm unity Rehab Comm unity Rehab Comm unity Rehab

44 In-patient Rehabilitation Starts with Community Rehab CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

45 In-patient Rehabilitation Starts with Community Rehab CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

46 Community Programs Collaboration with NGOs Stroke Interfacing Program Partnership with Community Rehab Network (NGO) & HK Stroke Association (Patient Group) Sharing the rehabilitation experience by volunteers of stroke victims and their carers. Introduction of Community Rehabilitation Resources

47 Introduction of Community Rehabilitation to in-patients To the pt/family and the team In-patient rehab is the initial part of rehabilitation ONLY... NOT the whole process. To prepare our patients to enter the next stage of rehabilitation.. in the community.

48 Introduction of Community Rehabilitation to in-patients To our patients You are not dying, You can survive & go home You can recover.. Just like those who come back today. Later when you go home, you can (and are expected to) contribute to the society.... Just like those who visit you today.

49 Community Rehabilitation Starts in in-patient phase CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

50 TMH-YOT Integrated Acupuncture Service for Rehab patients To provide a safe platform for trial of TCM acupuncture service for rehab patients. Expertise (in Chinese and Western Medicine Acupuncture) Safe Transition Screening and Triage to Continuous Communication Community TCM Acupuncture Services

51 Community Rehabilitation CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC

52 Community Rehabilitation CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC

53 Out/Day-Patient Rehab Service 門診及日間病人康復服務 M&G Rehab Ambulatory Service 內科及老人科日間服務 Rehab Specialist Clinic 康復專科門診 Brain Injury Clinic (BIR) 腦創傷診所 Visceral Rehab Clinic (VIR) 官能康復診所 Spasticity, Musculoskeletal and Pain Rehab Clinic Extended Rehab Centre (ERC) 延展康復中心 Cardiac Rehab Program / Visceral Rehab Program 心臟 / 官能康復計劃 Work rehab service for cardiac patients 心臟病人職能康復服務 Osteoporosis, Exercise & Rehabilitation Clinic (OER) 骨質疏鬆運動及康復診所 Special Rehab Clinic (SPR) 特別康復診所 Advanced Rehab Services Cognitive / Work Rehab Services Driving/Work Rehab Services

54 HA Support after Discharge Geriatric Day Hospital CGAT Community Geriatric Assessment Teams Integrated supported discharge program (IDSP) Community Nurse/ Physio/ Occupational services Out-patient Allied Health services.

55 Community Rehabilitation CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

56 Community Rehabilitation CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

57 Community Rehabilitation CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)

58 The Neighbourhood Advice-Action Council (NAAC) NT West Community Rehabilitation Day Center (CRDC) 75

59 CRN 社區復康網絡 Stroke Interfacing Program 中風分享會 Thank You PLK / NAAC Home Care Service Patient visiting Program by previous Stroke Patients/ Patient self-help groups TMH Rehab Centre NAAC 鄰舍輔導會 Community Rehabilitation Day Center To Our Team Of Community Rehab Partners 社區日間康復中心 YOT 仁愛堂 In-reaching Acupuncture Service 結合針灸服務 Advanced Rehabilitation Vocational Rehab (VRRC)