Evolution of a model: Creating stroke rehabilitation quality in community settings
Authors: Jeanne Bonnell, Theresa Grant
Introduction: Numerous health report cards in Ontario highlight geographical inequities in relation to stroke rehabilitation access and outcomes. These gaps necessitate development and evaluation of care models that bring stroke rehabilitation closer to home for people living in smaller communities. The Champlain Local Health Integration Network has established a community-based stroke rehabilitation model to deliver specialized services in the Stormont, Glengarry, Dundas and Akwesasne (SDG-A) and more recently in Renfrew County (RC) where people had with no previous access to outpatient stroke rehabilitation.
Methods: Specialized Interdisciplinary rehabilitation was delivered through a flexible model that allowed for both home and community clinic visits over a period of 8-12 weeks post hospital discharge. Operating procedures included regular team rounds, patient conferences and liaison with primary care. Innovations included the adoption of in-home technologies: Jintronix - a game-based platform in which a therapist recommends exercises and levels, and then can monitor performance and adjust programming remotely, and iPads - primarily used for Speech and Language home programming between visits but can also be used for remote visits in rural areas.
Results: In SDG-A, a total of 76 patients were referred over 12 months and received 25 therapy sessions (mean) each. Between admission and discharge, mean Canadian Occupational Performance Measure (COPM) scores improved by 3 performance and 3 satisfaction points on a 10 point scale. Reintegration to Normal Living Index (RNLI) scores revealed a mean improvement of 11% on a 110 point scale. Depression screening with Patient Health Questionnaire 9 (PHQ-9) indicated that fewer patients were at risk of depression at discharge as indicated by a mean drop of 4 points on the 10 point scale. All outcomes surpassed clinically important difference values indicating a positive effect. Since expanding to RC in April 2018, 42% of all referrals have been diverted from in-patient rehab services, resulting in cost savings.
Conclusion: This model of community based rehabilitation was found to be feasible to deliver, and effective. Prioritized next steps involve enhanced integration of hospital and community care stroke teams and expansion.