| Popis: |
Background The WHO recognises several specialist rehabilitation provision models; in-patient, outpatient and outreach. Intensive early neurorehabilitation is required after severe Acquired Brain Injury (ABI), usually necessitating in-patient care. In the UK, children receiving specialist neurorehabilitation often remain in-patients for long periods because of the lack of appropriate out-of-hospital provision. Aims To explore feasibility and funding implications of developing a regional specialist neurorehabilitation outreach service to facilitate earlier discharge. Methods Analysis of data on children receiving in-patient neurorehabilitation at a paediatric Regional Neuroscience Centre (RNSC), 2014–2018. Information concerning therapy provision was obtained from Trust Clinical Information System Suite (CISS). Patient dependency and rehabilitation complexity was assessed by Rehabilitation Complexity Scale--Extended (RCS-E), scored by multi-disciplinary team (MDT) at weekly meetings over 15 months. For modelling purposes, a specialist neurorehabilitation outreach tariff equating to 50% in-patient tariff was assumed. Data analysis was undertaken by linear programming model (XpressIve©) and Discrete-Even Simulation (Simul8©).Various eligibility criteria for outreach provision were modelled: 1) needing >1 therapies Results 156 children received neurorehabilitation as in-patients over 4 years. Mean age=7.34 years (range 0.1–17). 66 (55%) were male, 53 (45%) female. 84% had ABI, others acquired spinal injury, acute polyneuropathy or somatisation disorders. 52% lived >40 miles from RNSC, 47%>60 min’ drive away. 49% were inpatients 1–28 days; 34%, 29–84 days; 18, 85–168 days; 6,>168 days. Patients showed significant functional improvements between admission to neurorehabilitation and discharge (p Conclusion Modelling supports the feasibility and affordability of specialist neurorehabilitation outreach provision, although efficacy remains uncertain. |
