FROM HOSPITAL REHABILITATION INTO THE COMMUNITY LESSONS FROM AFAR - PowerPoint PPT Presentation

FROM HOSPITAL REHABILITATION INTO THE COMMUNITY – LESSONS FROM AFAR Dr. Peter Wright

CONTENT 1. Exercise – the miracle cure 2. Why rehab and exercise means a return of investment? 3. Comparison of international rehabilitation systems 4. Disease management programmes [DMPs]

EXERCISE - THE MIRACLE CURE THE KEY DOCUMENT WAS PRODUCED BY THE ACADEMY OF MEDICAL ROYAL COLLEGES IN 2015

CAD-MORTALITY AND FITNESS IN QUARTILES (NORWAY, 1960 MEN, 40-59 YEARS, 16 FOLLOWING YEARS) 1 4 = lowest fitness 0 4 1 = highest fitness 8 3 Cumulation [%] 6 2 4 1 2 0 2 4 6 8 1 1 1 1 0 2 4 6 [years] SANDVIK et al. (1993)

EFFECTS OF AN ENDURANCE TRAINING ON THE O 2 -CONSUMPTION OF THE MYOCARDIUM IN CARDIAC PATIENTS 3.0 2.5 V O2 ( l min - 1 ) 2.0 1.5 40 myok. V O2 ( ml min -1 100g - 1) . 1.0 30 0.5 0.0 Angina Pectoris Threshold 20 in CHF . 10 0 0 25 50 75 100 125 150 Schulz 2005 workload (Watt)

STRENGTH TRAINING AFTER CARDIAC TRANSPLANTATION: EFFECT ON MUSCLE MASS (BRAITH, MSSE 30:483-89 1998)

EFFECTS OF A STRENGTH TRAINING ON THE KNEE EXTENSORS IN 85-97 YEAR OLDS 11 Subjects (8 w, 3 m) 92 J. + 44% 12 weeks strength training male Dynamic maximal strength of the knee extensor +134% Muscle cross section +10% before after Harridge et al., Muscle Nerv 22, 831-839, 1999

REDUCTION OF MORTALITY RISK Type Intervention Reduction of Author relative Risk Mamma- Minimum 3x 1 hr 26-40% Holmes et al. Ca. moderate activity 2005 per week (9 MET s) Colon-Ca. Minimum 6x 1 hr 40-50% Meyerhardt et al. moderate activity 2006, 2007 per week (18 MET s) Prostate- Minimum 3x 1hr 61% Kenfield et al. Ca. intense physical 2011 activity per week

WHY REHAB & EXERCISE MEANS A RETURN OF INVESTMENT

DIFFERENT REHAB SETTINGS Definition of different rehabilitation measures • Ambulatory rehabilitation is a form of medical care provided on an outpatient basis. • Stationary or inpatient rehabilitation is a form of medical care for patients whose condition requires admission to a hospital or rehabilitation clinic. • Vocational rehabilitation measures are used to overcome barriers to maintaining or obtaining an employment relationship. Average duration of interventions Average duration of interventions Ambulatory rehabilitation 14.3 days (stdev. 7.4) Stationary rehabilitation 26.5 days (stdev.9.2) International Social Security Association 2017

OVERVIEW OF COUNTRY SPECIFIC SOCIAL SECURITY PARAMETERS (PERCENTAGE) Social security Temporary disability Permanent disability Country contribution rate on insurance benefit insurance benefit income 1 rate 2 rate 3 Austria 42.35 60 35 Canada 15.38 75 35 Chile 22.14 100 35 Finland 30.60 70 35 Germany 40.75 75 35 10.50 75 Indonesia 35 Italy 42.87 62.5 35 Malaysia 26.75 80 35 New Zealand 0.00 80 35 42.09 90 Poland 35 United States 15.90 66 35 Zimbabwe 7.00 51 35 Notes: 1. Retrieved from Retrieved from SSA and ISSA (2014a, 2014b, 2015a, 2015b); New Zealand is a special case without contribution collection since its programme is financed through general taxes. 2. See note 1. For Germany, Indonesia, Italy and Poland, the average of the two given values for the different providers of compensation payments was used. 3. Set by authors at 35 per cent, as most countries calculate benefits based on a variety of factors via a formula and do not provide average values. A survey of the empirical literature has shown, however, that permanent disability insurance usually recovers around 30 – 40 per cent of past earnings on average.

WHY REHAB WORKS FROM AN ECONOMICAL POINT OF VIEW Employer balance sheet Societal benefits Societal costs Increased productivity Decreased productivity (lost time) Social security balance sheet Social security benefits Social security costs Reduced work compensation Intervention costs (from expenditure short term questionnaire) Reduced work compensation Increased overtime costs expenditure long term Increased contributions Societal balance sheet Employer benefits Employer costs Increased productivity Decreased productivity (lost time) Reduced overtime costs Increased overtime costs Reduced recruitment costs

COST EFFECTIIVENESS International Social Security Association 2017

COMPARISON OF INTERNATIONAL REHABILITATION SYSTEMS

THE GERMAN REHABILITION PROCESS Schüle, K. (2013): Thirty years of physical activity in oncology in Germany — from the birth of the first rehabilitative cancer sports group until today. European Group for Research into Elderly and Physical Activity (EGREPA)

COMMUNITY BASED POLY CLINIC/REHAB CENTRE - ONE OF 1500 NATIONAL REHABILITATION CLINICS/HOSPITALS Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

A MULTI-DISCIPLINARY PRIMARY HEALTH AND REHAB APPROACH Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

XYZ Bio-psycho-sozialer Erklärungsansatz von Krankheit und Gesundheit

REHABILITATION – NORWEGIAN STYLE

AN EXAMLE OF REHAB FOR CHILDREN AND YOUNG ADULTS – NORWEGIAN STYLE Beitostolen-rehab hospital/Norway: https://www.youtube.com/watch?v=2MnwUQ2rfW4

Rehabilitation in Norway Structure of the Norwegian Health System:  Around 50 rehabilitation-hospitals in Norway (6 Nord; 8 Midt; 6 Vest; 30 Sør-Øst)  Every one has contracts with one or several Health-regions  Pathway of rehabilitation varies between the regions  Every institution is specialised on specific groups of diagnoses

REHAB – NORWEGIAN STYLE: ABILITY , NOT DISABILITY FOCUSED  In general groups are mixed  Specialist groups: – Active in the wheelchair (both for children and adults) – Children with MS – Muscular dystrophy (both for children and adults) – Blind – Children with dysmelia – Children with spina bifida

INTERDISCIPLINARY TEAMS Basic structure of the interdisciplinary team Overarching rehabilitation-team Medical specialists; nurses; riding instructors + assistants Children-section Adult-section Section leader/coordinator; 1 Section leader/coordinator; 1 Occupational therapist; teachers Occupational therapist 3 interdisciplinary teams that consist of 2 interdisciplinary teams that consist of (8-9 children per group): (15 clients per group): • 1 physiotherapist • 1 physiotherapist • 1 sports pedagogue/-therapist • 1 sports pedagogue/-therapist • 1 teamassitant or first year • 1 teamassitant or first year physiotherapist physiotherapist • 2-3 students in practical training • 2-3 students in practical training

DISEASE MANAGEMENT PROGRAMMES

WHAT ARE DISEASE MANAGEMENT PROGRAMMES? Disease management programmes (DMPs) are coordinated health care intervention programmes using interdisciplinary clinical teams , continuous analysis of relevant data , and cost ‐ effective technology to improve the health status of patients with treatable chronic diseases (e. g. asthma, diabetes, etc.). The design of a DMPs involves typically a certain number of disease management activities. According to the Disease Management Association of America (DMAA), these activities comprise “population identification processes, evidence-based practice guidelines; collaborative practice models, patient self-care management education as well as process and outcomes measurement” .

DO DMP WORK?

HOSPITALISATION RATE OF ALL TRAINING GROUPS VS. THE DIETARY AND THE CONTROL GROUPS Hospitalisation 100 Control Group 36% NTG (Dietary) 33.3% 80 Non hospitalisation rate [%] Training Group 15.4% 60 40 Control group Non training group 20 Training group 0 0 5 10 15 20 25 30 weeks Wright, 2012

SURVIVAL RATE OF ALL TRAINING GROUPS VS. THE DIETARY AND THE CONTROL GROUPS 100 Mortality Control Group 28% 80 NTG (Dietary) 5.6% Training Group 3.1% Survival rate [%] 60 40 Training group 20 Non training group Control group 0 0 5 10 15 20 25 30 weeks Wright, 2012

DMP – AN EXAMPLE Disease Management: a multi- or interdisciplinary model? Wright, 2012

REHAB INFRASTRUCTURE - EXAMPLE FOR A SMALL SIZE SOLUTION www.huruk.co.uk