Future of Stroke Rehabilitation
Future of Stroke Rehabilitation
Future of Stroke Rehabilitation
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<strong>Future</strong> <strong>of</strong> <strong>Stroke</strong> <strong>Rehabilitation</strong><br />
Mark Bayley,MD, FRCPC<br />
Medical Director,<br />
Neuro <strong>Rehabilitation</strong> Program<br />
Associate Pr<strong>of</strong>essor,<br />
Dept. <strong>of</strong> Medicine,<br />
University <strong>of</strong> Toronto
<strong>Future</strong> <strong>Stroke</strong> Rehab Scenario<br />
• Its 2014!<br />
• Your intake coordinator emails you<br />
• the pr<strong>of</strong>ile <strong>of</strong> the new stroke rehab admission<br />
for today and the secure web-link to their EMR<br />
• The alpha FIM and their stroke severity score<br />
that indicates a projected length <strong>of</strong> stay is 20<br />
days.
<strong>Stroke</strong> Patient<br />
• 70 year old male lawyer who is an advocate for<br />
decriminalization <strong>of</strong> marijuana use and is a regular<br />
pot smoker but not tobacco<br />
• Has right hemisphere MCA stroke<br />
• Left-sided hemiparesis and neglect<br />
• Other risk factors- hypertension, peripheral<br />
vascular disease with claudication symptoms,<br />
COPD
Your first assessment<br />
• He tells you that he asked for your program<br />
because it is in the top 10 % <strong>of</strong> patient satisfaction<br />
on the Hospital report card. But…<br />
• He is concerned because your program FIM<br />
efficiency is in the lower quartile across Canada<br />
• Nevertheless he Googled your name and was<br />
pleased to see that you were teaching at local<br />
stroke conferences
Later that week<br />
• You are sitting in a meeting with your<br />
manager discussing this new prospective<br />
payment system that pays your program a<br />
set fee per stroke patient based on preadmission<br />
indicators such as FIM.<br />
• Things are going better and your program<br />
may be able to hire more therapists if you<br />
continue to improve<br />
• You are startled by the buzz <strong>of</strong> your<br />
Blackberry Gold
Email<br />
To: Therapist@rehabcenter.ca<br />
From: Ms C. Chong@gmail.ca<br />
• I heard at the peer support session today about<br />
mental practice. Would you can please email me<br />
the pod cast <strong>of</strong> mental practice instructions?.<br />
• I also concerned because he only had 60 minutes<br />
<strong>of</strong> therapy today and I read the Canadian<br />
guidelines that suggest a minimum <strong>of</strong> 2 hours. I<br />
am going to try to find the rehabilitation assistant.<br />
Talk soon!!<br />
MC
The <strong>Future</strong><br />
( The Opportunity And The Threats)<br />
• Medically complex patients<br />
• Increasing Accountability<br />
• Aging <strong>of</strong> a well informed, fairly wealthy<br />
population<br />
• Information Technology<br />
• Ongoing competition for Health Care $<br />
• Increasing Evidence for <strong>Rehabilitation</strong>
Graham et al
The Challenge In Front Of Us
<strong>Rehabilitation</strong> Providers need to adapt<br />
quickly to the Changes ahead<br />
Lets go Flying!!!
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