CBRTs in Queensland

1
CBRTs in Queensland

• A new way of delivering rehabilitation?

2
Locations

• Community based rehabilitation teams established
  under the stroke election commitments 2004 (and
  funded under this pool)
• Based at the following locations
• Logan
• Redcliffe/Caboolture
• Sunshine Coast (Caloundra and Nambour)
• Mackay (also cover Sarina and Proserpine)
• Fraser Coast (Hervey Bay and Maryborough)

3
Additional CBRTs established at

• QEII Hospital (Southside Health Service District)
  
• Brisbane North Community Health (Northside Health
  Service District)
• Supported financially through districts

4
New team

• Gold Coast have recently announced they will be
  establishing a new team.

5
Models Community Rehabilitation vs Community
Based Rehabilitation

• The literature says.
• CBR is largely about community development (more
  common in developing countries) while CR is about
  rehabilitation delivered in a community setting
• General lack of consensus on model
• Griffith University, 2006 suggests that the
  major difference between CR and CBR is the
  extent to which the process is Consumer-driven
  and based in grass roots foundations

6
What was proposed for QH

• Specialist, multi-disciplinary stroke
  rehabilitation in the community, post acute
  rehabilitation
• Support from rehabilitation specialists
• Database that captures information on
  interventions and patient demographics
• Carer also to be supported in process

7
What we have

• No one clear model for CBRTs
• Variations in
• Types of services and clientele
• Governance
• Resourcing offered from district
• Integration with other district services (i.e day
  therapy, Transition Care
• Recently implemented database

8
Governance

• CAHS was sponsor of the Stroke Election
  Commitments
• CBRTs have no single point of accountability or
  professional support within organisation
  (districts only line manage)
• CBRT Steering Committee set up late last year to
  try to address this. Restructure announced.
  Likely to be co-ordinated form Policy, Planning
  and Resourcing Division

9
Client Eligibility

• Medically stable.
• Clients with a diagnosis of stroke
• As time permits other frail aged /or clients
  with neurological conditions or multi-trauma
  orthopaedics (full weight bearing clients only)
  will be considered
• Community dwellers or those living in hostel
  level of residential care
• Potential for functional improvements / gains
  from allied health input
• Client is aware of referral and agreeable to
  participate in the program

10
Referrals

• While a referral to a CBRT must come from a
  medical practitioner, patients can be referred to
  the service from acute hospital wards, inpatient
  rehabilitation units, or directly from the
  community

11
Interventions

• Type
• Individual
• Program
• Location
• Centre Based
• Domiciliary
• Community

12
Also run clinics.

• For example
• Balance clinics
• Education programs for stroke survivors and
  carers
• Risk Factor Modification Education program
• Amputee clinics
• weekly circuit programs of exercises activities
  
• Aquatic Therapy
• Second Skin Clinics
• Stroke Support Meetings
• Provide support for local support groups
  Stroke, Parkinsons disease, Multiple Sclerosis,
  etc

13
Team profiles

• Team Leader
• Occupational Therapist
• Physiotherapist
• Therapy Assistant
• Dietician
• Social Worker
• Nursing
• Speech and Language Pathology
• Rehabilitation consultant (only some teams)

14
Outcome Measures

• Was AUSTOMS
• Teams have piloted three measures for
  consideration as core measures
• WHOQoL, Frenchay and HACE (Home and Community
  Environment)
• Compendium of measures for community
  rehabilitation
• http//qheps.health.qld.gov.au/cpic/documents/Stro
  ke/comp_tandm_rehab.pdf

15
Data

• Need to standardise business rules and data
  definitions
• Agree on core outcome measure to enable
  comparison within and across teams

16
Evaluation

• Evaluation of CBRTs currently underway
• To be completed by end September
• Will inform next steps for CBRTs