Alternate Level of Care (ALC)
Beyond Acute Care: Next Steps in Understanding ALC Days (March 2008)
This report extends the picture of Alternate Level of Care (ALC) beyond acute care and into rehabilitation hospitals with new 2008 survey data.
GTA Rehab Network ALC Survey 2006: Mapping the way to targeted solutions (November 2006)
The report provides information on the ALC survey conducted in February 2006, including: the approach used; the conclusions drawn from the data analysis; and the targeted solutions and implementation strategies that have been developed to reduce ALC days.
GTA Rehab Network ALC Subgroup Final Report: Development of Inpatient Referral Guidelines (July 2005)
The development of the Inpatient Rehab Referral Guidelines has resulted in the standardization of best practices for the inpatient rehab referral process to improve patient flow through the system. This is one of a number of initiatives led by the Network that contributes to smooth and efficient patient transitions from acute care to rehab.
Further to the recommendations set out in the GTA Rehab Network report, Analysis of Alternate Level of Care (ALC) Snapshots: Patients Awaiting Rehabilitation in ALC and Inpatient Rehabilitation Capacity (May 2004), a subcommittee of the ALC Task Group convened in the fall of 2004 to develop a set of guidelines for the inpatient rehabilitation referral process for use by both acute care and rehabilitation hospitals. This report summarizes the work of the ALC Subgroup and provides a detailed account of the approach used to develop the Inpatient Rehab Referral Guidelines, the results of the process evaluation and the recommendations submitted to the ALC Task Group.
Analysis of Alternate Level of Care (ALC) Snapshots: Patients Awaiting Rehabilitation in ALC and Inpatient Rehabilitation Capacity (May 2004)
Some patients in need of rehab following acute care face delays in accessing appropriate services. To better identify the types of patients affected and the factors contributing to these delays, the Network conducted five “snapshot” surveys of the patient populations in ALC beds awaiting rehab. The surveys were conducted throughout the GTA between April and September 2003. This report provides a detailed analysis of the snapshot data by individual regions of the GTA, aggregate information across the GTA, and organization type. The report concludes with a summary of the implications of these findings and recommendations to address the identified issues.
Geriatric Rehabilitation
Clarifying the Complexities of Inpatient Geriatric Rehab (February 2007)
Many elderly patients do not receive the rehabilitation they need. One of the reasons is a lack of consistent services and referral criteria among programs providing geriatric rehab. This report addresses this issue by providing standardized definitions for inpatient and outpatient geriatric rehabilitation that describe geriatric rehab services provided in various types of units and programs; delineating differential criteria for each type of service; and identifying key activities and the nature of the services provided.
Musculoskeletal (MSK)
Exploring the Applicability of the RNAO Best Practice Guidelines for Pain Assessment and Management in Hip Fracture Patients (November 2008)
The GTA Rehab Network, in collaboration with the Regional Geriatric Program of Toronto and researchers across the province, conducted a study designed to help clinicians evaluate and implement the RNAO Best Practice Guideline for Pain Assessment and Management through an innovative approach to knowledge translation. Funded by the Canadian Nurses Foundation (Nursing Care Partnership program made possible by a grant from the Canadian Health Services Research Foundation), the study focused on pain management in elderly hip fracture patients in the last 24 hours of acute care and the first 24 hours of inpatient rehabilitation.
Consensus and Collaboration in the Care of Hip Fracture Patients: Towards a Plan for the System (November 2006)
A new initiative to improve hip fracture care is moving forward thanks to funding from the Ministry of Health and Long-Term Care. The project, led by the Total Joint Network and supported by the GTA Rehab Network, will implement a new model of care for GTA hip fracture patients who are admitted to hospital from their home or a community setting. The new model combines a shorter length of stay in acute care with an earlier transfer to an inpatient rehabilitation setting. Once transferred, patients will receive an interdisciplinary rehab assessment and participate in a comprehensive rehabilitation program focused on both physical and cognitive functioning. Based on their response to treatment, patients' rehabilitation may continue in that setting, or they may be discharged to complex continuing care, long-term care or home. The model and the consultations related to it are summarized in this recent report of the GTA Rehab Network hip fracture committee.
Current Status and Future Opportunities for Inpatient Musculoskeletal Rehabilitation: An Analysis of Supply Data and Provider Viewpoints on Future Needs (June 2006)
This report reflects the system changes resulting from the new model of joint replacement care being implemented across Toronto. As such, it complements the GTA Rehab Network's earlier report, which provided a baseline snapshot prior to those changes. This report combines and analyzes data from stakeholders in the acute and inpatient rehabilitation sectors and the GTA Rehab Network's Rehab Finder database; and makes recommendations related to: (a) enhanced services for the elderly hip fracture population, especially those with concomitant cognitive impairment; (b) improved access to low tolerance, long duration rehabilitation beds; (c) the need for consensus around the key characteristics of a complex MSK patient such that service needs and resources can be matched; and (d) standardized definitions and programs for MSK rehab patients.
Exploring the Hip Fracture and Joint Replacement Landscape in a Changing Context: Implications and Recommendations (March 2006)
This report provides a snapshot of the system prior to recent system changes in Total Joint Replacement Care. It also provides a cross continuum look at the available data on supply and demand for hip fracture and joint replacement patients. The full report is accompanied by an Executive Summary as a stand alone document and a quick reference document.
Best Practices Across the Continuum of Care for Total Joint Replacement (July 2005)
What is the evidence in joint replacement care? What do patients want to know? What are we currently giving patients for education material? This report provides a review of over 270 publications on joint replacement care across the continuum, a review of education resources currently offered to joint replacement patients, and the results of a qualitative study with patients to understand what their information needs are. The report was completed for the GTA Rehab Network by research associates Leslie Soever and Crystal MacKay. This research has been generously funded by a grant from The Change Foundation and the Government of Ontario. The views expressed here do not reflect those of The Change Foundation or the Government of Ontario.
Leading by Design: Standardizing and Tracking the Information Used to Make
Decisions on Access to Rehab Services (May 2005)
This report summarizes the work of the GTA Rehab Network's Referral and
Response Form Task Group. The Task Group developed, piloted and
implemented a standardized rehab preadmission, referral and response form
for musculoskeletal patients. The forms are intended to improve access,
accountability and transparency through the referral process and provide
the basis for the technological infrastructure needed for monitoring
access, gaps, and waiting lists.
Stroke
High Tolerance Long Duration (LTLD) Stroke Demonstration Project: A Summary of Findings (July 2009)
The GTA Rehab Network conducted a stroke demonstration project from February to December 2007 to explore the feasibility of a High Tolerance Long Duration (HTLD) stroke rehab program. This report summarizes the approach and key findings of the project.
Low Tolerance Long Duration (LTLD) Stroke Demonstration Project Final Report (June 2006)
Final results from the Network’s Low Tolerance Long Duration (LTLD) Stroke Demonstration Project suggest the need for a review of the service delivery model and admission criteria for stroke rehab programs. This is one of several recommendations contained in the project’s final report. The project collected and analyzed data on patients admitted to LTLD stroke rehab programs at Bridgepoint Health, Castleview-Wychwood Towers, Lakeridge Health and Providence Healthcare between October 2004 and September 2005. The goal was to better understand the rehab needs and outcomes of survivors of severe stroke within the Toronto Central LHIN boundary in order to improve program planning.
Other
Implementation Status of HSRC Bed Directions by Organization and Site (May 2010)
This report reflects the number of designated and funded rehabilitation beds at Network member organizations. The report shows the distribution of these beds by organization, geographic region, and Local Health Integrated Network (LHIN).
The LIFEspan Transition Model: A Process Evaluation (March 2010)
In 2010, the GTA Rehab Network completed a process evaluation of the LIFEspan (Living Independently and Fully Engaged) transition model on behalf of the Toronto Central LHIN. The LIFEspan model is a unique partnership between Holland Bloorview Kids Rehabilitation Hospital and Toronto Rehab that supports young adults transitioning from pediatric to adult healthcare services. The evaluation provided key considerations for expanding or replicating the model, as well as "lessons learned" to help future planning of youth to adult transition services.
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