Mohammed Rakib, Poss Jeff, Egan Mary, Rappolt Susan, Berg Katherine
Graduate Department of Rehabilitation Science.
School of Public Health and Health Systems, University of Waterloo, Waterloo.
Physiother Can. 2013 Spring;65(2):125-32. doi: 10.3138/ptc.2012-09.
To explore decision-making processes currently used in allocating occupational and physical therapy services in home care for complex long-stay clients in Ontario.
An exploratory study using key-informant interviews and client vignettes was conducted with home-care decision makers (case managers and directors) from four home-care regions in Ontario. The interview data were analyzed using the framework analysis method.
The decision-making process for allocating therapy services has four stages: intake, assessment, referral to service provider, and reassessment. There are variations in the management processes deployed at each stage. The major variation is in the process of determining the volume of therapy services across home-care regions, primarily as a result of financial constraints affecting the home-care programme. Government funding methods and methods of information sharing also significantly affect home-care therapy allocation.
Financial constraints in home care are the primary contextual factor affecting allocation of therapy services across home-care regions. Given the inflation of health care costs, new models of funding and service delivery need to be developed to ensure that the right person receives the right care before deteriorating and requiring more costly long-term care.
探讨安大略省目前针对长期复杂居家护理客户分配职业治疗和物理治疗服务时所采用的决策过程。
对安大略省四个居家护理区域的居家护理决策者（病例经理和主任）进行了一项探索性研究，采用关键 informant 访谈和客户案例。访谈数据采用框架分析法进行分析。
分配治疗服务的决策过程有四个阶段：入院、评估、转介给服务提供者以及重新评估。每个阶段所采用的管理流程存在差异。主要差异在于各居家护理区域确定治疗服务量的过程，这主要是由于影响居家护理计划的资金限制。政府的资助方式和信息共享方式也对居家护理治疗分配有显著影响。
居家护理中的资金限制是影响各居家护理区域治疗服务分配的主要背景因素。鉴于医疗保健成本的上涨，需要开发新的资助和服务提供模式，以确保合适的人在病情恶化并需要更昂贵的长期护理之前得到恰当的护理。
