调查新南威尔士州脑损伤康复计划中基于社区的病例管理模式：一项前瞻性多中心研究。

Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study.

机构信息

Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia (Dr Simpson and Dr Gillett and Ms Strettles); Liverpool Brain Injury Rehabilitation Unit, Sydney, New South Wales, Australia (Dr Simpson and Ms Forman); John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia (Dr Simpson); South West Brain Injury Rehabilitation Service, Murrumbidgee Local Health District, Albury, New South Wales, Australia (Ms Mitsch); Westmead Brain Injury Rehabilitation Service, Sydney, New South Wales, Australia (Ms Doyle); Mid Western Brain Injury Rehabilitation Program, Bathurst, New South Wales, Australia (Ms Young); Mid North Coast Brain Injury Rehabilitation Service, Port Macquarie, New South Wales, Australia (Ms Solomon); Rural and Regional Health Services, Hunter New England Local Health District, Tamworth, New South Wales, Australia (Ms MacPherson); Department of Neurology, Liverpool Hospital, Sydney, New South Wales, Australia (Dr Gillett); and New South Wales Brain Injury Rehabilitation Directorate, Agency for Clinical Innovation, Sydney, New South Wales, Australia (Ms Strettles).

出版信息

J Head Trauma Rehabil. 2018 Nov/Dec;33(6):E38-E48. doi: 10.1097/HTR.0000000000000370.

DOI:10.1097/HTR.0000000000000370

PMID:29385013

Abstract

OBJECTIVE

To investigate a model of community-based case management (CM).

SETTING

New South Wales (NSW) Brain Injury Rehabilitation Program (BIRP).

PARTICIPANTS

All clinicians (N = 72) providing CM within 14 BIRP community rehabilitation teams.

DESIGN

A prospective, multicenter study.

MAIN MEASURES

A purpose-designed survey.

METHODS

Participants from the 12 adult and 2 pediatric services (8 located in metropolitan areas, 6 in rural areas) completed a 3-part survey investigating their organizational context, clinical approach, and CM interventions. Between-groups analyses explored differences among individual services, as well as differences based on age (adult vs pediatric) and location (metropolitan vs rural).

RESULTS

All services provided a direct service model of CM. The underlying principles were uniform across services (more direct than indirect service provision; with more client-related than administrative-related tasks; more holistic than service-led in defining client needs; with decision making equally directed by staff and clients; and undertaking a more comprehensive than minimalist range of tasks). CM interventions included the provision of individual support, family support, advocacy, and community development alongside assessment, monitoring, referral, and liaison tasks. There were little differences in practice based on age or location.

CONCLUSION

The NSW BIRP has drawn upon the results to produce a model of service for CM.

摘要

目的

研究一种基于社区的病例管理（CM）模式。

地点

新南威尔士州（NSW）脑损伤康复计划（BIRP）。

参与者

在 14 个 BIRP 社区康复团队中提供 CM 的所有临床医生（N=72）。

设计

前瞻性、多中心研究。

主要措施

一项专门设计的调查。

方法

来自 12 个成人和 2 个儿科服务（8 个位于大都市区，6 个位于农村地区）的参与者完成了一项 3 部分调查，调查他们的组织背景、临床方法和 CM 干预措施。组间分析探讨了各个服务之间的差异，以及基于年龄（成人与儿科）和地点（都市区与农村）的差异。

结果

所有服务均提供 CM 的直接服务模式。各服务的基本原则是一致的（直接服务比间接服务多；与客户相关的任务多于与行政相关的任务；在定义客户需求方面更全面而不是以服务为主导；决策同样由员工和客户共同指导；并且承担更全面而不是最低限度的任务）。CM 干预措施包括提供个人支持、家庭支持、倡导和社区发展，以及评估、监测、转介和联络任务。基于年龄或地点，实践上的差异很小。