Department of Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, Miami, Florida.
Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia.
J Stroke Cerebrovasc Dis. 2020 Apr;29(4):104622. doi: 10.1016/j.jstrokecerebrovasdis.2019.104622. Epub 2020 Feb 6.
Consensus on how rehabilitation teamwork and services are optimally coordinated continues to be a work in progress. One area of recent research has been inpatient-rehabilitation team conferences in stroke. The prevalence of Americans living with stroke is expected to gradually increase as the U.S. population ages, as will the related direct and indirect costs. Effective interdisciplinary team conferences during acute-stroke inpatient-rehabilitation are key to managing long-term costs while improving functional outcomes. Effective team conferences help to identify patients at risk for medical complications and institutionalization and help to determine interventions that will focus on patients' medical, physical, cognitive, emotional, and social barriers to recovery and barriers to a community/home disposition. This scoping review paper identifies and analyzes literature on theory and structure of effective teams with the focus on stroke interdisciplinary rehabilitation team conferences and offers suggestions for improvement. Potential flaws of commonly used team conference formats are described. Studies are outlined showing associations between stroke patient outcomes and better care coordination and leadership in medical teamwork; and 2 examples of successful interdisciplinary team conference models used in stroke inpatient-rehabilitation are provided that support a case for a proactive, conscious structure to team conferences. Given the complexity of many stroke patients' clinical care, greater attention to team functioning, and especially team conference leadership and structure, may be a promising area of focus to improve the quality of health care services for people with stroke.
康复团队合作和服务的最佳协调方式仍在不断探索中。最近的研究领域之一是中风患者的住院康复团队会议。随着美国人口老龄化，美国中风患者的患病率预计将逐渐增加，相关的直接和间接成本也将增加。在急性中风住院康复期间进行有效的跨学科团队会议是管理长期成本的关键，同时可以改善功能结果。有效的团队会议有助于识别有医疗并发症和住院风险的患者，并有助于确定将重点放在患者的医疗、身体、认知、情感和社会康复障碍以及社区/家庭处置障碍上的干预措施。本文对关于有效团队的理论和结构的文献进行了识别和分析，重点是中风跨学科康复团队会议，并提出了改进建议。还描述了常用团队会议模式的潜在缺陷。研究表明，中风患者的预后与更好的医疗团队协作和领导力之间存在关联；并提供了中风住院康复中使用的 2 种成功的跨学科团队会议模式的例子，这支持了团队会议采取积极主动、有意识的结构的观点。鉴于许多中风患者的临床护理非常复杂，因此，更加关注团队功能，特别是团队会议的领导力和结构，可能是改善中风患者医疗服务质量的一个有希望的重点领域。
