The development of Alfred Health's Acquired Brain Injury Rehabilitation Unit presented healthcare providers, patients and the community with an opportunity to use research to develop a state-wide model of care for Acquired Brain Injury (ABI).
Acquired Brain Injury is the leading cause of disability in Australia and affects one in 45 people however, until recently, there had been no consensus about how to best organise healthcare for ABI patients in Victoria.
Alfred Health's centre aimed to change this, by using research to develop and deliver a state-wide, evidence-based ABI rehabilitation program.
The first phase in this research involved a review of the existing state of ABI rehabilitation care models in Victoria to determine how differences in care have impacted upon ABI patients and their families, and to identify best practice.
About the Acquired Brain Injury Unit
People who experience an acquired brain injury often require care and rehabilitation that may last for months and will involve many health professionals and health care services. Intensive rehabilitation programs have been shown to result in improved outcomes for the patient and be cost effective. However, a key barrier facing patients with moderate to severe brain injury is the transfer from acute care to an appropriate inpatient rehabilitation setting.
It is therefore important to determine the best way to organise health and rehabilitation services for the benefit of all stakeholders. Within Australia, models of care vary depending on the health care organisation delivering the service. Services are often fragmented and funded by different bodies, although the pathway for TAC-funded patients is clear and well established.
For rehabilitation to be effective, it must be based on best-practice evidence. Research into the most effective methods of intervention is increasing, and this project aimed to address some of the knowledge gaps regarding models of care and the best ways to organise services for people with an acquired brain injury.
Several research projects were conducted, with a series of reports that together paint a picture of ABI care in Victoria prior to 2014.
- An overview of existing evidence on the subject of ABI care in Victoria, drawn from existing literature, guidelines and clinical trials.
- A paper informed by the team's participation in a National Trauma Research Institute forum about the role of caregivers and how to minimise the risk that carers encounter in transferring and handling ABI patients.
- An evaluation of who gets into rehabilitation and why, which finds that decisions in this area are usually based upon health system issues (such as the availability of beds) rather than the nature of specific injuries.
- A report on the topic of goal setting and planning for ABI patients, which finds that patients and carers rely on healthcare workers for direction in this, and includes several recommendations to help develop these relationships.
- A report that confirms the value of linking the Victorian StateTrauma Registry with data from the TAC and the Victorian Admitted Episode Dataset to provide information for the ongoing evaluation of the centre.
- A report evaluating current ABI attendant care practices, how this care is delivered and how much it costs.
A further project is analysing pathways and outcomes for young people (18-64 years of age) with ABI who are at risk of early admission into aged care. Read about Diego, an ABI patient in this position. (This project is managed by the Summer Foundation.)
The Process-ABI project evaluated the implementation, mechanisms of change and context of implementing the model of brain injury rehabilitation at the Alfred Health Acquired Brain Injury Rehabilitation Service 2014–2015, with the aim of developing a best-practice service.
Meanwhile, the TAC also commissioned an ISCRR evidence review of segmented rehabilitation for increasing vocational outcomes in adults with brain injury, including effectiveness and model of care protocols.