Rehabilitation: finding expert advice.

According to Webster's New Dictionary, rehabilitate means, "restore to reputation or former physical state." I'm not sure health care has much control over one's reputation, but physical state is another matter. Medicine may not always be able to restore a patient to his/her former physical state, but it can and does do everything possible to help patients achieve their highest possible level of functioning.

Rehabilitation is an important component of post-acute care not only in acute hospitals, but nursing homes, subacute care units, assisted living facilities, day care centers, outpatient clinics, home health services and physicians' offices. Sometimes rehabilitation is offered as a single modality, such as physical therapy, but more often it is structured as a program. The program can include an array of professionals that make up an interdisciplinary or transdisciplinary team (depending on the organization's philosophy).

A comprehensive rehabilitation team is comprised of: physician, case manager, rehabilitation nurses, physical therapist, occupational therapist, speech and language pathologist, respiratory therapist, dietitian/nutritionist, recreation therapist, quality manager and/or the party responsible for collecting and monitoring treatment data, activity staff, social worker and, of course, the family/caregivers. Others that may be added as appropriate are: the vocational therapist, kinesiologist, neuropsychologist, music, dance and art therapist and clergy. As mentioned, a rehabilitation service can include any one or combination of these disciplines - and, not surprisingly, it can be costly.

In today's economic and regulatory climate, this can be a challenge demanding considerable creativity on the part of providers. The good news is that help is out there from various professional and trade associations. These organizations spend goodly sums not only on lobbying, but on developing new methodologies and collecting and disseminating new data that are useful to their members and others in their fields. They stand ready to advance their professions and, by extension, your professional mission and, at the very least, may be able to connect you with others who already have experience doing what you are trying to do.

Two such organizations that are actively pursuing ways to help providers are: the National Stroke Association (NSA) and the American Hospital Association (AHA) Section for Long-Term Care & Rehabilitation. Karen Iannella, Vice President of NSA, and Susanne Sonik, Section Director at AHA, took time out from their busy schedules to respond to the following questions:

Hyatt: How does your association help post-acute rehabilitation providers?

Iannella: NSA works closely with professionals in a variety of settings to provide them with information and educational materials on all aspects of stroke.

NSA holds several meetings for professionals to advance the understanding of stroke. Local chapters are one of the best sources of information and access. NSA also publishes a number of educational materials, including the Journal of Stroke and Cerebrovascular Diseases, which is a multidisciplinary medical journal, and Stroke: Clinical Updates, a medical periodical.

The Clinical Trial Acceleration Program (CTAP) helps speed the delivery of proven medications into the hands of clinicians who can use them to save lives and improve patient outcomes. NSA also developed the Stroke Information and Resource Center and makes available information on stroke statistics, manufacturers and distributors of adaptive resources and equipment.

Foremost among NSA's rehabilitation programs is its Rehabilitation Advisory Board, which brings together the nation's leading experts to identify and respond to critical issues for stroke patients. Comprised of 10 members, the board addresses issues that influence rehabilitation, including specific programs and products.

Sonik: The AHA Long-Term Care Section provides representation, advocacy and member services to providers of rehabilitation, long-term care and continuing care to better serve the health needs of patients and communities.

The Section develops relationships with key organizations, such as state and local hospital and healthcare associations, CARF, the JCAHO, the American Rehabilitation Association, and the National Chronic Care Consortium. We foster relevant services such as research, data activities and technical assistance. In addition, we serve as a clearinghouse for information concerning aging, long-term care and rehabilitation providers. And recently we collaborated with the American Rehabilitation Association on its Third Annual Joint Conference to be held in Atlanta this November 11-13.

In general, this Section provides access to a national network of information, ideas, experts and insights, as well as advocacy on legislative and regulatory issues.

Hyatt: What do you see as future challenges to rehabilitation providers, and what steps are you taking to help prepare them?

Iannella: Next year NSA will embark on a five-year education effort focusing on reducing stroke incidence and improving patient outcomes. Recent articles in the Journal of the American Medical Association have indicated that discharge destinations make a difference in functional outcomes of stroke survivors, and discharge destinations can vary considerably. Functional outcome studies of the various different discharge destinations may increase the perception of the value of rehabilitation at whatever site, and therefore its funding. Other issues the NSA plans to address in the coming years include regulations, legislation, reimbursement and the integration of rehabilitation disciplines.

Sonik: Healthcare providers, whether networks, systems or hospitals, are developing services to provide a full continuum of care. A major interest has been to fill the gaps at both ends of the spectrum - from prevention to post-acute care. This encompasses home care, community-based care, the range of assisted and independent living centers, along with outpatient services. AHA offers professionals in these fields opportunities for development, education and networking.

One of our primary goals is to help shape public policy to create an environment conducive to the development and operation of provider-based integrated delivery systems and to expand health coverage and access to healthcare services. However, shifting trends and reimbursement uncertainty will probably continue into the future, and this will undoubtedly produce recurring nightmares for providers - especially those with complex services, such as rehabilitation. It is critical that as providers we draw upon the experience, wisdom and resources already available. Professional and trade associations, as well as accrediting bodies, should be able to assist providers to better do their job in the future.

Certainly, those organizations that duplicate efforts, waste valuable resources and don't deliver the benefits that they promise will not likely survive the next decade.

And - to add my own parting shot - that is a fate that can be avoided, at least in part, by accessing expert information, especially where it is available in concentrated form. For more information, you can contact the AHA at [phone] and the NSA at [phone].

Other post-acute care-oriented organizations that offer similar resources should let me know: Laura Hyatt, 2956 Kelton Avenue, Los Angeles, CA 90064; telephone [phone]. Suggestions for future columns are welcome.