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Shorter hospital stays have created a new challenge for rehabilitation facilities, forcing them to find creative ways to provide their services in the allotted time. The UAB (University of Alabama at Birmingham) Spain Rehabilitation Center did just that, with a home-teleconferencing project, "information days" for patients and family caregivers, and other new initiatives.
Using a computer, modem, and video conferencing, patients and caregivers stay in contact with Spain via TV, allowing them to address many issues that were traditionally addressed during their inpatient stay: psychological issues, issues of family care, and the many "what ifs" that come up when home care is being provided. "Telemedicine is an effective way to continue our care," says Amie Jackson, MD, director of the UAB Spain Rehabilitation Center.
There are several challenges presented by shorter hospital stays, says Jackson. "For one thing, there’s the shorter acute hospitalization, where [diagnosis related groupings] and pressures from insurance companies generally allow somebody who just had a stroke or an accident to be in an acute setting for much less time than usual," she observes.
"We get the patients faster; they come into rehab just when they’re getting over the main event. Even though they’re stable, they may not quite be ready for an intense rehab program. In the past, the program could be handled more gradually, and only when the patient was able to fully participate."
What’s worse, she says, not only are patients sicker when they arrive for rehab, but similar constraints are placed on the centers themselves. "Once we get them, we can’t keep them as long, either," asserts Jackson. "Patients get the short end both ways. Many times we just have the capacity to get them into physical therapy, assessment and nutrition while we’re still battling pneumonia, blood clots, and other acute things that can occur. And some patients have to learn to deal with permanent disabilities, which introduces psychological factors and other medical issues. We used to deal with all of that during their stay, but now we don’t have the time to deal with it adequately."
With home care beginning sooner and lasting longer, the home teleconferencing project just made sense, says Jackson. "When patients leave us, they go to the home setting. Some of them leave with disabilities that require a significant amount of education and psychological support, and that contact with the health care clinician is sacrificed by their having to leave early. When I was a resident in the 1980s, we kept some patients six months after a spinal cord injury or a stroke. We dealt with the family, and with issues like community re-entry. Now, all that’s gone."
The issues, however, have not gone away. To Jackson, teleconferencing would allow those important issues to be addressed while the patients were at home. "We tried to think of how we could physically accomplish this," she recalls. "We had to be creative because not all patients have computers. We’ve gotten some help from the local telephone provider, and some equipment was donated at cost. We have also gotten grant funding from the state and federal governments." Insurance, she notes, does not cover such services.
Because there are limits as to how many patients can be served, diagnosis-specific treatment is currently offered. "We deal with spinal cord injury, a few stroke patients, and traumatic brain injury," says Jackson. Scheduling depends on the patients. Jackson got her first grant about four years ago, and the project was in place a year later.
Jackson and her staff conduct regular assessments of the program. "We want to know whether it’s helpful to the caregivers, in terms of stress and depression. We conduct an initial assessment, and then once a year later," she says. "We also assess whether those patients who receive the home teleconferencing find it beneficial, and whether after one year they have suffered fewer complications, such as: Were they in the hospital more? Did they have more secondary problems?"
The response to the program has been overwhelmingly positive. "The patients all felt it was very helpful to have that connection, but the family caregivers especially appreciated it because they had that link that really helped allay their fears of not doing everything right for their loved ones. All of the data so far show the program has been very beneficial," Jackson reports.
There are other initiatives under way at the Spain center to help offset the disadvantages of shortened stays. For example, in July they held their first after-center information day. It consisted of focus groups dealing with traumatic brain injury and spinal cord injury, with physicians and psychologists running the programs. Each program began with a short presentation and then a question-and-answer session. "The sessions were well-attended and a lot of people asked questions," says Jackson. "More are being planned."
The center also has several web sites that patients can use to get their questions answered. Patients can log in from all over the country. "We have a grant set up for patients to go through different diagnoses," says Jackson. "The first is for spinal cord injury. It will be a series of educational presentations almost like Power Point. The patient logs on and reads text on the consumer level about a specific problem they have. It will provide a lot of the education they used to get in the hospital."
[For more information, contact: Amie Jackson, MD, director, Spain Rehabilitation Center, 1717 Sixth Ave. S., UAB, Birmingham, AL 35233. Telephone: (205) 934-3330.]