澳大利亚的老年康复医学进展.ppt
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1、Geriatric Rehabilitation in Australia Model of Care and Funding Arrangements澳大利亚老年康复医学 服务和筹资模式Professor Barbara Workman 巴巴拉沃克曼教授Professor of Geriatric Medicine 老年医学教授Medical Director Rehabilitation and Aged Services 康复和老年服务项目医学主任Director of Monash Ageing Research Centre 蒙纳仕老年研究中心主任12 June 2010AUSTRA
2、LIA/CHINA澳大利亚与中国澳大利亚与中国Land mass and demographics国土和人口Area(sq km)国土Population 人口 65 years in 201065岁及以上老年人 65 years in 2050(projected)预计2050年65岁及以上老年人China中国Australia澳大利亚9,596,9607,682,3001.3 billion22 million102 million 2.9 million8%14%322 million 9 million24%23%Demographics人口学Source:Australian Bur
3、eau of Statistics(2005)资料来源:澳大利亚统计局Source:World Population Prospects(2005)资料来源:世界人口展望CHINA中国中国AUSTRALIA澳大利亚澳大利亚AUSTRALIA澳大利亚澳大利亚北领地北领地昆士兰昆士兰南澳南澳西澳新南威尔士新南威尔士塔斯玛尼亚塔斯玛尼亚维多利亚维多利亚首都领地首都领地Southern Health catchment南区卫生服务集团覆盖区域南区卫生服务集团覆盖区域Aerial view of Monash Medical Centre蒙纳仕医学中心鸟瞰蒙纳仕医学中心鸟瞰Main entrance M
4、onash Medical Centre蒙纳仕医学中心大门蒙纳仕医学中心大门 Kingston CentreOriginal buildingFront entrance to Dandenong HospitalKingston Centre in 2012金士顿中心,2012年 Perspective view looking north east from Warrigal Road Artists impression 从从Warrigal路向东北看路向东北看Aged Rehabilitation selection老年康复 选择Patients are selected for re
5、habilitation according to need for restoration of functionAssessed by a Geriatrician or Rehabilitation ConsultantThey may be accepted toinpatient rehabilitation community rehabilitation Community Rehabilitation Centre(CRC)Rehabilitation in the Home(RITH)Outpatient Rehabilitation根据功能恢复的需要,来选择接受康复服务的患
6、者由老年医学专家或康复专家来评估患者可以接受住院康复 社区康复 社区康复中心(CRC)居家康复(RITH)门诊康复Aged Rehabilitation Selection老年康复 选择Must be predominantly medically stableMain goals for rehabilitation must be stated at the time of assessmentThe person must have the potential to become independent and return to their homePeople requiring r
7、esidential care or long term care are not accepted to a rehabilitation bed even as an interim measureThere are two funding options for aged rehabilitation in hospital with slightly different acceptance criteria必须明显地处于医学上的稳定状态评估时必须明确康复的目标患者必须有可能恢复独立,返回家庭康复病床不接受照护机构服务或长期保健服务根据接收标准,有两种针对老年康复的付费方式Aged R
8、ehabilitation Selection老年康复 选择Geriatric Evaluation and Management(GEM)More medical managementChronic medical conditions that require stabilization Allow time for evaluation of whether a person will manage at homeOften managed by a GeriatricianAn example may be recovery following pneumonia in a perso
9、n with chronic airways disease who is oxygen dependant and has poor mobility老年医学评价和治疗(GEM)主要侧重于医学治疗需要稳定病情的慢性疾病需要花时间进行评价,即便患者在家治疗经常由老年医学专家来管理举例:肺炎后的恢复过程,该患者有慢性呼吸道疾病,依赖氧气,行动困难Aged Rehabilitation-SelectionCasemix Rehabilitation and Funding Tree(CRAFT)More physical therapyOften a single medical problemU
10、sually shorter length of stayOften more predictable length of stayOften managed by a Rehabilitation PhysicianAn example may be rehabilitation following total knee replacement in a person who is otherwise well病例组合的康复和付费分类(CRAFT)主要侧重于物理治疗通常针对患者的一个疾病通常是短期住院往往能预测患者的住院天数通常由康复医师来管理举例:全膝关节置换术后的患者,该患者其他方面很健
11、康Aged Rehabilitation Patient Focused老年康复 以病人为中心Information about rehabilitation is provided to the patient at assessmentTransfer to the rehabilitation facility usually occurs within 1-2 daysOnce in the rehabilitation facility patients are expected wherever possible to be out of bed and dressed in no
12、rmal clothesPatients are expected to work with the staff to agree on their goals for management在评估病人的时候,提供有关康复的信息通常在1-2天内把患者转道康复机构一旦患者进入康复机构,希望患者尽早离开病床,自己穿衣服希望患者和工作人员一起合作,对康复目标达成共识Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Each patient will have their own Doctors,and allied health staff thr
13、oughout the admissionEach staff member will assess the patient and work with the patient to determine the goals for rehabilitation within 1-2 days of admissionIt is routine for all patients to be seen by a physiotherapist and occupational therapist每个患者住院期间,都有他们自己的医生和辅助性的卫生服务人员患者入院后1-2天内,每个员工都要评价患者,和
14、患者在一起确定康复目标作为常规,所有患者都要接受物理治疗和功能治疗专家的服务Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Patients are only seen by speech pathologist,social worker,dietitian and psychologist if there is a need for these interventionsA member of staff is allocated as the Key Liaison Person(KLP)to ensure consistent
15、communication with the patient and family The KLP can be from any health discipline如果需要的话,病人可以接受语言治疗师、社会工作者、营养师、心理医师的服务专门设置关键协调人(KLP)来保证与患者和家人的持续沟通关键协调人可以是任何卫生工作者Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Example of staffing in a rehabilitation ward of 30 beds with neurological rehabilitati
16、on举例:神经康复科30张病床病房的人员配置EFT(employed full time)全职工作岗位Medical consultant 医师 0.3-0.5 Registrar 学员1HMO/intern 住院医师1Nurse:patient 护士:患者1:5 am,1:6 pm,1:10 overnight Physiotherapist 物理治疗师3 Occupational therapist 功能治疗师2.5 Speech pathologist 语言治疗师1Dietitian 营养师0.7Clinical psychologist 临床心理师 0.2Neuropsychologi
17、st 神经心理师 0.3Social worker社会工作者1.8 Allied health assistant 辅助卫生人员2Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Medical problems eg control of diabetes,airways disease,angina,wound,poly-pharmacyPhysical function walking,gait aid,balance,stamina Self care bathing,dressing,cooking,shoppingNutriti
18、on current status,access to foodSwallowing and speech in the context of stroke or other neurological rehabilitationCognition delirium/dementia,brain injuryMood depression/anxiety/other mental health issuesHome environment and services includes ability to continue driving医学问题 如控制糖尿病、呼吸道疾病、心绞痛、外伤、使用多种
19、药物躯体功能 走路、助步器、平衡、耐力自我照顾 洗澡、穿衣、做饭、购物营养 目前状况、获得食物吞咽和说话 与中风或其他神经康复有关认知 精神错乱/老年痴呆、脑损伤心情 抑郁、焦虑/其他心理健康问题家庭环境和服务 包括继续开车的能力Patient being assisted to learn how to drink following a stroke 工作人员帮助中风后患者学习喝水工作人员帮助中风后患者学习喝水Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Daily ward round with Registrar and HMO
20、/InternTwice weekly ward round with ConsultantDaily brief meeting(30 minutes)of staff for update on progress for each patientDaily therapy with main allied health staff,other staff as neededWeekly Team MeetingFamily meetings occur as needed with complex discharge planning学员和住院医每天查房医学专家每周两次查房员工每天30分钟
21、例会,更新每个患者的情况辅助卫生工作者每天进行治疗服务每周团队例会如果是比较复杂的出院计划,请家属开会Aged Rehabilitation Multidisciplinary team老年康复 多学科团队Weekly Team Meeting plan treatment estimate date of discharge documentation of goalsmajor decision making requiring full team contributionmonitoring progress towards achieving goalssharing informat
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