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KCE Reporst 57 Musculoskeletal & Neurological Rehabilitation 251
12 HOW CAN A REHABILITATION MODEL BE
IMPLEMENTED IN BELGIUM: A REFLECTION
12.1 INTRODUCTION
People suffering from musculoskeletal and neurological impairments belong to a specific
group requiring tailored care. Inspiration for an implementation approach for the
rehabilitation model in Belgium can be found in the way Ontario (Canada) developed
and implemented changes in post-acute rehabilitation care. Likewise, we will propose
suggestions for a stepwise development and implementation of changes in the Belgian
post-acute rehabilitation care.
12.2 THE EVALUATION AND SELECTION OF A
CLASSIFICATION/ASSESSMENT TOOL FOR
REHABILITATION CARE IN ONTARIO, CANADA
Ontario has been working on the development of an integrated funding model for
rehabilitation. This work has been hindered by a lack of a general agreement on the
patient classification system and assessment tool to be used for rehabilitation. A group
of experts from different fields has been mandated to evaluate and recommend the
implementation of a classification and assessment tool used for different purpose:
inpatient and outpatient resource allocation, quality indicators, outcome measurement
and care planning.
See Appendix to chapter 12.
12.3 STEPWISE DEVELOPMENT, VALIDATION AND
IMPLEMENTATION OF CHANGES IN POST-ACUTE
REHABILITATION MEDICINE IN BELGIUM.
Rehabilitation services have to manage the rehabilitation process in an efficient way.
Patients should be referred to the right rehabilitation services whenever necessary and
according to their rehabilitation needs and goals.
The transition through phases and different levels of service should be guaranteed by
use of a patient classification system, implying continuity of care from acute over postacute
to chronic care.
Development, validation and implementation of changes in post-acute rehabiliation
medicine in Belgium will next described in four steps (see Figure 12.1).
12.3.1 First step: Identification of a patient with rehabilitation needs and goals
The identification of a patient with rehabilitation needs and goals is necessary in order
to initiate a rehabilitation trajectory. Moreover, from an organisational and financing
point-of-view data are needed in advance about the number of patients needing a
rehabilitation program. Therefore, the theoretical definition proposed in the first
chapters of this study, has to be tested in the field to see whether practically all aspects
necessary to organise rehabilitation in practice are included.
12.3.2 Second step: Selection of an appropriate functionality tool
As has already been extensively been discussed, a patient classification system implying a
functional assessment is necessary in order to refer the patient within the stratified
rehabilitation model.
A Steering Committee mandated by the Public Authorities should select one (or more)
assessments tools, while a PCS, integrated in a outcome model is under development
(see Chapter 3). The selected tools should be adapted to the Belgian context.
Continuity from acute over post-acute to chronic care should be taken into account.
The Committee could validate the tools in use in other countries in the Belgian context,