Stroke Rehabilitation in Ontario: An Opportunity for Health Care Transformation

Abstract

In this article, Ontario's stroke rehabilitation system is used to exemplify the challenges faced by rehabilitation and healthcare systems across Canada who are attempting to provide quality care to patients in the face of increasing demands. Currently, Ontario's rehabilitation system struggles in its efforts to provide accessible and comprehensive care to patients recovering from stroke. We begin our exploration by identifying both the primary stakeholders and the underlying factors that have contributed to the current challenges. The framework put forward in the Canadian Medical Association's recommendations for transformation is then used to suggest a vision for a more patient-focused system incorporating three key principles: a broader perspective, a patient-first approach, and greater unity. The use of health information technology, proper incentives, and greater accountability are discussed as mechanisms to improve the quality and efficiency of care.

A Vision for Stroke Rehabilitation Transformation in Ontario

“…Matthew J. Meyer and colleagues have written a thoughtprovoking article on the challenges faced by Ontario's stroke rehabilitation system. 1 They mirror a 2010 Canadian Medical Association (CMA) document entitled Health Care Transformation in Canada: Change that Works, Care that Lasts 2 and use it to highlight the complicated system of post-stroke rehabilitation "where involvement of multidisciplinary teams that include physicians, therapists, nurses, social workers and many other professionals is required. In order to be effective, these professional services must be available from the time of acute discharge through to community reintegration, posing tremendous challenges.…”

Factors influencing clinicians' referral or admission decisions for post‐acute stroke or traumatic brain injury rehabilitation: A scoping review

“…7 A systematic review of admission criteria for rehabilitation also found age, as well as pre-and post-stroke functional level, to be consistently associated with patient selection for rehabilitation. 8 Although these reviews help us understand discharge patterns, important variations in access to post-acute rehabilitation persist [9][10][11][12][13] even when datadriven predictors of discharge disposition are taken into consideration. 14 Models of access to health care, such as the Behavioral Model of Health Services Use, posit that access cannot be explained solely by patient-related factors but rather the relationship between these factors and characteristics of the health care system.…”

“…Although these reviews help us understand discharge patterns, important variations in access to post‐acute rehabilitation persist 9–13 even when data‐driven predictors of discharge disposition are taken into consideration 14 . Models of access to health care, such as the Behavioral Model of Health Services Use, posit that access cannot be explained solely by patient‐related factors but rather the relationship between these factors and characteristics of the health care system 15 .…”