Abstract
Background: Healthcare is duplicated and lacks integration when health professionals possess overlapping clinical skills and deliver services that are designed around their professional expertise.
Approach: At the Mater Hospital Brisbane (Australia), consumers would undergo lengthy assessments with duplicated questions when occupational therapists, physiotherapists, and speech pathologists complete separate, profession-specific stroke assessments. A “transdisciplinary” approach was used to redesign stroke assessment around consumer needs and eliminate unnecessary duplication. “Transdisciplinary” approaches involve sharing clinical skills/roles and training professionals to work beyond their usual scope of practice. Healthcare professionals met fortnightly to co-design and monitor implementation of a transdisciplinary stroke assessment, replacing profession-specific assessments of occupational therapy, physiotherapy, and speech pathology. To compare usual and transdisciplinary assessment methods, a pre-/post-implementation clinical study was conducted over 22 months. Patient and public involvement occurred in two ways: 1) patients with stroke were surveyed after completing the usual/transdisciplinary stroke assessment, and 2) people with stroke/their carers watched a pre-recorded transdisciplinary assessment and were asked for feedback via an online survey. Data was also collected via timed assessments and medical record audits. Inductive content analysis was used to understand consumer needs and experiences. Multivariable linear regression estimated assessment time differences. Cost minimization and sensitivity analyses estimated organizational cost savings.
Results: Compared to profession-specific stroke assessments (N=63), when the transdisciplinary assessment was used (N=116), patients spent 37.6 minutes less undergoing stroke assessment (95% CI −47.5, −27.7; p<0.001). Patients also required 3 fewer occasions of service from allied health professionals (p=0.011) before discharge to their usual residence or rehabilitation. Due to time savings, the estimated cost saving was $379.45 per patient (probabilistic 95% CI −487.15, −271.48). Patient safety (e.g., hospital readmission and fall rates) and patient outcomes (e.g., quality of life at 3 months) were not different. Patients who received profession-specific assessments reported they would “waste a lot of time repeating some activities and questions.” Whereas patients who received the transdisciplinary stroke assessment did not experience assessment duplication. People with stroke emphasized the importance of integrating multiple professions into one transdisciplinary assessment and suggested a greater focus on assessing cognition and mental health. The project's impact was three-fold, 1) improved efficiency for a more sustainable stroke service, 2) improved patient experience related to reduced duplication and intensity of stroke assessment, and 3) consumer-generated improvements for the transdisciplinary stroke assessment.
Implications: Using transdisciplinary stroke assessment was a successful strategy to integrate the expertise of multiple allied health professionals, redesign stroke services around consumer needs, reduce assessment duplication, and improve consumer experience. Next, the consumer-generated improvements should be applied to the transdisciplinary stroke assessment. The co-designed transdisciplinary approach can be translated to other services to leverage the impact of integrated care for a sustainable future.