ABSTRACT
WorkSafe Victoria and the Transport Accident Commission are two Victorian government agencies that determine the policies that guide decisions to fund treatments and services provided to Victorians injured in transport or workplace accidents. These agencies identified that an internal system was required to manage requests for funding of new or emerging treatments. In particular, the agencies recognised a system that supported consistency in decision making in the context of therapeutic uncertainty and ensured the safety of injured Victorians was needed. The New, Emerging or Non-Established Treatments (NENETs) policy was launched in its current form by the agencies in 2013. The NENETs system includes a record of contemporary evidence for emerging treatments and an evidence-informed decision-making system to ensure consistency and information sharing. A system of recording decisions on emerging treatments was also implemented to ensure that funding decisions could later be reversed if necessary. The NENETs system has proved to be a robust and sustainable method of managing uncertainty for WorkSafe Victoria and the Transport Accident Commission and could be transferable to other funding bodies.
Subject(s)
Accidents, Traffic , Decision Making , Disease Management , Health Policy , Insurance, Health, Reimbursement , Occupational Injuries , Accidents, Traffic/economics , Evidence-Based Practice , Humans , Insurance Benefits , Occupational Injuries/economics , Occupational Injuries/therapy , Organizational Case Studies , Program Development , Transportation , Uncertainty , Victoria , Wounds and Injuries/economics , Wounds and Injuries/therapyABSTRACT
BACKGROUND: There are an estimated 62 million stroke survivors worldwide. The majority will have long-term disability. Despite this reality, there have been few large, high-quality randomized controlled trials of stroke rehabilitation interventions. SUMMARY OF REVIEW: There is excellent evidence for the effectiveness of a number of stroke rehabilitation interventions, notably care of stroke patients in inpatient stroke units and stroke rehabilitation units providing organized, goal-focused care via a multidisciplinary team. Stroke units (in comparison with care on general medical wards) effectively reduce death and disability with the number needed to treat to prevent one person from failing to regain independence being 20. Unfortunately, only a minority of stroke patients have access to stroke unit care. The key principles of effective stroke rehabilitation have been identified. These include (1) a functional approach targeted at specific activities e.g. walking, activities of daily living, (2) frequent and intense practice, and (3) commencement in the first days or weeks after stroke. CONCLUSION: The most effective approaches to restoration of brain function after stroke remain unknown and there is an urgent need for more high-quality research. In the meantime, simple, broadly applicable stroke rehabilitation interventions with proven efficacy, particularly stroke unit care, must be applied more widely.
