ABSTRACT
PURPOSE: To assess the impact of increased physiotherapy capacity in an acute regional Neurosurgery Centre on outcomes for people with an acquired brain injury (ABI) requiring a tracheostomy. MATERIALS AND METHODS: A service review of patients undergoing active tracheostomy weaning, admitted over two 15-week time periods; normal physiotherapy staffing with enhanced physiotherapy staffing. RESULTS: With a 50% increase in staffing, physiotherapy rehabilitation sessions increased from 2 to 4 times weekly. A mean improvement was found for patient outcomes; time with a tracheostomy in situ reduced by 11 days and the length of hospital stay reduced by 19 days. Functional status on discharge also improved, with 33% of patients able to mobilise on discharge with normal staffing levels and 77% of patients able to mobilise on discharge with enhanced staffing levels. CONCLUSION: A temporary increase in physiotherapy capacity gave the opportunity to evaluate the impact on physiotherapy rehabilitation frequency and patient outcomes. Results demonstrate the positive impact for this complex patient group on outcomes including rehabilitation frequency, length of stay, time to decannulation, and functional status on discharge. Early access to high-frequency specialist physiotherapy rehabilitation is a critical component of improving functional independence in people with an ABI requiring a tracheostomy.IMPLICATIONS FOR REHABILITATIONIncreasing the capacity of specialist neurological physiotherapy treatment within this healthcare setting for people who have acquired a brain injury and require tracheostomy intervention may have a significant impact for patients and the NHS.Service improvement projects that use rigorous research methodology produce outcomes and evaluations that are robust and reliable.Supporting health and care professionals to use research methods within service improvement projects exposes them to the value of embedding research within their clinical environments.
ABSTRACT
OBJECTIVE: To identify factors associated with small group employer participation in New Mexico's State Coverage Insurance (SCI) program. DATA SOURCES: Telephone surveys of employers participating in SCI (N=269) and small employers who inquired about SCI (N=148) were fielded September 2008-January 2009. STUDY DESIGN: Descriptive and multivariate analyses investigated differences between employer samples, including employer characteristics, concerns that applied to the business when deciding whether to participate in SCI, prior offerings of insurance to workers, and perceived affordability of the program. DATA COLLECTION/EXTRACTION METHODS: Unweighted employer samples yielded 88 and 75 percent response rates for the participating and inquiring employers, respectively. PRINCIPAL FINDINGS: The administrative issue most commonly selected by inquiring employers as applying to their business was difficulty understanding how eligibility requirements applied to their business and its employees (53.5 percent). Inquiring businesses were significantly more likely to report concern about affording to pay the premiums in the first month (35.6 versus 18.7 percent) and the cost to the business over the long run (46.5 versus 26.6 percent) relative to participating employers. From the model results, businesses with the fewest full-time employees (zero to two) were 19 percentage points less likely to participate relative to businesses with six or more full-time employees. CONCLUSIONS: Administrative and cost barriers to participation in SCI reported by employers suggest that the tax credit offered to small businesses under new federal provisions, which merely offsets the employer portion of premium, could be more effective if accompanied by additional supports to businesses.