【正文】 工具和培訓(xùn)一攬子計(jì)劃，以便發(fā)展和加強(qiáng)適應(yīng)訓(xùn)練及康復(fù)服務(wù) ? Proposed inputs for international and national partners: ? Work with health ministries to expand and strengthen the provision of rehabilitation and habilitation services 建議國(guó) 際和 國(guó)家伙伴開展 的工 作：與衛(wèi)生部一起開展工作，推廣和加強(qiáng)提供康復(fù)服務(wù) Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Health accounts vs. strategies No Dimensions of ICHAHC Health Care Strategies (Stucki et al.)衛(wèi)生保健策略 1 : Services of curative care根治性治療服務(wù) Curative care (curative strategy)根治治療 (根治性策略） 2 : Services of rehabilitative care康復(fù)治療服務(wù) Rehebilitative care (rehabilitative strategy)康復(fù)治療（康復(fù)性策略） 3 : Services of longterm nursing care長(zhǎng)期護(hù)理服務(wù) Maintenance care (supportive strategy)保養(yǎng)治療（支持性策略） 4 : Ancillary services to health care衛(wèi)生保健的附屬服務(wù) 5 : Medical goods dispensed to outpatients門診病人的醫(yī)療用品發(fā)放 6 : Prevention and public health services預(yù)防與公共衛(wèi)生服務(wù) Prevention (preventive strategy)預(yù)防（預(yù)防性策略） 7 : Health administration and health insurance衛(wèi)生行政與健康保險(xiǎn) Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Inpatient or day clinic rehabilitation for patients with chronic conditions Levels to describe rehabilitation康復(fù)的各描述水平 Macro level宏觀水平 Meso level中間水平 Micro level微觀水平 Health strategy, policy 健康策略及政策 Service provision, concepts 服務(wù)分配及慨念 Health condition amp。 functional level (B) Health condition amp。 functional level (A) 健康條件及功能水平（ A) …. Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Time Intensity強(qiáng)度 Acute care急性治療 Postacute care急性期治療 Lonterm care長(zhǎng)期治療 Intermittent rehabilitation (inpatient or dayclinic)間斷性康復(fù)（門診或日間診所） Postacurte rehabilitation (inpatient) 急性期后康復(fù)（住院病人） Community based rehabilitation (outpatient)以社區(qū)為基礎(chǔ)的康復(fù)（門診病人） Acute rehabilitation (in hospital)急性康復(fù)（院內(nèi)） Integrative phase model of rehab care康復(fù)治療的整合分期模式 Gutenbrunner C, Meyer T, Stucki G: : Am J Phys Med Rehabil 2022。 90: 521525 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Level 4: Multiprofessional rehabilitation services水 平 4多專業(yè)性康復(fù)服務(wù) Level 1: families, peers, etc. 水平 1：家庭，病友等等 Level 3: PRM, specialized PT, OT 3：康健醫(yī)學(xué)，專業(yè)理療師，職業(yè)治療師等等 Level 2: primary care physicians, PT, OT, 2：初級(jí)護(hù)理醫(yī)生，理療師，職業(yè)治療師等等 Level 5: highly specialized rehabilitation services (SCI, TBI)水平 5高專業(yè)化的康復(fù)服務(wù)（脊髓創(chuàng)傷，腦創(chuàng)傷 Levels of specialization 康 康復(fù)專業(yè)水平 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Community Based Rehabilitation基于社區(qū)的康復(fù) Gutenbrunner C (2022): submitted Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 The health systems approach衛(wèi)生系統(tǒng)探討 ? Rehabilitation can be seen as a health strategy it also is described as ―a set of measures‖ 康復(fù)可被視為健康戰(zhàn)略也可描述成 ‖一攬子計(jì)劃 ‖ ? Rehabilitation should be integrated in acute, postacute and longterm care康復(fù)應(yīng)被整合于急性期 ,急性期后及長(zhǎng)期性治療中 ? Rehabilitation should be integrated in primary, secondary and tertiary levels of health care services康復(fù)應(yīng)被整合于醫(yī)療服務(wù)的一級(jí)至三級(jí)水平中 ? Multiprofessional rehabilitation services need high standard of service provision including resources such as facilities, technical equipment and human resources 多專業(yè)性康復(fù)服務(wù)需要高標(biāo)準(zhǔn)的服務(wù)供給 ,包括設(shè)施 ,技術(shù)設(shè)備及人力資源 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 The individual approach (examples)病人個(gè)人探討 (舉例 ) ? Patients with long term mechanical ventilation will develop contractures, loose ventilation capacity, develop muscle atrophy, loose circulatory capacity, are in risk of pneumonia and thrombosis and others 機(jī)械通氣患者常會(huì)發(fā)展有氣管痙攣 ,肺活量降低 ,肌肉萎縮 ,循環(huán)血量降低等并發(fā)癥 ,處于發(fā)生肺炎 ,血栓及其他的危險(xiǎn)下 . ? Patients after stroke will loose opportunity to induce neuroplasticity if rehabilitation does not start immediately after incident 腦卒中病人若在事件后未立即進(jìn)行康復(fù)治療 ,神經(jīng)可塑性引導(dǎo)的可能性講會(huì)降低 ? Patients with musculoskeletal pain syndromes are at risk do develop chronic generalised pain syndromes if primary source of pain is not treated sufficiently肌肉骨骼疼痛癥患者如疼痛的首因未被有效治療 ,將可能發(fā)展成為慢性廣泛性疼痛綜合征 . ? Patients with chronic health conditions are at risk to be unfit for work if rehabilitation is lacking 慢性疾病患者?？杀晃＜盁o(wú)法適應(yīng)于工作 ,如果康復(fù)醫(yī)療缺失的話 ? Lack of rehabilitation is a health risk, threat to develop disability缺失康復(fù)是一個(gè)健康風(fēng)險(xiǎn) ,甚至可威脅發(fā)展至殘疾 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Economic amp。 development approach (arguments)經(jīng)濟(jì)與發(fā)展探討 (論證 ) ? Lack of rehabilitation increase costs of health care and social pensation, 缺少康復(fù)會(huì)導(dǎo)致健康醫(yī)療費(fèi)用的增長(zhǎng)及社會(huì)補(bǔ)償 . 例如 ? length of stay in ICU?s an in hospital will be longerICU時(shí)間將會(huì)增加 ? outes of interventions (. surgery) will be poorer ? 干預(yù)手段 (