【文章內容簡介】 如外科手術 )的結果變差 the prevalence of disability will be higher 致殘發(fā)生率增加 ? Contribution of individuals to society (and social productivity) will be lower個人對社會 (和社會生產力 )的貢獻減少 ? Lack of rehabilitation is an economic and developmental risk, . ? disability without rehabilitation is a burden for health systems ? Lack of employees (esp. of high education) harms developmental processes缺少康復是一個經濟和發(fā)展危險因素，例如無康復醫(yī)療的殘疾會成為衛(wèi)生系統的負擔。缺少被雇傭者（尤其受過高等教育）會損害發(fā)展過程 ? The provision of rehabilitation services may also be a business康復服務的分配也可成為 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Conceptual approach: how to analyse, plan an implement rehabilitation services 概念方法：如何分析，計劃開展康復服務 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Stepwise approach (1) 階梯式方法 ? Step 1: Agreement on basic principles (. UNCRPD, WRD, WHA Resolution , Disability action plan) 第一階段 達成基本共識 ? Step 2: Analysis of the burden and major causes of disability: 第二階段 殘障的主要原因及難點分析 ? Traffic accidents and other trauma (incl. spinal cord injury, traumatic brain injury, multiple trauma)交通事故及其他外傷 ? Cardiovascular and metabolic diseases (incl. hypertension, myocardial infarction, diabetes)心血管及代謝疾病 ? Neurological conditions (including stroke, multiple sclerosis, Parkinson’s disease)神經系統疾病 ? Chronic musculoskeletal conditions (incl. Low Back pain, osteoarthritis, rheumatoid arthritis, chronic widespread pain and fibromyalgia) 慢性運動系統疾?。∪夤趋溃? ? Paedriatric conditions 兒科疾病 ? Geriatric conditions (incl. frailty, dementia) 老年病 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Stepwise approach (2)階梯式方法 ? Step 3: Use models of rehabilitation services:第三階段 使用康復服務模型 ? Implement rehabilitation along the continuum of care (acute, postacute, and long term rehabilitation) 沿用連續(xù)性護理實施康復治療 ? Levels of specialization (from acute care to the munity) 專業(yè)化水平 ? Multiprofessional teamwork as principle of staffing (PRM, PT, OT, SLT, Psychotherapy Social work and others) 多專業(yè)混合團隊協作原則編制人員 ? Defined interfaces (incl. transfer systems) 界定轉診標準 ? Create financial system (insurances, states financing or others) 建立財務系統 ? Step 4: Define regions/areas and calculate concrete demand of services 第四階段 定義區(qū)域并估算具體服務需求 ? Step 5: Mach demand with principles and define concrete plan 第五階段：以服務需求為原則，并確定具體計劃 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Level 1a Level 1b Level 2a Level 2b Rehabilitation policy 康復政策 Highly specialized centre Specialized centre Rehab centre Rehab centre Doctor PT OT Samp。LT others Peers, families, selfhelping groups and others Level 3 Case management Levels of care provision 護理級別 高度?？浦行? 專科中心 康復中心 康復中心 病歷管理 同伴，家人，自主互助小組及其他 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 Example 舉例 Systematic approach to implement rehabilitation in health systems Professor Christoph Gutenbrunner, MD, PhD Post congress Tour on Rehabilitation Topics Hannover June 23rd, 2022 ? Acute rehabilitation services: in or close to (acute) hospitals 急診康復 院內或附近 ? Postacute rehabilitation services: standalone rehabilitation facilities in close cooperation with hospitals (highly specialized and specialized) 急診后康復 獨立康復機構 合作醫(yī)院附近 ? Longterm rehabilitation service: outpatient or mobile services 長期康復 門診或隨診 ? Services for intermittent rehabilitation in chronic conditions: inpatient or dayclinics 慢性病不連貫康復服務 入院或日間診療 ? Vocational rehabilitation services: integrated in rehabilitation and vocational services 職業(yè)訓練康復服務 康復與職業(yè)訓練集成的服務 ? Links to social system: . munity and peers 與社會系統連接 比如社區(qū)及同伴支持 Definition of services 定義服務 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 Framework of Rehab Services: dimensions 康復服務的構架 —多維度 ? Service provider: the categories to describe the provider include the framework of the institution (location, anisation etc.) the resources (human and technical resources) and some aspects of service anisation such as profitorientation and quality assurance programs. The main questions behind are where and in which context the service is delivered 服務的提供者， 最主要的背后問題是在何地，何背景下提供服務 ? Funding of the service: the categories of funding describe the main sources of ine and refunding of services. They include the basic principles of payment such as diagnosisrelated groups, perday payment of other forms of service refund. The question behind is what are the principles of financial resources 服務資金來源， 背后的問題是融資資金來源問題 ? Service