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ABI Rehab Definitions Initiative
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The Toronto ABI Network, in collaboration, with the GTA Rehab Network has developed an ABI Rehab Definitions Framework. The framework articulates the essential components of ABI rehab drawing on evidence-based research to define the “gold standard” of rehab care. Where there was absence of literature, definitions were derived through consensus on current clinical practices. The completed ABI/Neuro Rehab Definitions Framework is available from the GTA Rehab Network's website.
The overall intent of the ABI Rehab Definitions Framework is to:
- Define and promote consistency in ABI rehab care across different care settings
- Increase clarity for patients, families and referrers through the use of consistent terminology
- Establish a standard of care to enable targeted discussions regarding system planning, resourcing of services and performance measurement in rehab to ensure the availability of quality rehabilitation interventions across settings.
Development of Self-Assessment Survey Tools:
Following the development of the GTA Rehab Network’s ABI Rehab Definitions Framework, a self-assessment survey tool was developed for each sector of the rehab continuum (i.e. acute care, inpatient and outpatient/ambulatory rehab, and community-based rehab).
The self-assessment tools provide a mechanism through which the Networks and individual organizations can:
- Identify opportunities for quality improvement initiatives
- Improve the delivery of ABI rehab services
- Advocate for resources to promote consistency and equitable access to ABI rehab services.
See the Definitions Frameworks page of the GTA Rehab Network's website for self-assessment tools and further information on the rehab definitions projects.
Self-Assessment Survey Approach:
The self-assessment survey tools and framework for ABI rehab were sent to all Network member acute care and rehab hospitals and GTA CCACs in winter 2008. These organizations were asked to evaluate the capacity of their ABI rehab programs to meet the definitions of the ABI Rehab Definitions Framework. These organizations used the rating scale below for services provided to ABI rehab patients within the past six months of the survey date.
Rating Scale:
| Fully met |
>= 80% of time |
| Partially met |
40% - 79% of time |
| Not met |
< 40% of time |
Designation of Key Criteria:
Members of the ABI Rehab Definitions Task Group subsequently identified a set of key criteria that ABI rehab programs would be expected to “fully meet” (i.e. at minimum, 80% of the time) in order to be consider a dedicated/specialized ABI rehab program. These key criteria typically represent 50% of the criteria for each type of program (e.g. inpatient rehab, outpatient/ambulatory etc.).
A total of 27 surveys were received from acute care, inpatient, outpatient and community-based rehab programs.
 
The overall findings of these surveys are as follows:
- One of the three programs that identified themselves as having a dedicated inpatient ABI rehab program fully met the surveyed key criteria 100% of the time; one program fully met 96% of the key criteria; and the third met 84% of the surveyed key criteria.
- None of the ‘Inpatient ABI Rehab on Mixed Unit’ programs fully met all criteria. Five of the six programs fully met 80% or more of all criteria; and one program met 43% of the criteria.
- For LTLD ABI rehab (or slow stream): Two of three programs met 81% of all criteria; and one met 53% of all criteria.
- Two of the nine outpatient/ambulatory rehab programs that responded met 100% of the criteria; five fully met between 70-85% of the criteria; and two met less than 60% of the criteria.
- For community ABI rehab programs: One program met 100% of criteria; and the other met 71% of the criteria.
Analysis of this data is currently being finalized. The Network’s Advisory Committee will be considering how the information can be used to further our advocacy for sufficient and appropriate ABI resources. As an example, the key criteria most frequently missed for the dedicated inpatient ABI rehab programs was the existence of appropriately secured units. It is expected that this contributes to the challenge the system has in meeting the needs of the complex ABI patient who may wander. This is the very patient who often has extended stays in acute care ALC beds. Another finding of the self-assessment analysis points to some gaps in human resources needed to appropriately staff these programs (e.g., behavioural management therapists, psychiatry, psychology).
Individual organizations will be receiving the results of their self-assessment surveys in the coming weeks allowing them to identify areas for improvement and compare their performance to that of their peers.
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