Table 2 Survey items reaching consensus^a

STEP 1 Initial patient identification

 S1.1

Members of a rehabilitation team should be the ones who identify patients who might be suitable for RITH

1

 S1.2

Members of acute care teams are able to identify patients who might be suitable for RITH if they use a formal screening tool

1

 S1.3

To be identified as potentially suitable for RITH, the patient’s carer (if there is a carer) must agree that RITH is a possible option

1

STEP 2 Determining patient eligibility

 S2.1

Members of a rehabilitation team should be the ones who determine a patient’s eligibility for RITH

1

 S2.2

Members of acute care teams are able to determine a patient’s eligibility for RITH if they have used an appropriate assessment tool

1

 S2.3

The RITH team should have the final say on each patient’s eligibility for RITH

1

 S2.4

A rehabilitation physician (or their delegate) should sign off on each patient’s eligibility for RITH

1

 S2.5

Where a home visit is not undertaken in determining patient eligibility for RITH, some alternate means of assessing the safety and suitability of the home environment should be undertaken (such as a checklist)

2

 S2.6

In the absence of a home visit, a satisfactory initial assessment of the patient’s home environment could be done with a ‘virtual tour’ of the home

2

 S2.7

Patients and carers considering RITH should also be informed about the option of inpatient rehabilitation (including the pros and cons of each) so they can make an informed decision about participating in RITH

2

 S2.8

As part of the eligibility assessment for RITH, the RITH team and patient should jointly establish and agree on minimum achievable goals expected from a RITH program

3

 S2.9

A written agreement for carers, which makes explicit the expectations and roles of a carer when a patient enters a RITH program, is desirable

2

 S2.10

To be eligible for RITH, the patient’s carer (if there is a carer) must agree that the support available through RITH is sufficient for the carer to support the patient at home during their RITH program

1

 S2.11

When required, paid support services (e.g. personal care, home help, meal services) should be available to patients on RITH programs, irrespective of whether they have a carer or not

2

 S2.12

To be eligible for RITH, the patient must have a general practitioner who is willing to continue ongoing general medical care during their RITH program

1

 S2.13

The acute care team is responsible for organising patient discharge from acute care, even though a patient might have been accepted on to a RITH program

1

 S2.14

Discharge from acute care should not occur without liaising with a patient’s carer (if there is a carer)

1

 S2.15

A RITH team member should work in collaboration with the acute care team to facilitate the patient’s discharge from acute care

1

 S2.16

Acute care hospitals should not discharge medically unstable patients to RITH programs

1

 S2.17

RITH programs should not accept medically unstable patients

1

STEP 3 Development of the RITH care plan

 S3.1

An initial RITH care plan that is done before the patient is discharged from acute care can be developed by only one multidisciplinary team member, as long as that person is experienced and able to take an interdisciplinary approach

2

 S3.2

The patient cannot be properly assessed, and their RITH care plan cannot be properly developed, without a brief admission to a rehabilitation ward

1

 S3.3

A rehabilitation physician (or their delegate) should assess the patient before the initial RITH care plan is developed

1

 S3.4

The patient’s RITH care plan should include an indicative program duration

1

 S3.5

The patient’s RITH care plan should include an indicative number and type of therapy interventions

1

 S3.6

Patient assessment tools used in RITH programs should include those that are, or will be, supported by the Australasian Rehabilitation Outcomes Centre (AROC)

1

 S3.7

Flexibility in RITH program intensity and duration (within an approximate budget) should be available depending on patient preference and clinical situation

2

 S3.8

Patient need should be the primary determinant of the intensity and duration of a RITH program

1

 S3.9

Both Model 1 and Model 2 should be available RITH models

3

 S3.10

Under Model 2, in general, the maximum length of a RITH program should be considered as 10 weeks

3

 S3.11

Intensive ‘single discipline’ reconditioning rehabilitation programs should be available as a RITH model if the patient would need to remain in hospital, or cannot be safely discharged from hospital, without the availability of such a program

3

 S3.12

A RITH service provider is best placed to provide these intensive ‘single discipline’ reconditioning rehabilitation programs because of the expertise available within the RITH team to monitor patient progress with goals and take corrective action if necessary

3

 S3.13

To increase awareness of RITH, RITH for reconditioning should be included as a recognised post-acute care pathway

2

 S3.14

When a Rehabilitation Physician or Advanced Trainee assesses a patient in acute care, RITH should be included as one of a range of rehabilitation options to be considered

2

 S3.15

Where a patient is to have an elective procedure following which they might require reconditioning rehabilitation, then a discussion about RITH as a viable rehabilitation option should be commenced with the patient prior to their hospital admission

2

S3.16-S3.24 What do you think are important components of a RITH case manager’s role?

S3.16—Liaison between the different treating team members

1

S3.17—Liaison with the patient and their carer (if they have one) about their care plan

1

S3.18—Liaison with the patient’s RITH rehabilitation physician

1

S3.19—Establishing with the patient’s GP / GP Practice how the GP wants to receive communication about their patient’s participation in RITH

1

S3.20—Ongoing liaison with the patient’s general practitioner

1

S3.21—Ensuring the provision of community support services where necessary

1

S3.22—Ensuring that the patient care record is maintained and up-to-date

1

S3.23—Organising case and family conferences

1

S3.24—Managing the patient’s discharge from the RITH program

1

 S3.25

A case manager needs to be clinical

2

 S3.26

A case manager should have administrative support

2

 S3.27

Where available, the RITH Team (or an affiliated in-reach rehabilitation service) should commence rehabilitation with the patient still in acute care

2

 S3.28

The rehabilitation medicine physician should have a central role in the provision of RITH, as they do in inpatient rehabilitation units

1

 S3.29

The primary responsibility for rehabilitation care during RITH sits with the rehabilitation physician

1

 S3.30

Given that a rehabilitation physician must be involved in a patient’s RITH program, the rehabilitation physician bears responsibility for the oversight of the patient’s RITH program

2

 S3.31

The rehabilitation physician must be readily contactable by a RITH therapist or nurse (and vice versa) when either needs to discuss patient care

2

 S3.32

As a principle of care, the rehabilitation physician and the patient’s general practitioner should collaborate on relevant patient care decisions

1

 S3.33

The extent (frequency of review) of involvement of the rehabilitation physician will be determined by the complexity and needs of the patient

2

 S3.34

Other appropriately skilled medical specialists (e.g., geriatricians for patients in the geriatric aged group) could fulfil a similar role to the rehabilitation medicine physician in RITH for reconditioning

3

 S3.35

To be eligible for RITH, the patient must have a general practitioner who is willing to continue ongoing general medical care during their RITH program

1

 S3.36

The role of the GP will depend on the level of general medical care that can be provided by the RITH program

2

 S3.37

The patient must have a means of accessing their GP during their RITH program

1

 S3.38

As the duration of the RITH program increases, the patient’s GP should have more responsibility for providing general medical care

2

 S3.39

A full discharge summary should be provided to the GP when the patient leaves acute care

1

 S3.40

The GP needs to be informed when the patient has been discharged home to commence RITH

1

 S3.41

Information describing the general responsibilities of RITH team members should be provided to GPs at the start of their patient’s RITH program

2

 S3.42

Communication supplied to a patient’s GP should include the patient’s RITH care plan and the patient’s anticipated goals from RITH

1

 S3.43

An MBS-approved GP case conference with members of the RITH team towards the end of the RITH program is ideal

1

 S3.44

Each RITH service must have an overarching clinical governance framework under which RITH programs are delivered

3

 S3.45

In all RITH models, it is important to ensure that clinical governance arrangements (such as responsibility for medical care and emergency management plan) are determined and known to everyone involved (RITH team, GP and patient/carer) at the outset of the RITH program

3

 S3.46

There must be a reporting system in place for all adverse events and near miss incidents for patients participating in RITH programs

1

 S3.47

The Australasian Faculty of Rehabilitation Medicine (AFRM) should be responsible for developing specific standards for RITH programs

1

 S3.48

AFRM standards should be used to guide and optimise the care of patients in a RITH program

1

STEP 4 RITH program delivery

 S4.1

As long as team members know and understand their professional boundaries, an interdisciplinary approach can be an appropriate model of service provision for RITH for reconditioning

3

 S4.2

A suitably skilled nurse/s should be part of a RITH team

2

 S4.3

Allied health assistants have an important role to play in RITH

2

 S4.4

Rehabilitation in the home (RITH) patients should receive as comprehensive a rehabilitation service as they would have received if they had been undergoing inpatient rehabilitation

2

 S4.5

Reconditioning following cancer should include psychosocial care delivered by a social worker and/or a psychologist

2

 S4.6

Multi-disciplinary team case conferences should feature in each patient’s RITH program

1

 S4.7

Family conferences (if relevant) should feature in each patient’s RITH program

1

 S4.8

Resources (e.g. printed or electronic) that describe exercises or other rehabilitation therapies should routinely be provided to help patients (and carers) do their therapy when the therapist is not with them

2

 S4.9

If the carer is to partner in the patient’s rehabilitation (e.g. supporting therapy without a therapist present), then the RITH program must include time for carer education

2

 S4.10

Providing therapy at community locations (for example, a local community centre or gym) could be considered to fit within a RITH program

1

 S4.11

Providing therapy at health facilities (e.g., hydrotherapy pool, hospital gym or clinical space) could be considered to fit within a RITH program (as long as it did not involve the ‘admission’ of the patient to that hospital and did not breach other funding rules)

1

 S4.12

A RITH service could use an external brokerage model to provide personal care, home help and meals when required by patients while they undergo RITH

2

 S4.13

There is a role for technology (telehealth/telerehabilitation) within RITH programs

1

 S4.14

Technology can be an effective means of providing rehabilitation therapy in a patient’s home during a RITH program

1

 S4.15

Technology can be an effective means for a rehabilitation physician to monitor a patient’s progress during RITH

1

 S4.16

When rehabilitation physicians utilise telehealth/telerehabilitation, its use should be guided by the clinical situation, the availability of technology and the ability of the patient to participate in telehealth/telerehabilitation

3

 S4.17

Where IT literacy, or sensory or cognitive deficits limit the ability of a patient and/or carer to use the technology, a RITH MDT member should be in the patient’s home to assist during any telehealth/telerehabilitation session with a rehabilitation physician

2

 S4.18

It is acceptable clinical practice during a video consultation with the rehabilitation physician that a member of the RITH MDT be in the patient’s home to facilitate demonstration of the patient’s functional ability, where the patient cannot otherwise reliably do so

2

Step 5 RITH Program Discharge

 S5.1

RITH patient outcome data should be based on functional measures (e.g., FIM change)

1

 S5.2

RITH patient outcome data should be based on the degree of achievement of negotiated patient goals

1

 S5.3

PREMs (Patient Reported Experience Measures) and PROMs (Patient Reported Outcome Measures) are contemporary measures that should be included in RITH outcome assessment

3

 S5.4

RITH data should be submitted to AROC for benchmarking

1

 S5.5

Patient outcome tools used in RITH programs should include those that are, or will be, supported by the Australasian Rehabilitation Outcomes Centre (AROC)

1

 S5.6

Ideally, for the purposes of benchmarking for RITH, there should be a mandatory set of AROC-supported assessment/outcome tools used by all RITH services

3

 S5.7

Admission to inpatient rehabilitation should be available to RITH patients where progress has failed, and inpatient rehabilitation may assist

2

 S5.8

An acceptable key performance indicator (KPI) for subsequent admission to inpatient rehabilitation following a ‘failed’ RITH for reconditioning program is ≤ 10%

3

 S5.9

In a well-functioning RITH program, acute hospital readmission rates should be as low as or lower than acute hospital readmission rates following inpatient rehabilitation

2

 S5.10

Discharge from the RITH program should occur as soon as the patient’s goals have been achieved

1

Budgetary Factors

 BF.1

The available budget for a patient’s RITH program is more important than the patient’s clinical care needs

1

 BF.2

The cost of a patient’s individual RITH program should be no more than the cost of a comparable inpatient rehabilitation episode

1

 BF.3

Any RITH program/model should have an endpoint for service delivery

3

 BF.4

There should be some budget flexibility between individual patient RITH programs, as long as the overall RITH service is able to work to its budget for a given level of activity

2

 BF.5

Expenditure beyond a baseline budget amount for each patient’s RITH program should sit with someone above the case manager/team delivering care

2

 BF.6

There should be processes put in place to allow for the activation of a predetermined extension of a RITH program if it is likely that further quantifiable improvements in function and quality of life can be evidenced (but limits would still apply)

2

 BF.7

It is unlikely that any funder (public or private) will agree to support RITH for reconditioning unless budget parameters have been set and agreed to for the RITH program

2

 BF.8

Any RITH service, whether publicly or privately funded, must work to a budget (either an individual budget per patient OR an overall budget for the RITH service)

3

 BF.9

Predictive models used to develop a costing model for RITH are helpful at an overall program level but should not be strictly applied at the individual patient level

2

 BF.10

Prior to implementing a RITH for reconditioning service, the key ‘decision makers’ (i.e., the rehabilitation physician and RITH case managers) should receive formal education on setting, monitoring and managing individual RITH program budgets

2

 BF.11

A schedule of costs (that is, a pricing schedule or pricing tool) for each type and mode of delivery of therapy interventions could be used to aid in the development and costing of the patient’s RITH care plan

2

 BF.12

It will be attractive for health service administrators in the public system if the availability of RITH for reconditioning allows more patients to receive rehabilitation for the same financial outlay

2

 BF.13

It will be attractive for private health insurers if the same patient outcomes can be achieved by RITH for less cost than comparable inpatient rehabilitation

2

 BF.14

The nature of how a budget for RITH is applied may need to vary between public and privately funded RITH models

3

Potential utilisation of RITH

 PU.1

RITH for reconditioning for patients following medical illness, surgery, or treatment for cancer should be widely available for appropriate patients

1

 PU.2

It will be too complex to design a model of care for RITH for reconditioning

1

Miscellaneous

 M.1

Patients admitted to an inpatient rehabilitation ward usually require treatment by more than one allied health discipline

1