Using knowledge translation to establish a model of hospital-based early supported community reintegration for stroke patients in South Korea

Abstract

Background In 2019, the South Korean government started designating rehabilitation medical institutions to facilitate the early return of patients with stroke (PWS) to their communities after discharge. However, a detailed operating model has not yet been suggested. We aimed to develop a hospital-based early supported community reintegration model for PWS that is suitable for South Korea based on knowledge translation in cooperation with clinical experts and PWS. Methods Clinical experts (n = 13) and PWS (n = 20) collaboratively participated in the process of developing the early supported community reintegration model at a national hospital in South Korea, using the following phases of the knowledge-to-action cycle: (1) identifying knowledge, (2) adapting the knowledge to the local situation, (3) assessing barriers and facilitators to local use of knowledge, and (4) tailoring and developing the program. Barriers and facilitators to local use of knowledge were assessed multidimensionally at the individual, interpersonal, organizational, and community level based on the social-ecological model. Literature reviews, workshops, individual and group interviews, and group meetings using nominal group technique were conducted in each phase of the knowledge-to-action cycle. Results Each phase of the knowledge-to-action cycle for developing the early supported community reintegration model and a newly developed model including the following components were reported: (1) revision of strategies of organizations related to community reintegration support, (2) establishment of a multidepartmental and multidisciplinary community reintegration support system, (3) standardization of patient-centered multidisciplinary goal setting, (4) multidimensional classification of community reintegration support areas, and (5) development of guidelines for a tailored community reintegration support program. Conclusions We designed a hospital-based multidimensional and multidisciplinary early supported community reintegration model that comprehensively included several elements of community rehabilitation in connection with hospitals and communities, taking into account the South Korean situation of lacking community rehabilitation infrastructure. In developing a guideline for a tailored community reintegration support program, we attempted to take into consideration various situations faced by PWS in South Korea, which is in a transitional stage for community rehabilitation. It is expected that this early supported community reintegration model can be referenced in other countries that are in a transitional stage of community rehabilitation.

Over- and under-supply of inpatient rehabilitation after stroke without a post-acute rehabilitation system: a nationwide retrospective cohort study

“…This study investigated the rehabilitation healthcare delivery system before the introduction of the post-acute rehabilitation hospital system and identified that rehabilitation after stroke was not properly performed based on severity (9). Before 2000, Japan had no dedicated system in inpatient facilities to provide early and intensive rehabilitation (26). Prior to 2000, Japan faced the same situation as South Korea.…”

“…Patients who have completed functional improvement are subject to an active return-to-society program, and those whose condition does not improve discontinue rehabilitation treatment and are transferred to an LTCH (18). The Japanese national insurance system introduced kaifukuki (convalescent) rehabilitation wards (KRW) in 2000 (26). Rehabilitation treatment was limited to 3 h per day, and the maximum length of stay for patients with stroke in the KRW was limited to 150 days.…”

“…Therefore, rehabilitation treatment may not be implemented in the post-acute period in these groups, not for economic reasons, but because the referral system between medical institutions did not work. Since the median LOS in RCCVCs was 6 days or less and outpatient-based rehabilitation treatment is rarely performed in South Korea, rehabilitation services could be undersupplied for these patients (26).…”

“…Second, there were no criteria for determining whether inpatient rehabilitation was required in South Korean NHIS in 2017. Instead, if the hospitalization period exceeds 2 weeks, hospitalization reimbursement is deducted, and after 1 month, it is further deducted (26). However, when patients are admitted to another hospital post-discharge, the deduction rate is not applied cumulatively but rather is reset.…”

Analyzing Community Care Research Trends Using Text Mining

“…11 Existing studies on community care primarily focus on the current status of community care, building operational plans, and comparative analysis of care types. [12][13][14] To expand community care, which has not yet established a specific operational direction, it is necessary to analyze community care-related research in an integrated manner. By analyzing both unstructured data and community care-related papers, we intend to provide suggestions for the improvement of both current community care and future community care-related policies.…”