Concussion Service. Operational Guidelines

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1 Concussion Service Operational Guidelines This guide is to be read in conjunction with ACC s Standard Terms and Conditions and the Concussion Service Specification October 2016 This is a living document and will be updated as required

2 Contents Introduction to Concussion Services... 4 Purpose... 4 Philosophy... 4 Individual needs... 4 Interdisciplinary team... 4 Relationships... 4 Service objectives... 5 Useful contact numbers... 5 Concussion Service Forms... 5 Responsibilities... 5 Supplier responsibilities... 5 Client responsibilities... 7 ACC responsibilities... 7 Communication protocols... 8 Relationship expectations... 8 Communicating instead of reporting... 8 Service End to End Process... 9 Time Available...11 Client eligibility...12 Clinical diagnosis - severity of injury...12 Service Delivery...13 Referral...13 Accept or decline...14 Initial purchase order...14 Investigation...15 Process Map - Investigation and Triage...15 Clinical Notes...16 Case Reviews...17 Diagnosis...17 Triage...18 Assessing risk to recovery...18 Assessing of Therapy Needs...19 Planning Rehabilitation...19 Providing Education...19 Notification...20 Therapy...20 Key worker...20 Interdisciplinary Teams...21 Clinical reporting...21 Use of time...22 Service Administration...22 Service location...22 Maximum duration...23 Timeframes...23 Maximum funding limit...23 Purchase orders...24 Completing or extending the service...24 October 2016 Page 2 of 62

3 Other ACC services...24 ACC may request clinical notes...24 Client non-attendance...25 Invoicing ACC...26 Quality Services...30 Supplier and Service Performance Reporting...31 Results Based Accountability...31 Target Measures...33 Reporting Types...36 APPENDICES...39 Appendix 1: Bio-psycho-social model...39 Appendix 2: Continuum of care model...41 Appendix 3: Risk to recover assessment matrix...42 Appendix 4: Neuropsychological assessment guidelines...47 Appendix 5: Data Dictionary Discharge Report...52 October 2016 Page 3 of 62

4 Introduction to Concussion Services The Concussion Service (CS) is an interdisciplinary service consisting of triage, assessments and therapies that support clients to recover from a mild to moderate traumatic brain injury and to return to everyday life. It also aims to prevent long-term consequences such as post-concussion syndrome (PCS) by identifying clients at risk of PCS and giving them effective interventions and education. The Concussion Service is based on rehabilitation best practice and recognises the bio-psychosocial model. The service works holistically and adapts to provide services that best meet the rehabilitation needs of the client while recognising the legal responsibilities of ACC and the supplier. Purpose The purpose of the service is to: provide early intervention rehabilitation to support recovery and prompt return to everyday life, including work or school identify clients likely to develop long-term consequences, such as post-concussion syndrome (PCS), and provide them with effective interventions and education. Philosophy The Concussion Service has three core philosophies. Individual needs Each person who sustains a brain injury responds differently, therefore their assessment and rehabilitation needs can vary. ACC and suppliers will adapt services to get the best recovery for the individual. Interdisciplinary team The Concussion Service is provided by an interdisciplinary team specialising in treating clients mild to moderate traumatic brain injuries. The service includes assessments and treatments that helps clients achieve a long-term recovery where they no longer need support from ACC. The full interdisciplinary team participates throughout. Regular group meetings are held to discuss the client s rehabilitation progress and to identify their ongoing rehabilitation needs. Relationships ACC and suppliers work together to support the client s rehabilitation. This is achieved by maintaining close working ties through good communication, respecting each other s areas of expertise, and fully engaging the clients and their family/whānau in the recovery process to ensure the client gets the services they need in order to achieve independence. October 2016 Page 4 of 62

5 ACC will measure the success of this service based on the following objectives: clients are returned to their usual activities of everyday life, including work or school, and no longer require any continued support from ACC for their brain injury services are provided in the shortest timeframe and at the lowest cost while maintaining clinical appropriateness clients report overall satisfaction with the services provided. Provider helpline Ph: The supplier helpline staff can answer queries relating to supplier numbers, Assessment Report and Treatment Plan (ARTP) updates and general enquiries. Health Procurement Ph: Health Procurement can advise on appropriate documentation in relation to applying for contracts. All Concussion Service forms are available on the ACC website ww.acc.co.nz > Publications > Concussion page, or by searching the form number using the search box on the home page. ACC883 Concussion Service Referral Form ACC884 Concussion Service Client Summary Form ACC885 Concussion Services Did Not Attend report Responsibilities Supplier responsibilities The supplier is responsible: to for clients ensuring the education, triage, assessment and therapy provided is appropriate to the diagnosis providing services promptly, for example: o making the first appointment within 2 days of the referral being received o holding the first appointment within 5 days of the referral being received encouraging the client s self-management and active participation in the rehabilitation process providing high quality assessments and treatment services ensuring the interdisciplinary team works together throughout delivering services only when clinically necessary October 2016 Page 5 of 62

6 to for including the client s family and whānau, where appropriate ACC nominating a key worker to have primary contact with ACC ensuring the client has a confirmed diagnosis prior to commencing therapy by o investigating up to 5 years if prior clinical notes relating to the claim o conducting clinical case reviews to identify assessment needs conducting the appropriate clinical assessments to confirm the diagnosis as requested working within timeframes outlined in the service specification or as agreed with the case owner, including: o conducting a client needs assessment o submitting reports o acting in a timely way to maximise the client s rehabilitation outcome and keep weekly compensation costs down demonstrating commitment to the contracted outcome by completing section 12 of the ACC884 Client Summary maintaining contact with the case owner (as agreed) to discuss changes or developments, e.g. change in symptoms or work readiness, or social, family, or financial issues etc., to help ACC support the client giving ACC a copy of any clinical information provided to or collected from the GP relevant to the client s TBI maintaining high quality clinical notes to: o support and verify any risk assessment or ACC884 Client Summary form information o aid decision-making for ACC and other suppliers as appropriate operating the service within the terms and principles of the Concussion Service contract and these Operational Guidelines referrers (GPs) other service suppliers providing timely and relevant clinical information to support the overall care of the client, such as: o assessment and treatment programmes including medication o rehabilitation plans for return to work recommending return to work time frames maintaining good working relationships based on respect for each other s area of focus providing and receiving information appropriate to the situation and need. October 2016 Page 6 of 62

7 Client responsibilities The client is responsible for: attending appointments or rescheduling them when they are unable to attend, with reasonable notice participating in the rehabilitation process discussing any problems that may hinder their recovery with their case owner and supplier. ACC responsibilities ACC is responsible: to for clients ensuring they have the correct diagnosis and cover decision ensuring they get the appropriate services and support to help them rehabilitate and return to everyday life, including work or school making timely, efficient, and effective decisions suppliers making prompt decisions based on the available information or, if the information is unavailable, investigating as appropriate working with the supplier to rehabilitate the client agreeing new timeframes where the client s needs cannot be addressed within the existing timeframe keeping them up to date regarding o o o any other assigned service suppliers such as vocational services who the lead supplier is where services need to be coordinated any delays or issues that may impact on service provision following up with the supplier if they have not been in touch as agreed seeking clarification from the supplier if progress and outcomes are not being achieved referrers (GPs) confirming the acceptance or decline of the referral keeping the GP informed of the client s progress employers keeping them up to date with the client s rehabilitation process and encouraging them to keep the client s job available for a successful return to employment other service suppliers, eg Stay at Work or other vocational programmes keeping them informed of any relevant information for coordinating the rehabilitation process. October 2016 Page 7 of 62

8 Communication protocols Relationship expectations Concussion Service Operational Guidelines The rehabilitation partnership between the supplier and the case owner is one of the most important tools for ensuring the recovery of the client. Having the supplier and case owner working and communicating collaboratively will help with the client s rehabilitation. To be effective this relationship needs to be based on mutual respect open communication agreed timeliness and quality agreed client outcomes There is an expectation that: suppliers and ACC case owners will work together to assist in the client s rehabilitation both parties will respect each other s area of expertise suppliers are experts in the rehabilitation of brain-injured clients and are responsible for achieving the service outcome for the client within the context of the Service (as defined in the service specification) ACC case owners are expert at managing the complex mix of rehabilitation, entitlements, and compliance relating to claims ACC is ultimately responsible for funding rehabilitation servicesas necessary and appropriate. The supplier will nominate a key worker to have contact with ACC. The key worker will: keep ACC informed of any issues regarding the provision of assessments or treatment raise any issues with the service and suggest solutions ensure all services are carried out in accordance with the service schedule and this operational guideline. represent the supplier in service performance discussions inform ACC promptly when any contact details change. Communicating instead of reporting Formal written clinical reports are not purchased in this service. The assessments determine the client s requirements for the Concussion Service and are not intended to determine cover or entitlement, although they may be used to confirm diagnosis. Instead, suppliers are asked to convey to the ACC case owner information that supports appropriate fact-based decision-making. Suppliers may choose to provide further support information at their own discretion. Where a diagnosis is very complex and a separate report is required ACC may choose to purchase this separately. This does not form part of the CS spend. This will be purchased at the standard hourly rate under the service item codes MEDR. The reporting structure in the Concussion Service highlights the importance of effective communication between ACC case owners and the supplier. Phone calls and s should cover the following topics: October 2016 Page 8 of 62

9 the client s current status the potential recovery timeframe and plan the impact of other issues on the client any recommendations or needs the supplier may have The key to the Concussion Service is the flexibility to adapt to the needs of the client while remaining efficient and effective. The sections shown here of referral, assessment, triage and therapy are not rigid or inflexible. The discussion and agreement between the supplier and ACC determines the appropriate route for the client. See the full map overleaf. October 2016 Page 9 of 62

10 Referral Referral from GPs or A&M Clinics Referral from Medical or Allied Health Staff at DHB Concussion Service Supplier ACC Referral generated by ACC Unconfirmed Diagnosis Sends the referral to the Concussion Service Supplier Recovered or Cover Declined Supplier Confirms Diagnosis 1. Collect clinical notes and interview client 2. Identify what further assessments are required to confirm the diagnosis via IDT 3. Discus with ACC to agree purchase order 4. Conducted the approved consulations to confirm diagnosis such as - medical specialist and/or - clinical neuropsychologist and/or - allied health - other specialist 5. Provide a written confirmation of diagnosis Diagnosis Reported TBI Diagnosis Confirmed End Assessment (if not already assessed) ACC884 Client Summary Supplier Recommendation Supplier Assess the Client s Need 1. Collect clinical notes, interview client and draft summary 2. Conduct Med Spec & Clinpsych triage case reviews 3. With the IDT identify what other assessments are needed to assess the Client s needs (allied health, other specialists) 4. Conducted the required assessments 5. Develop rehabilitation plan 6. Prepare ACC884 Client Summary Triage ACC Not Recovered Low needs Stay in CSS Not Recovered Non-Concussion Needs Not Recovered Too complicated Exit CSS Recommend Therapy Services - Psychological Counselling - Medical Consultation - Allied Health Services Recommend Other Services: The case manager selects other ACC treatment and rehabilitation Services such as Vocation Services to work along side CSS Recovered ACC884 Client Summary Supplier Recommendation Recommend Complex Services The case manager selects other ACC treatment and rehabilitation Services such as - Neuropsychological Assessment Service - Clinical Services contract - Training for Independence - Psychological Counselling Service - Physiotherapy contract Therapy Delivery Therapy Services - Psychological Counselling - Medical Consultation - Allied Health Services October 2016 Page 10 of 62

11 The following table is a guide to use service item codes for the different activities in the service. Once again these should not be seen as rigid stages. Case owner and the supplier should discuss the client s needs regularly. Stage Activities Service Items Codes Referral Investigation TBI21, TBI29 Diagnosis TBI23 1, TBI24, TBI25 Assessment Risk assessment TBI21 Identify specialist assessment needed Assessment of therapy needs Rehabilitation planning Education Notification TBI13, TBI14 TBI22, TBI23, TBI24, TBI25 TBI21 TBI21 TBI21, TBI29 Therapy Therapy & review TBI26, TBI27, TBI28 Notification TBI29 Time Available Service Item Hours Variations TBI21 Education & Assessment 3 Hours for all service items maybe TBI22 Allied Health Assessment 2 varied in agreement with the case owner but must meet the following TBI23 Neuropsychological Screen 5 principles: TBI13 Neuropsychological Case Review TBI24 Medical Assessment 2 TBI14 Medical Specialist Case Review TBI25 Other Specialists Fee Fee At cost TBI26 Allied Health or Nursing therapy 8 TBI27 Psychological Consultation 5 TBI28 Medical Consultation 2 TBI29 Key worker 4 Multi-disciplinary services are required (single discipline needs are met under other contracts) Rehabilitation plan fully explains the need for services, goals and expected outcomes and timeframes Services do not exceed the maximum funding of $3,150 for the total service cost 1 ^Physiotherapists have a number of tests that can differentiate TBI from physical injuries such as neck and shoulder injuries, such as the Treadmill Stress Test October 2016 Page 11 of 62

12 The client can access the Concussion Service if referred by a medical practitioner or an ACC case owner. The client cannot be referred if the injury was more than 12 months before the referral and any subsequent treatment. The client cannot self-refer. To be referred by a medical practitioner the client: must and and have an accepted ACC claim, and be diagnosed with or be suspected of having mild TBI, moderate TBI or postconcussion syndrome have at least one of the following on-going signs and symptoms such as: mood changes memory problems fatigue difficulty concentrating loss of balance headaches visual disturbances nausea muscular aches dizziness have at least one of the additional risk factors such as: the inability to work or attend school for more than one week second or subsequent MTBI within six months post traumatic amnesia lasting more than 12 hours a requirement to operate machinery or drive at work a pre-existing psychiatric disorder or substance abuse problem a high functioning job such as engineer, medical practitioner or lawyer currently attending secondary or tertiary education Clinical diagnosis - severity of injury Clients diagnosed with a mild or moderate traumatic brain injury (TBI) are suitable for the Concussion Service. The table below is used to categorise TBI at the acute stage. Severity of injury Glasgow Coma Scale (GCS) Duration of Post-traumatic Amnesia (PTA) Mild less than 24 hours Moderate days Severe days or more (Source: Evidence best practice guideline traumatic brain injury: diagnosis, acute management and rehabilitation 2006 (TBI Guidelines) Note: If the GCS and PTA do not correlate the client will be assigned to the greater of the two severity categories. October 2016 Page 12 of 62

13 Example: A client has a GCS score of 14 and also experiences PTA of 2 days. Based on the more severe indicator (PTA of 2 days) the client is considered to have a moderate TBI. If notification of a TBI has been delayed but is less than 12 months after the injury, the case owner will check the GCS and PTA where provided, and any other information such as clinical notes, to review the concussion symptoms and decide if it is appropriate for the client to access the Concussion Service. ACC may refer the client to the Concussion Service to have the diagnosis investigated by the medical specialist. Service Delivery Referral The referrer must only refer clients who meet the eligibility criteria. The supplier should decline any referral that does not meet the above conditions. The referral form The referrer should use the ACC883 Concussion Service Referral form on the ACC website. DHB referrers must use the ACC883 Referral form and send it to their appropriate ACC Short Term Claims Centre. The ACC883 is an acceptable notification of a concussion where the form is signed by a medical practitioner. Letters of referral Some referrers use other formats such as a letter of referral. ACC does not consider them to - have sufficient detail, unless they are accompanied by clinical notes outlining presenting symptoms, pre-injury health status and any other potential rehabilitation impact - be an update to the diagnosis on the ACC45 The supplier and ACC will contact the referrer at every occasion recommending the use of the ACC883 Referral form and to send it to ACC. Who can refer? At the DHB A medical practitioner allied health professional acting on behalf of a medical professional: In the community A GP or Accident & Medical (A&M) Centre: At ACC A case owner: can refer a client to the service by sending the completed ACC883 form to the nearest ACC Short Term Claims Centre for consideration. A qualified medical professional must have noted in the client s DHB clinical notes either a confirmed diagnosis or a direction to refer to the service. can refer a client by sending the completed ACC883 or letter of referral with clinical notes to ACC directly or to a Service supplier who must forward it to ACC for approval. can refer a client to the Service if they consider that the client may have sustained a TBI. The case owner also completes the ACC883 form to ensure the supplier receives consistent information and provide any other October 2016 Page 13 of 62

14 information relevant. If there has been no diagnosis of TBI by a medical professional, the case owner will request a medical assessment to confirm the diagnosis. Who cannot refer? Other clinical professionals, such as a physiotherapist in the community, cannot refer a client to the Concussion Service. They may, however, refer a client to a registered medical practitioner for a medical assessment, after which the client may be referred to the Concussion Service. Accept or decline If the referral meets the criteria ACC will notify the client directly and send the ACC883 referral form to the supplier to start the service. If the claim does not meet the criteria and is declined ACC will notify the referrer and the client. The supplier will be notified if the referral came via the supplier. Initial purchase order A referral to a supplier for the Concussion Service will be accompanied by an initial purchase order (PO) that supports the timely assessment and triage of the client. The purchase order will include Service Item Codes Quantity/Time Comment TBI21 Education & Assessment 3 hours All hours TBI22 Allied Health Assessment 1 hour Another hour available on request. TBI13 Case Review by Clinical Neuropsychologist 1 fee only Single fee. TBI23 Neuropsychological Screen 5 hours Total hours TBI24 Medical Assessment 1 hour Another hour available on request. TBI14 Case Review by Medical Specialist Set fee only Single fee. TBI29 Keyworker 2 hours Half of total number This will enable the supplier to quickly adapt to the needs of the client without having to come back to the case owner to update the PO. The supplier will submit the ACC884 Client Summary once all the assessments are complete and will make recommendations on the way forward. Prior to this the supplier will keep the case owner up to date on the client s progress. The supplier will only complete the assessments which are clinically necessary. October 2016 Page 14 of 62

15 Investigation The service item TBI21 is designed to allow the supplier to investigate both clinical and the psychsocial background of the client. The following process map shows the comprehensive investigation required under TBI21. Process Map - Investigation and Triage While the supplier may operate their interdisciplinary team in their own way ACC expects that all the components of the following process map to be present. Key Worker Administration Supplier receives a referral directly from the referrer. Clause Send the referral to ACC immediately and wait for response ACC investigates cover & entitlement ACC makes a decision ACC notifies supplier and referrer of the entitlement decision within 2 working days Follow up if you haven t heard from ACC within 2 working days Confirm Acceptance of the referral with 1 working day Clause Supplier rreceives a referral from ACC Supplier contacts the client and make an appointment within 2 days Operational Guidelines October 2016 Page 15 of 62

16 Investigation, triage & education Summarise findings and provide summary and notes to full interdisciplinary team. (Med Spec, Clin Neuropsych & OT minimum) Clause 6.1 Contact DHB if referral from ED or other DHB service to obtain clinical notes Clause Supplier interviews the client Explain Rehabilitation process including investigation and confirmation of diagnosis if required. Clause and Get permission to access previous medical records. Clause Case reviews are completed by Clinical Neuropsychologist (TBI13) Clause Medical Specialist (TBI14) Clause to identify the need for full assessments Contact the GP get pre-injury clinical notes Clause and Get clinical history from client. Clause Ask about social factors and life impacts. Clause Ask about goals, expectations and commitment to rehabilitation. Clause Hold an IDT meeting to discuss information. Summarise IDT opinions & recommendations in clinical notes. Clause , Contact ACC to discuss IDT recommendations With the client s permission contact the employer or school (as appropriate) and Provide advice on symptom management. Clause Where diagnosis unconfirmed do NOT provide education on TBI. Provide education on TBI when the diagnosis is confirmed. Clause Education Conduct clinical assessments as clinically necessary Clause Allied Health (TBI22) Clinical Neuropsychologist (TBI23) Medical Specialist (TBI24) Other (TBI25) Meet with client to review findings and discuss rehabilitation plan including SMART goals & inputs Clause Draft ACC884 Client Summary Clause Clinical Notes Where the diagnosis is uncertain and/or the TBI unconfirmed the supplier should obtain up to five years of clinical history from the client s GP. This is to build a full medical history. This medical information is made available to the medical specialist to conduct a differential diagnosis and to other providers within the IDT only when clinical necessary. The supplier should notify the client and seek their permission to obtain the clinical notes. Should the client refuse then the supplier should suspend further services and refer the client to the case owner. The information collected should include - GP clinical notes covering all presentations including previous brain injuries and health issues (up to five years if relevant). Specifically pre-injury health issues such as depression, mental illness etc. This information can be provided to the specialists and will help in their diagnosis. - DHB clinical notes if the client was diagnosed and treated at any DHB service - Work or education information to help assess the cognitive demands that have been and could be on the client throughout the recovery October 2016 Page 16 of 62

17 - Family composition and responsibilities to help assess any stressors that may hinder recover and also where ACC may need to provide supports - Social background to identify any underlying social issues that may hinder recovery The supplier s clinical records should meet or exceed the expectations of the professional bodies. The supplier is responsible for ensuring the client s personal information is kept in a way that meets the relevant privacy legislation. Once the service is complete the client s medical information should be securely destroyed. The clinical information not relating to the concussion or other brain injures should not be made available to ACC. The supplier can go directly to the holder of the clinical records and arrange for the payment of any fees. Case Reviews It is important that the supplier collects all information about the client that may be relevant to their rehabilitation and recovery. The review of clinical notes by the medical specialist (TBI14) and the clinical neuropsychologist (TBI13) will identify any indication that the client does not need the clinical assessments the client was referred for. The specialists do not need to attend an actual meeting where this would be inefficient but ACC encourages face to face IDT meetings as they are considered best practice. If the case reviews agree with the referral then assessments by medical specialist (TBI24) and/or the clinical neuropsychologist (TBI23) should be arranged. Diagnosis A referral may be sent to a supplier with the clinical diagnosis accepted or still in question. Where the diagnosis is accepted the supplier can progress immediately to investigation, assessment and therapy. If the diagnosis is still in question then the case owner will direct the supplier to confirm the diagnosis using a comprehensive clinical investigation including a differential diagnosis. The investigation may also include all disciplines such as a musculoskeletal physiotherapist for neck and shoulder injuries. The medical assessment should take a neutral point of view until the appropriate tests and investigations have been taken to rule out other causes for the presenting signs and symptoms. Once the TBI diagnosis is confirmed the impact of the TBI should be assessed and advice provided on appropriate therapy and prognosis. Where the client s diagnosis is not confirmed the supplier should ensure the client understands that the diagnosis is being investigated and that they may or may not have a TBI. This is to minimise the likelihood of the client becoming invested in the TBI diagnosis when, in fact, it maybe another injury such as neck strain. Interim advice on managing pain and other systems can be provided as required without the diagnosis. The supplier is responsible for ensuring they have a confirmed diagnosis before therapy services are provided. October 2016 Page 17 of 62

18 Triage The Concussion Service has a strong triage focus, and a full interdisciplinary team using all available information will determine the suitability of the service for the client. If the client has recovered and no longer needs the CS has needs that can be meet within the resources of CS, either by itself or in conjunction with other services has needs that are greater than can be provided in the CS the supplier should recommend the client exits CS using the ACC884 as soon as identified continue in the CS recommend the client exits CS using the ACC884 as soon as identified Assessing risk to recovery The risk to recovery assessment matrix describes the client s situation using a bio-psycho-social framework. It is designed to be a communication tool between the supplier and ACC. It is not a clinical assessment and has no clinical validity. The tool describes potential barriers to the client s recovery as risk factors within the four domains - physical, psychological, work, and social. The 0-4 rating system describes where there is potentially little or no impact on the client s recovery (0) to where there is a potentially significant impact in the client s recovery (4). See Appendix 3: Risk assessment matrix. The supplier s IDT/keyworker will gather current and historical information about the client through interviewing the client. They will review all available clinical information via the clinical notes. If the supplier believes that the accuracy of the risk assessment is compromised by a lack of disclosure on the client s part they may, with the client s approval, contact the client s family, friends, and employer and ask relevant questions. The supplier must take care to maintain client confidentiality. If risks cannot be identified due to non-disclosure then the assessment will be at the less complex rating (1-2). The request for services will reflect this assessment. The supplier should explain to the client that the amount of service available is based on the information they give. Note: While a supplier may choose to have this risk assessment provided by a doctor, psychologist or neuropsychologist, the risk assessment will only be paid at the contract TBI21 allied health rate as it is not a clinical assessment. The risk assessment is an important part of the triage process and can assist in determine whether the client s needs can be met within the limits of the service. October 2016 Page 18 of 62

19 Assessing of Therapy Needs Concussion Service Operational Guidelines The client s therapy and support needs should be assessed throughout the rehabilitation. All clinical assessments will be completed by professionals operating within their scope of practice and within the interdisciplinary team. For guidance on what to include in the Clinical Neuropsychologist see Appendix 4.If you have any questions contact ACC s National Psychology Advisor. Planning Rehabilitation Where the client is progressing into therapy the supplier s interdisciplinary team will develop a rehabilitation plan that describes client s goals expressed as SMART goals (specific, measureable, achievable, realistic and time framed) and outline the therapy required to meet those goals. The supplier should either provide a copy of the rehabilitation plan to ACC or summarise the plan in the ACC884 Concussion Service Client Summary. The ACC case owner and the supplier will finalise and agree service composition and timeliness. The plan may be amended as additional information becomes available. Providing Education The education given to the client and their family/whānau should be clear and use plan language. If a diagnosis was not confirmed then the supplier will limit the education content to dealing with the symptoms. Once the diagnosis is confirmed as a mild or moderate TBI then education on TBI can be provided. The supplier may choose to provide education on concussion and brain injury to clients in a group session. The time will be spread across all attending clients (as per the Provider Handbook). It must cover, but not be limited to, the following items: Item Details Symptoms describe the symptoms describe the recovery journey describe the treatments that will target the individual symptoms cover lifestyle responses and dealing with stress Rehabilitation process rehabilitation response how it s different for everyone self-management help from family/whānau and friends supplier support via an interdisciplinary team getting back to normal functioning having realistic expectations returning to work if appropriate Brain injury structure of the brain mechanism of injury October 2016 Page 19 of 62

20 Item Details acute response Other support (where appropriate) other ACC services available working with the case owner working with the employer The supplier should explain the partnership between the supplier and the ACC case owner in the client s rehabilitation. Notification The supplier will keep in contact with the case owner throughout the rehabilitation programme and will notify ACC formally using the ACC884 Concussion Service Client Summary form when the rehabilitation plan has been agreed by the interdisciplinary team the rehabilitation is complete Therapy In line with rehabilitation best practice the client s achievements and rehabilitation needs will be continually assessed to ensure the service is tailored to the client. Therapy services will be provided with specific outcomes in mind and no unnecessary therapy will be provided. Where it becomes clear that the client will need more services than those available in the Service the supplier will notify ACC immediately. Key worker The key worker is a significant contributor to the success of the service and is important to the achievement of client goals. For each client, the supplier will nominate a rehabilitation professional to be the key worker. This role includes: holding, on behalf of the supplier and the interdisciplinary team, overall responsibility for the client s outcomes coordinating providers within the service to ensure the greatest efficacy and efficiency of the client s goals and outcomes ensuring the clinical notes are kept up to date and are at a high standard informing ACC of issues with providing the service ensuring reports are provided on time and accurately reflect the service provided maintaining links with community groups and other organisations working with the client coordinating and liaising with ACC and non-acc services to ensure the client receives smooth, supported transitions with integrated services maintaining an ongoing relationship with the client s ACC case owner to ensure high quality service and outcomes are achieved. The key worker is most effective in their relationship with the client when they: are proactive in their contact with the client, family and whānau are responsive to their cultural needs maintain a supportive, open relationship provide a safe and trusting environment October 2016 Page 20 of 62

21 approach the relationship in a holistic, client and family-centred way are committed to working within the bio-psycho-social model work across agencies work with families strengths and ways of coping. Interdisciplinary Teams The supplier must have an interdisciplinary team (IDT) fully qualified in their profession with a minimum of two (full time) years experience in acquired or traumatic brain injury. The IDT is fully engaged throughout the service to assist in the rehabilitation planning. The IDT will meet on a regular and scheduled basis to discuss the client s assessment and treatment rehabilitation needs. Notes of the meeting/s will be taken by the key worker who will summarise the individual clinical opinions. The notes will be kept in the client s notes. The supplier s team must include: medical specialists with qualifications in neurology or internal medicine with a particular focus in brain injury clinical neuropsychologists occupational therapists The supplier s team may also include: physiotherapists registered nurses, preferably with a rehabilitation speciality general practitioners speech language therapists social workers The supplier may refer the client to clinical specialists outside of the interdisciplinary team, on approval from the case owner, to obtain further advice on the client s specific rehabilitation needs. This will be funded within the maximum funding limited of the Concussion Service on a cost recovery basis. In addition to the supplier s interdisciplinary team, they must have access to: optometrists alcohol and drug addiction counsellors vocational counsellors anger management services driving assessment services cultural advisors, or services for Māori and Pacific Islanders and other ethnic groups if appropriate, which may include interpreting services consumer advocacy and support services. Clinical reporting Detailed clinical reporting is not purchased separately in this service but all suppliers are expected to maintain a high standard of clinical notes to evidence all therapies and recommendations. October 2016 Page 21 of 62

22 Those notes should be provided on request. Concussion Service Operational Guidelines If a client does not achieve the expected rehabilitation outcome the supplier must provide ACC with a copy of their full clinical notes with the ACC884. ACC will then use this information to support the on-going planning of the client s rehabilitation. Use of time The supplier will outline a treatment plan on the ACC884. The plan will be based on current best practice and will recommend the types of services and number of hours required. The supplier can determine how that time is to be used. Service Administration Service location ACC prefers suppliers to provide services in a location that best meets the client s rehabilitation needs. This can be the client s home, workplace, supplier s clinic or remotely via telerehab. The supplier is expected to plan the client s rehabilitation including identification of the best place for the rehabilitation. The options available to the supplier are the client s home, workplace, the supplier s clinic or remotely via a technological means such as phone or video conferencing. While text and are good communication tools they lack the immediate feedback required for engaging the client in their rehabilitation. Home-based Rehabilitation The delivery of services in the client s home is covered under the professional codes of practice and is not described in this document. Clinic-based Rehabilitation Suppliers may run clinics but they must ensure that the travel the client may have to undertake does not put the client at risk or adversely affect their rehabilitation outcome. The provision of services via a centralised clinic must be agreed with ACC at a services level and at a case level. The suppliers travel to and from the clinic and the cost of the clinic is considered to be a business overhead and will not be separately funded by ACC. Remote or Distance Rehabilitation - TeleRehab Suppliers can choose to provide services to clients using tele-rehabilitation as part of their rehabilitation programme. The NZ TeleHealth Resource Centre ( has a variety of resources available to practitioners and is able to assist suppliers to develop their telerehabilitation capability. October 2016 Page 22 of 62

23 ACC cannot and will not instruct a provider to deliver services remotely for any reason. Should the supplier choose to provide services remotely the supplier remains fully responsible for their actions, any consequences and the client s rehabilitation outcome. Maximum duration The maximum duration for service is six months (from the date of the referral to the last treatment date). It is expected that suppliers will work to ensure the client achieves the service objectives within 16 weeks. Clients with more complex and longer term service needs should have been triaged from the service. It s expected that the supplier will be available for the client as needed over the six month period. The supplier should not retain therapy hours to provide a follow-up service as therapy hours are for face-to-face therapy. Client follow-up via phone is considered part of the overhead component of the fees paid. ACC will monitor client duration based on the length of time between the first date of service to the last date of service of services invoiced for. Service duration will be discussed regularly as part of the dialogue between supplier and case owner. Timeframes The Service adapts to the needs of the client so there may be situations where the timeframes outlined in the service specification are not appropriate. The supplier is responsible for ensuring that timeframes are discussed and agreed. Section 8of the ACC884 should record a brief description of the client, their recovery needs and rehabilitation plan. Alternatively a separate rehabilitation plan can be included. The plan should outline expected timeframes for reviews and outcomes such as return to work etc. Maximum funding limit The Service has a maximum funding limit of $3,150, excluding Goods and Services Tax, travel costs and the single payment for non-attendance by the client (Did-Not-Attend fee). ACC will approve services up to that limit based on the client s diagnosis, clinical and risk assessments completed by the supplier. For treatment within the Concussion Service to be approved services must be: requested on the ACC884 Concussion Service Client Summary form provided within the maximum funding limit of $3,150. The supplier is responsible for ensuring that the maximum funding limit is not exceeded. Should the supplier exceed the maximum funding limit, ACC may choose to recover the overpayment. October 2016 Page 23 of 62

24 Purchase orders The supplier must hold a purchase order that approves the specific service items. The supplier may provide the services up to the approved maximum in the best way determined by the interdisciplinary team and based on the identified clinical need. To provide services differently than those specified on the purchase order prior approval must be sought from ACC to amend the purchase order. ACC is not liable to pay for services not specified on the purchase order. Completing or extending the service After the investigation and planning the ACC884 Concussion Service Client Summary form must be submitted within: 2 business days, when further treatment service needs are requested. The 2-day requirement recognises that both the supplier and ACC want to respond promptly to ensure the client s access to rehabilitation is not restricted. If this response time is not required the supplier can indicate a more appropriate timeframe on the form or in discussion with the case owner. 5 business days, when all services are complete, no further services are required and the client is exiting the Concussion Service. The 5-day requirement recognises that the client is no longer in need of services and therefore, while a timely response is required, there is no urgency. The supplier can request further services at any time by submitting an updated ACC884 to the ACC case owner. The case owner will use the same assessment parameters throughout. If further services are requested the ACC case owner will review the case, make a determination and, if approved, forward the purchase order within 2 business days. If the continuance is not approved, they will send decline letters to the client and the supplier. The supplier is not able to trade one service item for another. If the client s service needs have changed, the supplier should contact ACC with an amended ACC884 Concussion Service Client Summary form and negotiate an amendment of the purchase order. Other ACC services The supplier may recommend that the client receive other ACC services both during and after this service when they believe it will improve the client s recovery. During - Vocational, Home & Community Support After Neuropsychology, Psychology, Clinical, Training for Independence, Pain The case owner is responsible for reviewing the recommendations and deciding if the client is entitled to the services recommended. The supplier will be notified accordingly so they can coordinate the rehabilitation programme with the other services providers where they will be provided during this service. ACC may request clinical notes Suppliers will provide any clinical notes within 5 business days when requested by ACC, as there will be some situations where the summary information provided in the ACC884 will be insufficient. Suppliers are expected to have their client s clinical notes maintained to a high standard, detailing October 2016 Page 24 of 62

25 the client s status, rehabilitation needs, and all treatments provided to date. Client non-attendance Clients who keep their appointments generally take less time to recover and achieve better recovery outcomes than those who do not. ACC will pay one non-attendance (DNA) fee per client, no matter how many times they failed to attend an appointment. The service item code for nonattendance is TBIDNA.. The Service purchase order is updated for a single DNA fee by the case owner when the supplier: sends the case owner an ACC885 Concussion Service - Did-Not-Attend report within 1 business day of the missed appointment and explains why the client did not attend, and has made all reasonable efforts to remind the client of the appointment, such as an appointment card, a reminder letter, a phone call the day before and finally a text message on the day to the client s and a contact person s mobile phone. If the above criteria are met ACC will confirm funding within 2 business days of receiving the form. Invoicing the client for non-attendance ACC plays no part in scheduling appointments. Therefore after the first incidence of nonattendance where ACC has already paid a non-attendance fee, the supplier may choose to invoice the client directly where the client continues to not attend appointments. The supplier should alert the client and their supporting family and whānau both verbally and in writing at the start of the service about the possibility of being charged for non-attendance. ACC expects that the supplier will: not charge more than the agreed ACC fee that would have been payable take into consideration the client s financial situation. Service exit due to non-attendance The supplier must notify ACC on each occasion of non-attendance. If the DNA fee is not being paid, notification can be by phone or . If clients repeatedly do not attend appointments they can be exited from the service. This may result in all services and entitlements ceasing, including weekly compensation payments. Client exit A client exits the service when they have achieved the identified outcomes that enable them to return to work or school, and/or normal daily living. The client is considered to be discharged six weeks after the last service in the Service. Note: If the client has not achieved these outcomes within the specified timeframe the supplier must October 2016 Page 25 of 62

26 make a full comment on the ACC884 Concussion Service Client Summary form and record whether this is for non-compliance or a non-injury related factor, e.g. mental health issues. Post-service client support On going support will be provided to the client throughout the rehabilitation programme and the supplier will act as a point of contact for the six months from the date the referral was received. The supplier will contact ACC and refer the client to their ACC case owner if the client reports new symptoms. Not included in the service The following services are not included in the Service: transporting the client to and from the clinic transport from the supplier s place of residence to the base of operation transport from the base of operation to another base of operation inpatient services for TBI elective surgical treatment arising out of any initial assessment social rehabilitation assessments vocational rehabilitation services radiological and other clinical investigations, for example: - computerised tomography (CT) - magnetic resonance imaging (MRI) - electro-encephalogram (EEG) sleep studies. Invoicing ACC Reimbursing for Clinical Notes Where a supplier is has obtained up to 5 years of GP client notes and are invoiced by the GP they can be reimbursed by invoicing ACC use the service item code COPY up to a $1 per page Where the supplier is a DHB and reviews up to 5 years of DHB notes they can cannot bill ACC as they have not incurred a cost, unless a copy of those notes is requested by ACC as which point ACC will pay the normal changes. Where the supplier is not a DHB and they obtain up to 5 years of DHB notes and are billed by the DHB they can be reimbursed by ACC billing COPY up to a $1 per page Where are supplier obtains client notes but is not billed then the supplier can not be reimbursed. Supplier Service Service description code DHB DHBC Photocopying of medical notes. Paid per page and includes all administration time to process the request Fee (GST excl) DHB providers refer to the existing price schedule. October 2016 Page 26 of 62

27 Non-DHB COPY Used when requesting photocopies of notes that do not need reviewing and editing by a GP or specified treatment provider Includes admin tasks, such as searching, reviewing and collating $1.00 per page (min $5.00, max $30.00) Minimum charge of 5 pages Maximum of 30 pages Invoicing for services The invoice should present the time in hours and minutes. Each separate service should be listed by service date. Minutes % Information Client name Example John Smith Client number Purchase order number Service date Service code Time/ Quantity Amount claimed DD/MM/YY TBI21 1 hour 15 mins $ (GST Exc) Service date Service code Time/ Quantity Amount claimed DD/MM/YY TBI22 30 mins $54.84 (GST Exc) Divide the hourly rate with the appropriate percentage to calculate the portion of the hourly rate. 1 hour $ mins = 25% $ Total $ Total amount of invoice $ GST $28.79 Total $ Invoicing for Travel The service item codes for travel are TBITT5, TBITT1, and TBITD10 depending on the type of fee. The codes are used throughout the service. If the services are provided in a place other than the supplier s facility and the supplier needs to travel to the client, travel should be managed to maximise coverage and service time and minimise the distance travelled. Territorial Local Authorities (TLA) October 2016 Page 27 of 62

28 TI services use territorial authorities (TA) to define areas of coverage. When a supplier has applied for and been approved for a specific TA area they are agreeing that they can deliver within the individual TA area. Travel to and from that TA area is at their own cost unless otherwise agreed with ACC. Invoice travel within the TA - 1 TA - 2 TA - 3 Do not invoice travel between TAs unless by prior approval TA - 4 Maximise coverage All attempts should be made to ensure that the supplier is fully occupied throughout the day of travel, therefore, multiple appointments should be made and the maximum number of clients scheduled. Service time The scheduled service time will be appropriate to clinical need and best practice and will only be as long as required. If the time with the client is less than required the supplier should fill in the time up to the scheduled time with client-related activities such as updating client notes, phone calls etc. Distance travelled Appointments will be arranged to ensure the shortest distance between clients, thereby minimising the time and distance travelled. The supplier cannot claim travel time or distance when a supplier travels from one base of operation to another or from their private residence to the base of operation. Home or Base ûtravel Not Covered Base ütravel Covered Client Location No Travel Clinic Based Service Travel distance TBID10 ACC expects that suppliers and their staff work to minimise travel costs. Travel from a base of operation should be for services to a number of clients. As represented in this loop ü rather than this star û October 2016 Page 28 of 62

29 2 25 kms 2 18 kms 26 kms 26 kms kms kms 20 kms Base 15 kms 20 kms Base 18 kms 28 kms 4 18 kms 4 In the case of the loop the supplier would recognise a single incidence of 20km, whereas the star would recognise four incidences of 20km. In many instances clients may not all be ACC clients. Allocation of travel costs between the ACC and non ACC clients should be done in a fair and reasonable way that is reflective of the true costs to the service purchasers/funders. This example assumes one of the clients is not being funded by ACC. ü Total Travel (km) Return Travel (km) Tot. Incl Return Travel (km) Client 1 Other ACC Clients (km) Less 20 km deduction Invoiced Client 2 ACC Client 3 ACC Client 4 ACC Return Travel 28 - Total km û Total Travel (km) Return Travel (km) Total Travel Client 1 Other ACC Clients (km) Less 20 km deduction Invoiced to ACC Client 2 ACC Client 3 ACC Client 4 ACC Total Travel time TBITT5 If it takes 15 minutes to travel the first 20km and the overall time spent travelling for the day is 140 minutes, then the supplier can invoice for 125 minutes of travel time if all the travel time relates to ACC clients. October 2016 Page 29 of 62

30 Quality Services Supplier approval process ACC reserves the right to verify that individually service providers meet the qualifications and experience outlined in the Concussion Service contract. The supplier is required to submit a copy of the interdisciplinary team s current annual practicing certificate a full curriculum vitae and, if required, evidence of educational qualifications. ACC will review the documentation and advise the supplier of their decision about the supplier via letter and , within seven days. Where the supplier intends to provide specialist paediatric rehabilitation (16 years and under) all service suppliers must have at least two years experience providing brain injury therapy services to this age group. On application, or any time thereafter, the supplier should notify ACC of their ability to provide paediatric services to ensure ACC can refer appropriately. The supplier will notify ACC immediately regarding any changes in their ability to provide services. Approval of additional suppliers Services are intended to be provided on the basis of one provider to one client (family included). Should a supplier decide that two fully qualified and experienced providers will consult and treat the client at the same time, ACC would expect to be consulted in order to confirm the clinical efficacy of the treatment programme and ensure that sufficient hours have been allocated. If ACC does not approve, the supplier may still choose to have two professionals per contact hour but ACC will only pay for one supplier. Trainee health professionals Health professionals who do not have the required experience in the rehabilitation of clients with brain injuries (traumatic or acquired) may gain that experience with the contracted supplier only on written approval of ACC and with agreement of the client. Qualified Trainees Where the trainee is qualified in their chosen profession but does not have the required brain injury experience to operate independently they can gain that experience by participating in learning opportunities provided by the experienced supplier that includes o an introduction to the operation of the Service o case studies of clients with mild and moderate TBI o key readings about the impact, rehabilitation and recovery of traumatic brain injury undertaking extra study about traumatic brain injury considered appropriate by their clinical supervisor providing professional services under the supervision of a fully qualified supplier who reviews their work within a collegial relationship and who is competent to train and supervise others. Their work can be invoiced as appropriate within the Service. October 2016 Page 30 of 62

31 Unqualified Trainees Concussion Service Operational Guidelines Where the trainee is unqualified and in a formal university training programme the supplier can provide clinical experience opportunities where they consider appropriate. The trainee must be under the direct supervision of a fully qualified and approved supplier. The trainee s time cannot be invoiced for. The supervising supplier remains responsible for ensuring client safety and for providing quality services. Annual targets are set with an expectation that the majority of the clients will recover and the supplier will achieve the required outcomes. The targets also recognise that some clients may not experience a full recovery but this does not automatically mean that the supplier has failed. Overall, ACC and suppliers will identify and improve best practice by monitoring performance through the analysis of client data. ACC will issue a report at least annually providing national averages that will show a comparison of supplier performance. Clinical best practice will be identified by studying the suppliers with the best outcomes and the lowest cost. This information will be shared so other suppliers can improve their practice. Information will be collated so that individual suppliers are not identified. Note: This section is subject to further development Results Based Accountability Results Based Accountability (RBA) is a simple, practical way for ACC to evaluate the results of their services. The question How are our clients better off as a result of our work? is central to RBA. There is more about the RBA framework on these websites - MoH Results Based Accountability and NZ Government Procurement. Results Based Accountability was developed by Mark Friedman, author of Trying Hard Is Not Good Enough. Programme Performance Measures The development of performance measures and data collection methods will be done collaboratively with the suppliers. This chart shows in detail the different types of measure we typically find in each quadrant of the RBA framework, and the measures that go with the three basic categories of performance measurement: How much did we do? How well did we do it? Is anyone better off? October 2016 Page 31 of 62

32 How much did we do? We typically count clients and activities. How well did we do it? There are a set of common measures that apply to many different programs. activity specific measures. For each activity there is one or more measures that tell how well that particular activity was performed, usually having to do with timeliness or correctness. Is anyone better off? Numbers (#) Percentages (%) These measures usually have to do with one of these four dimensions of better-off: Skills/knowledge, Attitude, Behavior and Circumstance. For each of these measures, we can use point in time measures or point to point improvement measures. An example of the performance measures in the current service specification is provided in the table below. A collaborative approach is being developed to ensure these performance measures are fit for purpose. The service specification and operating guidelines will be updated once the performance measures have been finalised. Recovery is defined as no longer needing any services or support from ACC within 6 weeks of the end of the last service. After six weeks the supplier is considered to no longer have any direct influence for the client s recover. RBA How much did we do? How well did we do it? Performance Area Client based entitlement rather than a population. Triage Clause Performance measure Target Report Report of volume. N/A 1 & 2 Client cases will be reviewed by clinical neuropsychologist. Client cases will be reviewed by medical specialist. 100% 1 & 2 100% 1 & 2 Assessments Clause Clients will have clinical assessments with clinical neuropsychologist. Clients will have clinical assessments with medical specialist. 30% 1 & 2 30% 1 & 2 Service Delivery (Triage) Measure 1 Recover with triage only. <5% 1 Measure 2 Recover with triage and assessment. Measure 3 Triaged to comprehensive services. <10% 1 >20% 1 Measure 4 Recover with the full service. >50% 1 October 2016 Page 32 of 62

33 Measure 5 Fail to recover with the full service. <10% 1 Clause Claims will be within the specified funding cap. 95% 1 & 2 Satisfaction Clause Client will be satisfied with the Supplier s service. 80% 3 Timeliness Clause 6.5 Claims meet all the timeliness expectations. 85% Is anyone better off? Outcome Clause Clients identified as not having a complex presentation (cohort 1, 2, 4 & 5) recover within 6 weeks of the last date of the service. 85% 2 Target Measures The claims have been grouped into cohorts based on the services they have received as we are unable to categorise claims into groups based on client complexity due to a lack of information. Investigate & triage Activity Group Education, risk assessment Clinical Assessments Service Item Codes TBI21 Education, assessment of risks to recovery TBI13 Clinical neuropsychologist case review TBI14 Medical Specialist case review TBI22 Allied health client assessment TBI23 - Clinical neuropsychologist client assessment TBI24 Medical Specialist TBI25 Other clinical assessment Rehabilitation Therapy Administration TBI26 Allied health therapy TBI27 Psychologist consultation TBI28 Medical Specialist consultation TBI29 Key worker TBIDNA Non attendance fee The following measures assess how well the triage model is working and how well the clients are recovering. October 2016 Page 33 of 62

34 Measures/Cohort Description of cohorts Cohort ID Codes Measure 1: Target: Up to 5% of people recover with triage only. Outcome: Achieved. Clients are triaged. The clients receive education, risk assessment and document case reviews but no clinical assessments or therapy services. TBI21 TBI13 TBI14 The clients may have had other services which are not available in the Service such as vocation rehabilitation. Measure 2: Target: 5% to 10% of people recover with triage and assessment. Outcome: Achieved. A successful triage. Measure 3: Target: More than 20% of people are triaged to comprehensive services. Outcome: Achieved. Successful triage. Clients are triaged and assessed by IDT as appropriate. The clients receive education, risk assessment, document case reviews and clinical assessments but no therapy services. The clients may have had other services which are not available in the Service such as vocation rehabilitation. Clients did not have any comprehensive services described later. Clients are triaged and assessed by IDT as appropriate and then exit. The clients receive education, risk assessment, document case reviews and clinical assessments but no therapy services as they are triaged out of the service. The clients received one or more of a group of services that are considered comprehensive because the type of services provided are available, in a smaller way, in the Service. The services are: Psychological Service Neuropsychological Assessment Clinical Services Training for Independence with - Traumatic Brain Injury, Children & Young People, Sensitive Claims, Other Injuries and Advisory Service Clients total claim cost is greater than the total claim cost for measure 1, 2 and 4. TBI21 TBI13 TBI14 TBI23 TBI24 TBI25 TBI21 TBI13 TBI14 TBI23 TBI24 TBI25 TBI26 TBI27 TBI28 October 2016 Page 34 of 62

35 Measures/Cohort Description of cohorts Cohort ID Codes Measure 4: Target: More than 50% of people recover with the full service. Clients receive the full service. The clients receive education, risk assessment, document case reviews and clinical assessments and therapy services. Outcome: Achieved or not achieved. The clients may have had other services which are not available in the Service such as vocation rehabilitation but did not have any comprehensive services described in measure 3. It is this group of clients that are measured for key performance indicators such as length of service, cost per claim and outcomes. Achieved There are no further payments for the claim six weeks after the last Service. Not Achieved There is a payment for anything post the six weeks. TBI21 TBI22 TBI13 TBI14 TBI22 TBI23 TBI24 TBI25 TBI26 TBI27 TBI28 Measure 5: Target: Less than 10% of people fail to recover with the full service. Outcome: Not achieved. Clients receive the full service. The clients receive education, risk assessment, document case reviews and clinical assessments and therapy services. The clients have had also had one or more of a group of services that are considered comprehensive as listed in measure 3 TBI13 TBI14 TBI21 TBI22 TBI23 TBI24 TBI25 TBI26 TBI27 TBI28 October 2016 Page 35 of 62

36 Reporting Types The purpose is to monitor progress and quality of service delivery by the comparison against expected performance. There are three reporting mechanisms to achieve this. They are: Report Type ACC Service Outcome and Performance Report No. Description 1 Extract from the ACC payments system summarised to measure outcome and performance. Provided By ACC Frequency Twice a year Client level Discharge Report 2 MS Excel spread sheet template specified the minimum content. supplier Twice a year Supplier Service Report 3 Word document with ACC having specified the minimum content. supplier Annual ACC Service Outcome and Performance Report ACC will assess the supplier s performance by using ACC s payment data. The key point of measure would be the client s utilisation of ACC s supports six weeks after the last service within the concussion service. If the client is no longer receiving any services the client is considered to be recovered. ACC s analysis of performance will focus on: average cost per service excluding travel and DNA service length service outcomes in relation to client complexity service inputs in relation to client complexity client recovery client exits for more comprehensive services including big brother services any other information ACC considers relevant. Client level Discharge Report Each supplier is required to submit data on all Concussion Service clients who were discharged from the service in the previous six months. The report is completed using information from supplier s clinical notes and completed mostly using pre-selected drop down fields. This ensures that the information is categorised to allow better analysis. The supplier provides information that is not easily available to ACC such as risk assessment, preinjury employment and the client s employment and recovery status at exit. The following table describes the reporting periods and due dates. October 2016 Page 36 of 62

37 Period start Period finish Submitted by Summarised by 1 July 30 September 31 October ACC will produce summarised reports when the data is 1 October 31 December 31 January sufficient for robust analysis. Supplier Annual Service Report The annual report provides the supplier with the opportunity to celebrate success, highlight best practice and identify issues. Suppliers are welcome to take the opportunity to use case studies (client stories) to show how their service has been successful over the preceding year. The annual report will, at a minimum, cover the following topics: Summary of admissions Capacity & How many referrals were received accepted and declined? utilisation Client composition by funder and service How client referrals were managed along with all other services? Identify the number (%) of referrals that were for non-acc clients. For Example Funder Service Capacity Received % ACC Concussion % ACC Training for Independence % DHB ABC Service % MOH DEF Service % Total 1,210 1,074 89% This information will help ACC understand what your capacity is and how much we are using your services. Where utilisation exceeds capacity explain what the implications were to the client. Were referrals declined? Was there a wait time before the service started, if yes, how long? Timeliness Identify the number and proportion of clients whose rehabilitation programme was completed to plan without extension. Service Completed Within % timeframe Concussion Service % TI Advisory Short Term % Total % October 2016 Page 37 of 62

38 Stakeholder satisfaction surveys Client satisfaction surveys are a good way to measure the quality of your service. ACC expects that as part of your quality management plan you will survey your clients on discharge. The feedback provided often leads to insights into business improvements that result in better client outcomes with increases in efficiency and effectiveness. The survey must include an opportunity for the client to indicate their overall satisfaction with the supplier, using the following question: overall thinking of the service you received from <Supplier Name> how satisfied are you? o o o o o completely satisfied mostly satisfied neither satisfied nor dissatisfied mostly dissatisfied completely dissatisfied. an opportunity for the client to comment on their ability to participate fully any barriers to their recover. Quality management and improvement plans Issues management Staff training and development Other The survey could include any topics about service or quality that would allow opportunities for improvement Provide an outline of any short, medium and long term actions planned as part of a: response to the satisfaction survey results continuous improvement process cultural responsiveness. Outline of any issues that may have presented during the year, a description of the process taken to resolve those issues and the resulting outcome. These issues may include: sentinel events such as a serious injury or death communication or access issues implementation issues staffing, including turnover and retention. Where appropriate comment on any training and development activities that have increased staff knowledge. The supplier is encouraged to provide background information on their other services, linkages and long term development plans that could provide insight into the supplier s business. October 2016 Page 38 of 62

39 APPENDICES Appendix 1: Bio-psycho-social model This model was sourced from The Brain Injury magazine January 2005; 19(1): and based on the article called Continuum of care model for managing mild traumatic brain injury in a workers compensation context: a description of the model and its development by Jeremy M. Rose of Millard Health, Edmonton, Alberta Canada. Its source reference was the World Health Organisation. The following extract from that paper describes the bio-psycho-social model: The model is not exhaustive but represents some of the common variables thought to influence outcomes following mild Traumatic Brain Injury (TBI). The model is broken down into pre-, periand post-injury variables. Four key points are: recovery following mild TBI can be influenced by a complex interaction of a variety of variables some people appear to be at risk for developing more chronic post-concussion symptoms after mild TBI post-concussion-type symptoms can potentially develop in the absence of any permanent structural damage to the brain following mild TBI differential diagnoses must be assessed in order to provide appropriate treatment. In relation to interventions following a mild TBI, the bio-psycho-social model highlighted the need to: assess risk factors for a protracted recovery educate the injured worker and his/her support system (eg family) in order to counter any tendency to catastrophise about symptoms or misattribute normally occurring symptoms (such as memory slips) to the head injury assess for differential diagnoses address co-morbid physical injuries develop and implement a treatment and case management plan before the symptoms become chronic. The paper presented the WCB Continuum of Care model developed by Millard Health. ACC s model, which is based on the WCB model, is presented Appendix 2. ACC recognises the bio-psycho-social impacts and requires suppliers within this contract to identify and assess the degree of risk to recovery using risk assessment matrix in Appendix 3. October 2016 Page 39 of 62

40 October 2016 Page 40 of 65

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