Integrating Services for Holistic Interdisciplinary Care AKG: a WA Health Excellence Award Finalist

The Armadale Kalamunda Group Community Rehabilitation Service was recently recognised as a finalist in the 2019 WA Health Excellence Awards for supporting the delivery of timely, holistic interdisciplinary care.

The program is helping to improve our patients’ quality of life through collaboration to ensure that they have access to a range of rehabilitation services that best suit their needs.

A review of community rehabilitation services in the area found there were issues surrounding access to and integration of services that were impacting on client referral options and continuity of care.

The Community Rehabilitation (CR) service delivery model was developed to provide comprehensive assessment and rehabilitation for adults through an inter-professional team (medical, nursing and allied health) coordinated at a single point of referral.

A dedicated CR triage officer ensures referrals are appropriate and directed to the most appropriate clinics resulting in the delivery of timely, holistic interdisciplinary care across services at Armadale Health Service, various community locations or in a patient’s own home dependent on their specific needs. This improves client access to comprehensive rehabilitation services without the need for multiple referrals.

Significantly, the goal setting process is completed in collaboration with clients, and/or their family and their relevant health professionals to directly address health risks and complex needs.

The service has successfully supported clients to regain/improve their physical and cognitive abilities allowing them to remain in the community, return to work, and improve their quality of life.

Congratulations to the Community Rehabilitation Service team!