UBC Theses and Dissertations

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UBC Theses and Dissertations

Follow up study of patients discharged from Lion's Gate Hospital Ghaed, Sylvia 1967

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- i -A FOLLOW UP STUDY OF PATIENTS DISCHARGED  FROM LION'S GATE HOSPITAL by SYLVIA GHAED DONALD ALFRED LADY KATHERINE TAKNEI LAM ORLA JOHN LAURITZ PETERSEN THOMAS M. TERANISHI R e s e a r c h R e p o r t S u b m i t t e d i n P a r t i a l F u l f i l m e n t o f t h e R e q u i r e m e n t s f o r t h e Degree o f MASTER OF SOCIAL WORK i n t h e S c h o o l o f S o c i a l Work We a c c e p t t h i s r e s e a r c h r e p o r t a s c o n f o r m i n g t o t h e r e q u i r e d , standard, f o r t h e d e g r e e o f M a s t e r o f S o c i a l Work S c h o o l o f ' S o c i a l Work 196? The U n i v e r s i t y o f B r i t i s h C o l u m b i a In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f t h e r e q u i r e m e n t s f o r a n a d v a n c e d d e g r e e a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , I a g r e e t h a t t h e L i b r a r y s h a l l m a k e i t f r e e l y a v a i l a b l e f o r r e f e r e n c e a n d S t u d y . I f u r t h e r a g r e e t h a t p e r m i s s i o n f o r e x t e n s i v e c o p y i n g o f t h i s t h e s i s f o r s c h o l a r l y p u r p o s e s may b e g r a n t e d b y t h e Head o f my D e p a r t m e n t o r b y h.i.is r e p r e s e n t a t i v e s . I t i s u n d e r s t o o d t h a t c o p y i n g o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l n o t b e a l l o w e d w i t h o u t my w r i t t e n p e r m i s s i o n . f o r S y l v i a Ghaed Donald Lady Katherine Lam Orla Petersen Thomas Teranishi D e p a r t m e n t of Snr-i al Work T h e U n i v e r s i t y o f B r i t i s h C o l u m b i a V a n c o u v e r 8, C a n a d a ABSTRACT T h i s s t u d y was u n d e r t a k e n t o t e s t t h e h y p o t h e s i s t h a t p a t i e n t s i m p r o v e d by u n d e r g o i n g t r e a t m e n t i n t h e A c t i v a t i o n U n i t a t L i o n ' s G a te H o s p i t a l , N o r t h V a n c o u v e r , B.C. I t was c a r r i e d o u t u n d e r t h e a u s p i c e s o f t h a t h o s p i t a l and t h e S c h o o l o f S o c i a l Work a t t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a . D a t a on two h u n d r e d e i g h t y - f o u r p a t i e n t s d i s c h a r g e d f r o m t h e U n i t b etween A u g u s t 1, 1965 and J u n e 3 0 , 1967 was c o l l e c t e d f r o m m e d i c a l a n d : s o c i a l s e r v i c e f i l e s a n d f r o m q u e s t i o n n a i r e s r e t u r n e d t o t h e u n i t by p h y s i c i a n s t h r e e months a f t e r p a t i e n t s ' d i s c h a r g e . T h i s d a t a was p r e p a r e d f o r t h e computer (MVTAB p r o g r a m ) , w h i c h was u s e d t o d e v e l o p u n i v a r i a t e and b i v a r i a t e f r e q u e n c y and p e r c e n t a g e t a b l e s . F i n d i n g s were i n t e r p r e t e d t o show c h a r a c t e r i s t i c s o f t h e p a t i e n t p o p u l a t i o n -a n d t o t e s t t h e h y p o t h e s i s . Two s u b h y p o t h e s e s s u p p o r t i n g t h e main one t h a t p a t i e n t s do i m p r o v e were t h e f o l l o w i n g : 1) t h a t most p a t i e n t s show improvement b e t w e e n a d m i s s i o n t o and d i s c h a r g e f r o m t h e A c t i v a t i o n U n i t ; a n d 2) t h a t d i a g n o s i s i s a n i m p o r t a n t f a c t o r i n d e t e r -m i n i n g w h i c h p a t i e n t s i m prove i n t h e p r o g r a m . Improvement was f o u n d i n 6 3 . 8 $ o f t h e 235 p a t i e n t s f o r whom t h e l e v e l o f f u n c t i o n i n g was r e p o r t e d a t a d m i s s i o n a n d d i s c h a r g e t o t h e u n i t . A r t h r i t i c p a t i e n t s t e n d e d t o im p r o v e l e s s t h a n n e u r o l o g i c a l , s u r g i c a l , o r c e r e b r a l f -v a s c u l a r p a t i e n t s . The o v e r a l l c o n c l u s i o n s u p p o r t e d t h e h y p o t h e s i s t h a t p a t i e n t s do b e n e f i t i n t e r m s o f a h i g h e r r a t e o f i n d e p e n d e n t f u n c t i o n i n g f r o m t h e i r s t a y i n t h e A c t i -v a t i o n U n i t . Recommendations were made on two l e v e l s : 1) f o r f u r t h e r r e s e a r c h , b o t h d e s c r i p t i v e and e x p l o r a t o r y , a n d 2) f o r c e n t r a l i z a t i o n a n d s t a n d a r d i z a t i o n o f i n f o r m a t i o n and r e c o r d s . - i i i -ACKNOWLEDGEMENTS We wish to express our sincere gratitude f o r a l l the help we received from the administration, nursing and medical s t a f f at the Lion's Gate Hospital. Our sp e c i a l thanks to the Soc i a l Service Department of the Hospital for t h e i r enthusiastic support and ever-readiness i n providing us with much valuable information necessary for the comple-t i o n of t h i s study. We wish a l s o , to acknowledge the help of Dr. J . Crane and p a r t i c u l a r l y Mr. J.M. Macintyre of the School of So c i a l Work, U.B.C. f o r t h e i r patience and constant guidance, to whom we give thanks. - i v -TABLE OF CONTENTS Page I . D e s c r i p t i o n o f R e h a b i l i t a t i o n and A c t i v a t i o n : P u r p o s e , Scope and Method o f I n v e s t i g a t i o n . . 1 I I . D a t a S o u r c e s and Method o f C o l l e c t i o n ^ T a b u l a t i o n 5 I I I . D e s c r i p t i o n and A n a l y s i s o f P a t i e n t C h a r a c t e r i s t i c s ; C o r r e l a t i o n o f P a t i e n t C h a r a c t e r i s t i c 7 IV. Summary, C o n c l u s i o n s , Recommendations 17 V. A p p e n d i c e s : A. B a s i c Codes f o r P a t i e n t V a r i a b l e s . . . . . . . . . . 21 B. S c h e d u l e f o r C o l l e c t i o n o f D a t a 26 C. B.C.H.I.S. P a t i e n t C a t e g o r i z a t i o n 27 D. Q u e s t i o n n a i r e t o t h e P h y s i c i a n s 28 E . F i g u r e s 1. Age D i s t r i b u t i o n 29 2. L e n g t h o f S t a y i n A c t i v a t i o n U n i t 30 3. M e d i c a l D i a g n o s e s on a d m i s s i o n t o A c t i v a t i o n U n i t 31 i+. P a t i e n t M o t i v a t i o n a t I n t a k e 32 V I . B i b l i o g r a p h y . . 35 TABLES T a b l e I . D i s t r i b u t i o n o f P a t i e n t s A c c o r d i n g t o B.C.H.I.S. C l a s s i f i c a t i o n on a d m i s s i o n t o U n i t 8 T a b l e I I . D i s t r i b u t i o n o f P a t i e n t s A c c o r d i n g t o B.C.H.I.S. C l a s s i f i c a t i o n on D i s c h a r g e f r o m U n i t 9 T a b l e I I I . P a t i e n t M o t i v a t i o n 10 T a b l e I V . D i f f e r e n c e between C a t e g o r y I n v s . C a t e g o r y Out 11+ T a b l e V. P a t i e n t Improvment w i t h R e s p e c t t o D i a g n o s i s 33 - 1 -I A. I n t r o d u c t i o n The t e r m " r e h a b i l i t a t i o n " has become a k e y c o n c e p t i n m e d i c a l a n d o t h e r r e l a t e d f i e l d s . R e h a b i l i t a t i o n c a n be d e f i n e d i n t e r m s o f a p r o c e s s i n t e n d e d t o h e l p r e s t o r e a n i n d i v i d u a l ' s f u n c t i o n i n g t o t h e f u l l e s t e x t e n t o f h i s p hy-s i c a l and m e n t a l c a p a c i t y . The s t a t e d g o a l o f t h e A c t i v a t i o n U n i t a t L i o n ' s G a t e H o s p i t a l i s t o r e s t o r e t o maximum s e l f s u f f i c i e n c y t h o s e p a t i e n t s who w o u l d l i k e l y r e q u i r e a d d i t o n a l t r e a t m e n t i n o r d e r t o e n a b l e them t o a t t a i n t h e i r h i g h e s t l e v e l o f f u n c t i o n i n g . W i t h o u t s u c h e f f o r t t h o s e p a t i e n t s w o u l d r e q u i r e some k i n d o f c u s t o d i a l c a r e . P a t i e n t s q u a l i f y i n g f o r A c t i v a t i o n t h e r a p y were s e e n t o have t h e f o l l o w i n g c h a r a c t e r i s t i c s : 1) w o u l d r e q u i r e a t l e a s t two weeks o f t r e a t m e n t . 2) w o u l d be a b l e t o r e a c h t h e g o a l o f s e l f c a r e and i n d e p e n d e n c e w i t h i n a t h r e e month p e r i o d . 3) have s u c h t r a u m a and n e u r o - v a s c u l a r d i s a b i l i t i e s a s : a m p u t a t i o n s , f r a c t u r e s , d e f o r m i t i e s , s t r o k e s , v a r i o u s n e u r o l o g i c a l d i s e a s e s , v a s c u l a r a n d p s y c h o s o m a t i c d i s o r d e r s . -2-B. P u r p o s e o f S t u d y The p u r p o s e o f t h i s e x p l o r a t o r y s t u d y d e v e l o p e d o u t o f t h e w i s h t o d e t e r m i n e i f p a t i e n t s b e n e f i t t e d f r o m t h e t r e a t m e n t p r o g r a m p r o v i d e d by t h e L i o n ' s G a t e H o s p i t a l A c t i v a t i o n U n i t . The s t u d y c o n c e n t r a t e d upon e x a m i n i n g t h e p a t i e n t s ' d i a g n o s e s and c o n d i t i o n s i n t e r m s o f t h e i r p r o g r e s s t h r o u g h t h i s u n i t and a s s e s s m e n t o f t h e i r f u n c t i o n i n g t h r e e months a f t e r d i s c h a r g e . From t h e r e s u l t s o b t a i n e d i n exam-i n i n g p a t i e n t c h a r a c t e r i s t i c s , i t was hoped t o a s c e r t a i n some s i g n i f i c a n t c o n c l u s i o n s r e g a r d i n g t h e t y p e o f p a t i e n t and the- n a t u r e o f t h e i l l n e s s w h i c h were b e s t s e r v e d by t h e U n i t . The s t u d y was a l s o i n t e n d e d t o c o l l e c t d a t a t h a t m i g h t be u t i l i z e d f o r f u t u r e r e s e a r c h , u s i n g a more r e f i n e d d e s i g n . The m a i n h y p o t h e s i s i n r e l a t i o n t o t h e p u r p o s e o f t h e s t u d y was t h a t p a t i e n t s a d m i t t e d t o t h e p r o g r a m a r e r e -s t o r e d t o some d e g r e e o f u s e f u l n e s s and i n d e p e n d e n c e . From t h i s , two s u b - h y p o t h e s e s w h i c h s u p p o r t a n d q u a l i f y t h e m a i n h y p o t h e s i s were d e v e l o p e d : 1) t h a t most p a t i e n t s show improvement between a d m i s s i o n t o and d i s c h a r g e f r o m t h e A c t i v a t i o n U n i t ; a n d 2) t h a t d i a g n o s i s i s a n i m p o r t a n t f a c t o r i n d e t e r -m i n i n g w h i c h p a t i e n t s improve i n t h e p r o g r a m . - 3 -F o r t h e p u r p o s e s o f t h i s s t u d y c e r t a i n a s s u m p t i o n s were made r e g a r d i n g t h e p r o g r a m : 1 . t h a t a l l t h e p a t i e n t s i n t h e p o p u l a t i o n s t u d i e d were g i v e n e q u a l o p p o r t u n i t y t h r o u g h t h e A c t i v a -t i o n p r o g r a m t o a t t a i n t h e i r maximum l e v e l o f f u n c t i o n i n g p o s s i b l e . 2. t h a t a l l p a t i e n t s i n t h e p o p u l a t i o n were d i s c h a r g e d o n l y a f t e r t h e y had r e a c h e d t h e maximum l e v e l o f f u n c t i o n i n g p o s s i b l e . C. N a t u r e and Scope o f t h e S t u d y T h i s i s a n e x p l o r a t o r y s t u d y u s i n g s u c c e s s i o n a l d e s i g n ; i . e . , c e r t a i n c h a r a c t e r i s t i c s o f t h e p a t i e n t p o p u l a -t i o n were examined b e f o r e t h e i r a d m i s s i o n t o a n d f o l l o w i n g d i s c h a r g e f r o m t h e A c t i v a t i o n U n i t ( 1 6 , p - 5 9 ) . A s e c o n d a s p e c t w i t h r e s p e c t t o t h e n a t u r e o f t h e s t u d y , was d e s -c r i p t i o n o f t h e p a t i e n t p o p u l a t i o n . The s t u d y was l i m i t e d i n s c o p e t o t h e 28^ p a t i e n t s who had b e e n d i s c h a r g e d f o l l o w i n g t r e a t m e n t between A u g u s t 1 , 1 9 6 5 a n d J u n e 3 0 , 1 9 6 7 . The p e r i o d between J a n u a r y 1 , 1 9 6 5 . when t h e A c t i v a t i o n U n i t was o p e n e d , t o J u l y 30» 1965,was n o t c o n s i d e r e d b e c a u s e t h e r e t u r n r a t e o f t h e i n i t i a l q u e s t i o n n a i r e s s e n t t o p h y s i c i a n s iwas: t o o low t o y i e l d v a l i d f i n d i n g s . The r e v i s e d q u e s t i o n n a i r e s were s e n t a s o f A u g u s t 1 9 6 5 . I n a d d i t i o n , t h e f i r s t s e v e n months o f p r o g r a m o p e r a t i o n r e p r e s e n t e d a p e r i o d o f s t a b i l i z a t i o n o f a d m i n i s -t r a t i v e and t r e a t m e n t p r o c e d u r e s . T h e r e f o r e , i n c l u d i n g t h e f i r s t s e v e n months i n o u r s t u d y w o u l d have made i n v a l i d t h e a s s u m p t i o n r e g a r d i n g c o n s i s t e n c y o f t h e t r e a t m e n t p rogram. Those p a t i e n t s who'we're " d i s c h a r g e d a f t e r June 30, I967 were n o t c o n s i d e r e d , as t h e s t u d y was i n i t i a t e d i n O c t o b e r and q u e s t i o n n a i r e s on p a t i e n t s d i s c h a r g e d a f t e r t h i s d a t e c o u l d h a v e n o t b e e n r e t u r n e d b y t h e 1 ' p h y s i c i a n s i n t i m e f o r i n c l u s i o n I n t h e s t u d y . O n l y d a t a on f i r s t a d m i s s i o n '..'was u s e d b e c a u s e i n f o r m a t i o n on s e c o n d and t h i r d a d m i s s i o n s was i n c o m p l e t e and w o u l d have b i a s e d t h e d i s t r i b u t i o n o f d i a g n o s e s , a g e s , sex, m a r i t a l s t a t u s , e t c . -5-II D a t a S o u r c e s , Methods o f C o l l e c t i o n , a n d T a b u l a t i o n s The s o u r c e o f d a t a f o r t h i s s t u d y was t h e i n d i -v i d u a l p a t i e n t ' s c a s e r e c o r d , A c t i v a t i o n U n i t i d e n t i f i c a t i o n o r i n d e x c a r d s , A c t i v a t i o n U n i t d i s c h a r g e summary s h e e t and a q u e s t i o n n a i r e s u b m i t t e d t o t h e p a t i e n t ' s p r i v a t e p h y s i c i a n . The r e t u r n e d q u e s t i o n n a i r e p r o v i d e d i n f o r m a t i o n c o n c e r n i n g t h e c o n d i t i o n o f t h e p a t i e n t s t h r e e months a f t e r d i s c h a r g e : -f o r t h e p e r i o d A u g u s t 1, I 9 6 5 t h r o u g h June 30 , 1 9 6 7 . The r e s e a r c h g r o u p p r e p a r e d a t a b l e o f 23 v a r i a b l e s s u c h a s a g e , s e x , d i a g n o s i s , e t c . * T h i s was co d e d a c c o r d i n g t o t h e number o f p o s s i b l e r e s p o n s e s . The r e c o r d i n g d e v i c e u s e d was a s c h e d u l e f o r i n d i -c a t i n g c o d e d v a r i a b l e s . The d a t a r e c e i v e d was t h e n t r a n s c r i b e d o n t o F o r t r a n s h e e t s and t h e c o m p l e t e d F o r t r a n s h e e t s were s u b m i t t e d t o t h e Computer C e n t e r f o r t r a n s c r i p t i o n t o d a t a c a r d s . The c o m p l e t e d d a t a c a r d s were f e d i n t o t h e computer w i t h programmed i n s t r u c t i o n t o p r o d u c e u n i v a r i a t e t a b l e s f o r t h e i n d i v i d u a l v a r i a b l e s a s w e l l a s b i v a r i a t e t a b l e s f o r t e s t i n g t h e h y p o t h e s i s . * See A p p e n d i x A. - 6 -I n t h e p r o c e s s o f c o l l e c t i n g a nd t a b u l a t i n g t h e d a t a c e r t a i n a s s u m p t i o n s were made: a) t h a t t h e i n f o r m a t i o n c o n t a i n e d i n t h e r e c o r d s u s e d was r e l i a b l e ; b) t h a t t h e d i a g n o s e s g i v e n p a t i e n t s upon e n t r y t o t h e A c t i v a t i o n U n i t was t h e c o r r e c t one; c) t h a t where more t h a n one d i a g n o s i s was l i s t e d , t h e one most a p p l i c a b l e t o t h e t r e a t m e n t p r o -gramme p r o v i d e d by t h e u n i t was u s e d ; d) t h a t judgments made c o n c e r n i n g p a t i e n t l e v e l o f f u n c t i o n i n g a t t i m e o f a d m i s s i o n , t i m e o f d i s c h a r g e , and a t t h r e e months were r e l i a b l e a n d v a l i d ; e) t h a t judgments b y m e d i c a l s o c i a l s e r v i c e s t a f f c o n c e r n i n g m o t i v a t i o n were r e l i a b l e a nd v a l i d ; f ) t h a t t h e r e s e a r c h e r s were c o n s i s t e n t i n t h e i r a c c u m u l a t i o n , c o d i n g , and t a b u l a t i o n o f d a t a . - 7 -I I I FINDINGS A. C h a r a c t e r i s t i c s o f P a t i e n t P o p u l a t i o n The f i n d i n g s o f t h i s s t u d y i n d i c a t e t h a t o f t h e p o p u l a t i o n o f 28k p a t i e n t s who r e c e i v e d t r e a t m e n t i n t h e A c t i v a t i o n U n i t a t t h e L i o n ' s G a t e H o s p i t a l t w o - t h i r d s were women. The a v e r a g e age o f a l l p a t i e n t s was 6 l y e a r s a n d 5k% o f them were m a r r i e d . I t was f o u n d t h a t ? 1 . 5 $ were a d m i t t e d f r o m t h e a c u t e h o s p i t a l ; t h o s e p a t i e n t s who came f r o m t h e a c u t e h o s p i t a l had "been t h e r e f o r a n a v e r a g e o f 3 . 7 weeks. The a v e r a g e l e n g t h o f s t a y i n t h e A c t i v a t i o n U n i t was 7 weeks. On a d m i s s i o n t o t h e A c t i v a t i o n U n i t , p a t i e n t s were c l a s s i f i e d a c c o r d i n g t o t h e B r i t i s h C o l u m b i a H o s p i t a l I n s u r a n c e S e r v i c e ( B . C . H . I . S . ) C a t e g o r i e s f o r l e v e l s o f p a t i e n t f u n c t i o n i n g . T h e s e r a n g e f r o m C a t e g o r y I ( h i g h l e v e l o f f u n c t i o n i n g ) t o C a t e g o r y V ( l o w e s t l e v e l . o f f u n c t i o n i n g ) . * The f o l l o w i n g t a b l e shows t h e d i s t r i b u t i o n o f p a t i e n t s i n t h e d i f f e r e n t c a t e g o r i e s upon a d m i s s i o n : See A p p e n d i x C f o r D e t a i l e d E x p l a n a t i o n o f C a t e g o r i e s . -8-TABLE I . DISTRIBUTION OF PATIENTS ACCORDING TO B.C.H.I.S. CLASSIFICATION ON ADMISSION TO UNIT C a t e g o r i e s No. o f P a t i e n t s P e r c e n t a g e o f P a t i e n t s I 28 9.9 I I kZ Hf.8 I I I 8k 29.6 I V 123 ^3.3 V 3 1.1 Not R e p o r t e d k l.k As i n d i c a t e d , t h e m a j o r i t y (207) o f p a t i e n t s e n t e r e d t h e A c t i v a t i o n U n i t i n C a t e g o r i e s 3 a n d k. On d i s c h a r g e f r o m t h e A c t i v a t i o n U n i t , t h e p a t i e n t s were a g a i n c l a s s i f i e d a c c o r d i n g t o t h e f i v e B.C.H.I.S. C a t e g o r i e s . T h e r e were 175 p a t i e n t s (61,6%) d i s c h a r g e d a t C a t e g o r i e s I and I I . Of t h e s e , 3k,2% were d i s c h a r g e d i n C a t e g o r y I I . The f o l l o w i n g t a b l e shows t h e d i s t r i b u t i o n o f p a t i e n t s a t t h e t i m e o f d i s c h a r g e u s i n g t h e f i v e B.C.H.I.S. C a t e g o r i e s : - 9 -TABLE I I . DISTRIBUTION OF PATIENTS ACCORDING TO B.C.H.I.S. CLASSIFICATION ON DISCHARGE FROM UNIT C a t e g o r i e s No. o f P a t i e n t s P e r c e n t a g e o f P a t i e n t s I 78 27.5 I I 97 3^.2 I I I 37 13.1 I V 21 7.4 V 2 .7 Not R e p o r t e d U-9 17.3 A p p r o x i m a t e l y 60% o f t h e p o p u l a t i o n were a d m i t t e d i n c a t e g o r i e s I I I and IV; and 60% were d i s c h a r g e d i n c a t e -g o r i e s I and I I . T h i s shows c o n s i d e r a b l e movement t o w a r d improvement i n t h e g e n e r a l p a t i e n t p o p u l a t i o n . P a t i e n t s were a l s o d e s i g n a t e d a t t h e t i m e o f a d m i s s i o n t o t h e p r o g r a m a s r e q u i r i n g e i t h e r m e d i c a l o r s u r g i c a l t r e a t m e n t . " M e d i c a l " t r e a t m e n t r e f e r s t o t h e c o n -t r o l o f i l l n e s s t h r o u g h m e d i c a t i o n and m a n i p u l a t i o n o f t h e e n v i r o n m e n t , e . g . , d i e t . " S u r g i c a l " r e f e r s t o t r e a t m e n t i n v o l v i n g manual a n d o p e r a t i v e p r o c e d u r e s . Out o f t h e t o t a l n o f 284, 59*9% were c l a s s i f i e d a s m e d i c a l and t h e r e m a i n d e r (kQ.1%) were c l a s s i f i e d a s s u r g i c a l . - 1 0 -W i t h i n t h e b r o a d c a t e g o r i e s o f m e d i c a l and s u r g i c a l , p a t i e n t s were a l s o g i v e n s p e c i f i c d i a g n o s e s . Of t h e s e , f r a c t u r e s c o m p r i s e d 2 7 . 5 $ o f n. T h i s r e p r e s e n t s 6 8 . 4 $ o f a l l s u r g i c a l c a t e g o r i e s . C e r e b r a l - v a s c u l a r a c c i d e n t s (CVA's) a c c o u n t e d f o r 2 1 $ o f t h e t o t a l m e d i c a l d i a g n o s e s ; t h u s , m a k i n g up t h e l a r g e s t g r o u p w i t h i n t h e b r o a d e r c a t e g o r i e s . S u b j e c t i v e a s p e c t s o f t h e p a t i e n t s ' c o n d i t i o n s , s u c h a s m o t i v a t i o n , were d i f f i c u l t t o a t t a i n . * I t was d e c i d e d t o r a t e t h e p a t i e n t s m o t i v a t i o n i n terms o f good, f a i r , a nd p o o r a s s t a t e d i n t h e s o c i a l s e r v i c e and m e d i c a l f i l e s o f t h e p a t i e n t s . "Good" m o t i v a t i o n was f o u n d i n 53*5% o f t h e p o p u -l a t i o n ; 1 2 . 6 $ were r a t e d a s " f a i r " a n d 1 2 . 6 $ a s " p o o r " . The r e m a i n i n g 1 1 . 3 $ were n o t r e p o r t e d . The f o l l o w i n g t a b l e shows t h e d i s t r i b u t i o n o f p a t i e n t s a c c o r d i n g t o t h e t h r e e d e g r e e s o f m o t i v a t i o n : TABLE I I I . PATIENT MOTIVATION Number o f p a t i e n t s P e r c e n t a g e o f p a t i e n t s Good F a i r P o o r Not R e p o r t e d 152 3.6 36 60 5 3 . 1 1 2 . 7 1 2 . 7 2 1 . 1 * M o t i v a t i o n i s d e f i n e d h e r e a s t h e e x p r e s s e d a t t i t u d e o f t h e p a t i e n t t o w a r d r e c e i v i n g t r e a t m e n t f r o m t h e A c t i v a t i o n Ward). -11-Of t h o s e whose m o t i v a t i o n was r e p o r t e d , t w o - t h i r d s were p e r c e i v e d a s b e i n g w e l l m o t i v a t e d t o w a r d a d m i s s i o n t o t h e A c t i v a t i o n U n i t . A n o t h e r c h a r a c t e r i s t i c o f t h e p o p u l a t i o n was ^des-c r i b e d i n t e r m s o f t h e p l a c e s t o where t h e p a t i e n t s were d i s c h a r g e d . A l m o s t 2 / 3 o f t h e p a t i e n t s (64-.8%) were d i s c h a r g e d t o t h e i r own homes* T a k i n g i t i n b r o a d e r p e r s p e c t i v e by-e x a m i n i n g b o t h own home and r e l a t i v e ' s homes, 8 2 . k % o f t h e p a t i e n t s d i s c h a r g e d f a l l u n d e r t h e s e two c a t e g o r i e s . The s m a l l p e r c e n t a g e o f p a t i e n t s d i s c h a r g e d t o n u r s i n g a n d b o a r d i n g homes wo u l d a p p e a r t o i n d i c a t e t h e e f f e c t i v e n e s s o f t h e p r o g r a m i n i n c r e a s i n g p a t i e n t a b i l i t y f o r s e l f - c a r e . To f u r t h e r a s s e s s t h e p a t i e n t ' s f u n c t i o n i n g , a f o l l o w - u p s t u d y was u n d e r t a k e n b y s e n d i n g q u e s t i o n n a i r e s t o t h e p h y s i c i a n s o f t h e p a t i e n t s t h r e e months a f t e r t h e i r d i s -c h a r g e . * P h y s i c i a n s r a t e d t h e p a t i e n t s u n d e r t h e h e a d i n g o f i m p r o v e d , m a i n t a i n e d , d e t e r i o r a t e d , d e c e a s e d , and h o s p i -t a l i z e d . B e c a u s e o n l y 166 q u e s t i o n n a i r e s were s u f f i c i e n t l y c o m p l e t e d f o r t h e p u r p o s e s o f t h e s t u d y , t h e d a t a c a n be i n t e r p r e t e d a s i n d i c a t i n g t r e n d s w i t h i n t h e t o t a l p o p u l a t i o n o n l y . W i t h n=l66 , however, 50% were r a t e d a s i m p r o v e d and * P l e a s e r e f e r t o A p p e n d i x D f o r t h e q u e s t i o n n a i r e . ! -12-36*7% a s m a i n t a i n e d . The combined p e r c e n t a g e o f p a t i e n t s s h o w i n g e i t h e r m a i n t a i n e d o r i m p r o v e d l e v e l s o f f u n c t i o n i n g i s g r e a t enough t o c o n c l u d e t h a t t h e d a t a t e n d s t o s u p p o r t t h e m a i n h y p o t h e s i s , i . e . , t h a t p a t i e n t s a r e d i s c h a r g e d a t a h i g h e r l e v e l o f f u n c t i o n i n g t h e n when a d m i t t e d a n d do m a i n t a i n t h i s improvement. B. C o r r e l a t i o n o f P a t i e n t C h a r a c t e r i s t i c s W i t h Improvement W i t h i n t h e m a i n h y p o t h e s i s t h a t p a t i e n t s a d m i t t e d t o t h e A c t i v a t i o n U n i t a r e r e s t o r e d t o some d e g r e e o f u s e -f u l n e s s a n d i n d e p e n d e n c e t h e r e a r e two s u b h y p o t h e s e s : 1) t h a t most p a t i e n t s show improvement between a d m i s s i o n t o and d i s c h a r g e f r o m t h e A c t i v a t i o n U n i t , and 2) t h a t d i a g n o s i s i s a n i m p o r t a n t f a c t o r i n d e t e r m i n i n g w h i c h p a t i e n t s improve i n t h e p r o g r a m . To t e s t t h e f i r s t s u b h y p o t h e s i s , a b i v a r i a t e f r e q u e n c y t a b l e was c o n s t r u c t e d e x p r e s s i n g t h e numbers o f p a t i e n t s a d m i t t e d i n e a c h o f t h e B.C.H.I.S. c a t e g o r i e s as o p p o s e d t o t h e numbers d i s c h a r g e d i n e a c h c a t e g o r y . Out o f t h e t o t a l n o f 284 p a t i e n t s , 2 3 5 had b o t h c a t e g o r y i n a n d c a t e g o r y o u t r e p o r t e d . The o v e r w h e l m i n g m a j o r i t y o f p a t i e n t s a d m i t t e d i n c a t e g o r y I l e f t i n c a t e g o r y I (26 o u t o f 28, w i t h 2 n o t r e p o r t e d ) . B e c a u s e no h i g h e r - 1 3 -c a t e g o r y e x i s t s b e y o n d c a t e g o r y I , i t was i m p o s s i b l e t o t e l l t h e d e g r e e o f p a t i e n t improvement w i t h i n t h i s c a t e g o r y ; t h i s g r o u p was t h e r e f o r e o m i t t e d f r o m t h e a s s e s s m e n t o f i m p r o v e -ment. F i g u r e s may t h u s be i n t e r p r e t e d a s l o w e r l i m i t s , i . e . , we know tha,t a t l e a s t X$ o f p a t i e n t s showed improvement.* Out o f 2 3 5 p a t i e n t s , 150 ( 6 3 . 8 $ ) showed improvement. Of t h i s , 78 (52%) l e f t i n c a t e g o r y I I and 4-9 ( 3 2 . 7 $ ) l e f t i n c a t e g o r y I . The r e m a i n i n g 2 3 ( 1 5 * 3 $ ) l e f t i n c a t e g o r y I I I . I f t h e l e v e l o f s i g n i f i c a n c e i s p l a c e d a t 1 5 $ » t h e d i f f e r e n c e s i n p e r c e n t a g e s a r e g r e a t enough t o be c o n s i d e r e d s i g n i f i c a n t . T h a t i s , ( 5 2 $ - 3 2 . 7 $ = ) 1 9 . 3 $ , and ( 3 2 . 7 $ - 1 5 - 3 $ = ) 1 7 . 4 - $ . b o t h o f w h i c h a r e g r e a t e r t h a n 1 5 $ . I n a nswer t o t h e q u e s t i o n o f how much improvement was shown, 75 ( 5 0 $ ) o f t h e 150 i m p r o v e d one c a t e g o r y , 6 l ( 4 - 0 . 6 7 $ ) l e f t 2 c a t e g o r i e s h i g h e r t h a n t h e y were a d m i t t e d and 14- ( 9 . 3 2 $ ) l e f t 3 c a t e g o r i e s h i g h e r . The f o l l o w i n g b a r g r a p h i l l u s t r a t e s t h e p e r c e n t a g e s o f p a t i e n t s who i m p r o v e d t h r o u g h 1 , 2 , a n d 3 c a t e g o r i e s : Improvement was d e f i n e d o p e r a t i o n a l l y a s movement f r o m one c a t e g o r y t o a h i g h e r one. -14-TABLE I V . DIFFERENCE BETWEEN CATEGORY IN VS. CATEGORY OUT Where n=150 P e r c e n t a g e o f P a t i e n t s 7 5 $ 1 U n i t 2 U n i t s 3 U n i t s U n i t s o f Improvement T h e r e were 8 5 p a t i e n t s who d i d n o t c o n c l u s i v e l y show improvement. T h i s i s 3 6 . 2 ^ o f t h e t o t a l n o f 2 3 5 * O n l y 3 p a t i e n t s a c t u a l l y d e t e r i o r a t e d , * * D e t e r i o r a t i o n i s d e f i n e d . a s a d r o p o f a t l e a s t one c a t e g o r y between a d m i s s i o n and d i s c h a r g e . - 1 5 -C o n c l u s l o n : . The d a t a s u p p o r t s t h e s u b h y p o t h e s i s t h a t most (63.8$) p a t i e n t s do show improvement i n t h e i r f u n c t i o n i n g between a d m i s s i o n and d i s c h a r g e . I n t e s t i n g t h e s e c o n d s u b h y p o t h e s i s — t h a t d i a g n o s i s i s a n i m p o r t a n t f a c t o r i n d e t e r m i n i n g w h i c h p a t i e n t s i m p r o v e i n t h e p r o g r a m — t h i s a s s e s s m e n t was made t h r e e months a f t e r d i s c h a r g e . T h i s was b a s e d on t h e r a t i o n a l e t h a t t h e t r u e e f f e c t i v e n e s s o f t h e r e h a b i l i t a t i o n p r o g r a m w o u l d b e s t be j u d g e d by t h e l a s t i n g e f f e c t on p a t i e n t f u n c t i o n i n g r a t h e r t h a n on t h e a d j u s t m e n t t o t h e p r o g r a m i t s e l f . A t a b l e o f f r e q u e n c i e s was c o n s t r u c t e d f o r t h e v a r i o u s d i a g n o s e s a s o p p o s e d t o p a t i e n t c o n d i t i o n ( i m p r o v e d , m a i n t a i n e d , o r d e t e r i o r a t e d ) a t 3 months a f t e r d i s c h a r g e . * The f i n d i n g s showed t h a t a r t h r i t i c p a t i e n t s do l e s s w e l l t h a n p a t i e n t s w i t h i n o t h e r d i a g n o s t i c g r o u p s ; t h a t s u r -g i c a l p a t i e n t s do b e t t e r t h a n any o t h e r g r o u p ; an d t h a t most n e u r o l o g i c a l p a t i e n t s i m p r o v e . Most C.V.S. p a t i e n t s e i t h e r m a i n t a i n t h e i r c o n d i t i o n o r i m p r o v e , b u t a s a g r o u p t h e y im-p r o v e l e s s t h a n do o t h e r g r o u p s . P r o g r e s s i n b o t h f r a c t u r e s and C.V.A. p a t i e n t s i s s h a r p l y upward. I n o b e s i t y p a t i e n t s , however, f e w e r improve * P l e a s e see T a b l e V i n A p p e n d i x -16-a f t e r d i s c h a r g e t h a n m a i n t a i n t h e i r C o n d i t i o n . The p a t i e n t a d m i t t e d f o r a f r a c t u r e i s more l i k e l y t o show c o n t i n u e d improvement a f t e r d i s c h a r g e t h a n i s t h e p a t i e n t a d m i t t e d f o r o b e s i t y . The d a t a i n d i c a t e s i m p o r t a n t t r e n d s t h a t s u p p o r t t h e h y p o t h e s i s t h a t d i a g n o s i s i s a n i m p o r t a n t f a c t o r i n d e t e r m i n i n g w h i c h p a t i e n t s i mprove i n t h e p r o c e s s . I V A. Summary a n d C o n c l u s i o n T h i s f o l l o w up s t u d y o f p a t i e n t s d i s c h a r g e d f r o m t h e A c t i v a t i o n U n i t o f t h e L i o n ' s G a t e H o s p i t a l was c o n d u c t e d by a U n i v e r s i t y o f B r i t i s h C o l u m b i a S c h o o l o f S o c i a l Work r e s e a r c h g r o u p . The p u r p o s e o f t h e r e s e a r c h was t o d e t e r m i n e i f t h e A c t i v a t i o n U n i t was a c h i e v i n g i t s g o a l o f r e s t o r i n g t h e p a t i e n t t o maximum l e v e l s o f f u n c t i o n i n g . The s t u d y was c o n d u c t e d o v e r a p e r i o d o f t h r e e months i n t h e f a l l , 1 9 6 ? . A p r e r e q u i s i t e t o t h e s t u d y was t h e s u r v e y o f l i t e r a t u r e i n r e l a t i o n t o r e h a b i l i t a t i o n p r o c e s s e s , p u r p o s e , f a c i l i t i e s , a n d r e s e a r c h . The n e x t s t e p was p r o b l e m i d e n t i -f i c a t i o n a n d f o r m u l a t i o n . Prom t h i s , a s s u m p t i o n s were d e v e -l o p e d and h y p o t h e s e s e s t a b l i s h e d . The s t u d y , t h e n , was a p r o c e s s o f c o l l e c t i n g d a t a f r o m a v a i l a b l e h o s p i t a l r e c o r d s , t a b u l a t i n g t h i s d a t a , com-p u t e r programming and a n a l y s i s o f r e s u l t s . I t . wa,s l e a r n e d f r o m t h i s t h a t t h e f o l l o w i n g p a t i e n t c h a r a c t e r i s t i c s e x i s t e d : t w o - t h i r d s o f t h e p o p u l a t i o n was f e m a l e , t h e m a j o r i t y were married;, t h e a v e r a g e age was 6 l y e a r s ; t h e a v e r a g e l e n g t h o f s t a y i n a c u t e h o s p i t a l b e f o r e t r a n s f e r t o A c t i v a t i o n was 3*7 weeks; t h e a v e r a g e l e n g t h o f s t a y i n A c t i v a t i o n was s e v e n weeks; t h e m a j o r i t y o f p a t i e n t s -18-i m p r o v e d i n t h e i r l e v e l o f f u n c t i o n i n g w h i l e i n A c t i v a t i o n ; a n d , t h e m a j o r i t y had m a i n t a i n e d o r i m p r o v e d t h e i r l e v e l o f f u n c t i o n i n g t h r e e months a f t e r d i s c h a r g e . From t h e a b o v e f i n d i n g s i t was c o n c l u d e d t h a t t h e A c t i v a t i o n U n i t o f t h e L i o n ' s G a t e H o s p i t a l was s u c c e s s f u l i n a c h i e v i n g i t s g o a l o f r e s t o r i n g p a t i e n t s t o a h i g h e r l e v e l o f f u n c t i o n i n g . B. Recommendations Recommendations c a n be made on two l e v e l s : 1) f o r f u r t h e r r e s e a r c h , and 2) s t a n d a r d i z a t i o n o f i n f o r m a t i o n . 1) F u r t h e r r e s e a r c h : The d e s c r i p t i v e p a r t o f t h e s t u d y r e v e a l s t r e n d s w i t h i n t h e p o p u l a t i o n t h a t r e q u i r e more i n t e n s i v e e x a m i n a t i o n . The c o r r e l a t i o n o f a g e , s e x , and m a r i t a l s t a t u s w o u l d d e t e r m i n e w h e t h e r t h e a p p a r e n t r e l a t i o n -s h i p b etween them i s t r u e ; i . e . , t h a t t h e a v e r a g e p a t i e n t i s a 6 l y e a r o l d m a r r i e d woman. A l s o , t h e c o r r e l a t i o n o f t h e p l a c e f r o m where t h e p a t i e n t was a d m i t t e d ^ a n d C a t e g o r y a t a d m i s s i o n c o u l d be examined t o d e t e r m i n e w h e t h e r p a t i e n t s i n f a c t do come f r o m t h e a c u t e h o s p i t a l when a d m i t t e d i n C a t e g o r i e s I I I a n d I V . S i m i l a r l y , a r e t h o s e p a t i e n t s who a r e p o o r l y m o t i v a t e d d i s c h a r g e d i n t h e same C a t e g o r y a s t h e y a r e a d m i t t e d . Age a n d d i a g n o s i s c o u l d be examined i n r e l a t i o n t o t h e l e n g t h o f s t a y i n A c t i v a t i o n t o d e t e r m i n e i f y o u n g e r - 1 9 -p a t i e n t s w i t h c e r t a i n d i a g n o s e s do b e t t e r t h a n o l d e r p a t i e n t s w i t h t h e same d i a g n o s i s . I n summary, e a c h c h a r a c t e r i s t i c m i g h t be h e l d , c o n s t a n t i n r e l a t i o n t o o t h e r s f o r f u r t h e r d e s c r i p t i o n . On t h e e x p l o r a t o r y l e v e l o f r e s e a r c h , f u r t h e r s t u d i e s c o u l d examine t h e r e l a t i o n o f t h e r o l e - n e t w o r k o f p a t i e n t s t o m o t i v a t i o n and t o improvement, r e s p e c t i v e l y . I t w o u l d be i m p o r t a n t t o examine t h e i n f l u e n c e o f t h e s e t t i n g and t h e t y p e o f p r o g r a m , w h i c h was c o n s i d e r e d c o n -s t a n t f o r t h e p u r p o s e s o f t h i s s t u d y , on t h e d e v e l o p m e n t o f m o t i v a t i o n a n d c a p a c i t y . I n r e s p e c t t o t h e o p p o r t u n i t i e s f o r d e v e l o p m e n t o f c a p a c i t y , f u r t h e r a s s e s s m e n t i s n e e d e d , i n t e r m s o f a c t u a l t r e a t m e n t p r o v i d e d by t h e p r o g r a m . 2) S t a n d a r d i z a t i o n o f i n f o r m a t i o n : T h i s s t u d y r e v e a l e d t h e n e e d f o r a c e n t r a l i z e d , i n c l u s i v e and compre-h e n s i v e p r o f i l e on e a c h p a t i e n t , b o t h t o f a c i l i t a t e f u r t h e r r e s e a r c h and t o c o - o r d i n a t e t r e a t m e n t e f f o r t s . U n n e c e s s a r y d u p l i c a t i o n o f i n f o r m a t i o n was f o u n d t h r o u g h e a c h d e p a r t m e n t k e e p i n g i t s own f i l e s a nd summary s h e e t s . One m o d e l i s t o have a c e n t r a l c a s e r e c o r d f o r e a c h p a t i e n t w h i c h w o u l d c o n t a i n s e p a r a t e d e p a r t m e n t a l d e s -c r i p t i o n s . The r e c o r d s s h o u l d be l o c a t e d on t h e ward a n d be a c c e s s i b l e t o a l l team members. S i n c e t h e r e were many i n c o m p l e t e f i l e s , i t i s -20-recommended t h a t more a t t e n t i o n be p a i d t o prompt r e c o r d i n g o f d i s c h a r g e summaries. M o t i v a t i o n has t o be more a c c u r a t e l y d e f i n e d and c o n s i s t e n t l y r e c o r d e d by t h e s o c i a l s e r v i c e d e p a r t m e n t . T h e r e i s n e e d f o r a r e f i n e m e n t o f t h e d e f i n i t i o n o f l e v e l s o f f u n c t i o n i n g w i t h i n C a t e g o r y I t o show improvement w i t h i n t h i s c a t e g o r y . C a t e g o r y a t t i m e o f d i s c h a r g e n e e d s t o be r e c o r d e d more c o n s i s t e n t l y . -2.1-A p p e n d i x A B a s i c Codes f o r p a t i e n t v a r i a b l e s : A. P a t i e n t ' s h o s p i t a l number 1) 2 ) 3) 4) 5 ) B. AGE 0 Not r e p o r t e d 1 L e s s t h a n 2 0 2 2 0 - 2 9 3 3 0 - 3 9 4 40-49 5 5 0 - 5 9 6 6 0 - 6 9 7 7 0 - 7 9 8 8 0 - 8 9 9 90 o r abo v e C. SEX 0 Not r e p o r t e d 1 Male 2 Female D. MARITAL STATUS 0 Not r e p o r t e d 1 S i n g l e 2 M a r r i e d 3 Widow o r widower 4 S e p a r a t e d 5 D i v o r c e d E . ADMITTED FROM 0 Not r e p o r t e d 1 D i r e c t f r o m own home 2 R e l a t i v e ' s home 3 A c u t e h o s p i t a l (LGH o r o t h e r ) 4 B o a r d i n g home 5 N u r s i n g home. 6 O t h e r F . DISCHARGED TO 0 Not r e p o r t e d 1 D i r e c t t o own home 2 R e l a t i v e ' s home 3 A c u t e h o s p i t a l (LGH o r o t h e r ) 4 B o a r d i n g home 5 N u r s i n g home 6 O t h e r G. LENGTH OF STAY IN ACUTE HOSPITAL 0 Not r e p o r t e d 1 0 d a y s 2 1 week 3 2 weeks 4- 3 weeks 5 4- weeks 6 5 weeks 7 6 weeks 8 7 weeks 9 8 weeks A 9 weeks B 10 weeks o r more H. LENGTH OF ADMISSION ON WARD A - 3 0 n o t r e p o r t e d 1 0 - 2 weeks 2 2-4-3 4 - 6 6-8 5 8-10 " 6 1 0 - 1 2 " 7 12-14- " 8 1 4 - 1 6 " 9 1 6 - " o r I . PATIENT CATEGORIZATION ON ADMISSION TO ACTIVATION 0 No t r e p o r t e d 1 I 2 I I 3 I I I 4- IV 5 v J . PATIENT CATEGORIZATION ON DISCHARGE 0 No t r e p o r t e d 1 I 2 I I 3 I I I 4- IV 5 V 6 D e c e a s e d K. PATIENT CONDITION THREE MONTHS AFTER DISCHARGE 0 No t r e p o r t e d 1 R e t u r n e d b u t n o t c o m p l e t e d b y d o c t o r 2 R e t u r n e d b u t p a t i e n t n o t s e e n b y d o c t o r - 2 3 -3 Improved 4 M a i n t a i n e d 5 D e t e r i o r a t e d 6 D e c e a s e d 7 H o s p i t a l i z e d L. MEDICAL DIAGNOSIS ON ADMISSION TO ACTIVATION 0 Not r e p o r t e d 1 A r t h r i t i s — r h e u m a t i c M e d i c a l 2 " — d e g e n e r a t i v e II 3 £ — o s t e o a r t h r i t i s II " — o t h e r it 5 N e u r o l o g i c a l — m u l t i p l e s c l e r o s i s it 6 N e u r o l o g i c a l — P a r k i n s o n ' s d i s e a s e M e d i c a l 7 11 — o t h e r II 8 G e r e b r a l - v a s c u l a r s y s t e m --C.V.A. II 9 H II II _ -C.V.S. ti A H II II _ - O b e s i t y II B II II II _ - O t h e r it C O r t h o p a e d i c — a r t h r i t i s S u r g i c a l D T r a u m a t i c II E F r a c t u r e it F A m p u t a t i o n ti G N e u r o l o g i c a l ti H O t h e r it M. MOTIVATION 0 Not r e p o r t e d 1 Good 2 F a i r 3 P o o r N. OCCUPATION 0 Not r e p o r t e d 1 P r o f e s s i o n a l a n d semi-- p r o f e s s i o n a l 2 P r o p r i e t o r s , managers and o f f i c i a l s 3 C l e r i c a l a nd s a l e s k C r a f t s m a n and f o r e m e n 5 O p e r a t o r s 6 U n s k i l l e d 7 S e r v i c e 8 F a r m e r s 9 Farm l a b o r A Nonmanual B M a nual a n d s e r v i c e C H o u s e w i f e D R e t i r e d E S t u d e n t 0. RELIGION 0 Not r e p o r t e d - 2 . 4 -1 C a t h o l i c 2 J e w i s h 3 P r o t e s t a n t 4 O t h e r P. PREVIOUS ADMISSION 0 Not r e p o r t e d 1 None 2 One 3 Two 4- T h r e e 5 F o u r Q. DATE OF ADMISSION 0 Not r e p o r t e d 1 J a n u a r y , 1 9 6 5 2 F e b r u a r y , 1 9 6 5 .3 M a r c h , 1 9 6 5 4- A p r i l , 1 9 6 5 5 May, 1 9 6 5 6 J u n e , 1 9 6 5 7 J u l y , 1 9 6 5 8 A u g u s t , 1 9 6 5 9 September, 1 9 6 5 A O c t o b e r , 1 9 6 5 B November, 19&5 C December, 1 9 6 5 D J a n u a r y , 1 9 6 6 E F e b r u a r y , 1 9 6 6 F M a r c h , I 9 6 6 G A p r i l , 1 9 6 6 H May, I 9 6 6 I J u n e , 1 9 6 6 R. DATE OF DISCHARGE 0 Not r e p o r t e d 1 J u l y , 1 9 6 5 2 A u g u s t , 1 9 6 5 3 September, I 9 6 5 4- O c t o b e r , 1 9 6 5 5 November, 1 9 6 5 6 December, 1 9 6 5 7 J a n u a r y , 1 9 6 6 8 F e b r u a r y , 1 9 6 6 9 M a r c h , 1 9 6 6 A A p r i l , 1 9 6 6 B May, 1 9 6 6 C J u n e , 1 9 6 6 J J u l y , 1 9 6 6 K A u g u s t , 1 9 6 6 L S eptember, 1 9 6 6 M O c t o b e r , 1 9 6 6 N November, 1 9 6 6 0 December, 1 9 6 6 P J a n u a r y , 1 9 6 7 Q F e b r u a r y , 1 9 6 7 R M a r c h , 1 9 6 7 S A p r i l , 1 9 6 7 T May, 1 9 6 7 U J u n e , 1 9 6 7 D J u l y , 1 9 6 6 E A u g u s t , 1 9 6 6 F September, I 9 6 6 G O c t o b e r , 1 9 6 6 H November, 1 9 6 6 I December, 1 9 6 6 J J a n u a r y , 1 9 6 7 K F e b r u a r y , 1 9 6 7 L M a r c h , 1 9 6 7 M A p r i l , 1 9 6 7 N May, 1 9 6 7 0 J u n e , 1 9 6 7 ESTIMATED LENGTH OF STAY 0 Not r e p o r t e d 1 One week o r l e s s 2 A t l e a s t two weeks, n o t more t h a n t h r e e weeks 3 A t l e a s t 3 " H ii II ij, II 4 4 — 5 weeks 5 5 - 6 -6 4 — 6 7 2 — 4 " 8 6 — 8 " 9 6 — 1 0 " A 8 - 1 0 " B 2 months C 2 . 5 months D 3 months E I n d e t e r m i n a t e -26.-APPENDIX B: S c h e d u l e f o r C o l l e c t i o n o f D a t a P a t i e n t s ' s Name VARIABLE DATA A. P a t i e n t Number B. Age C. 8ex D. M a r i t a l S t a t u s E. A d m i t t e d From F. D i s c h a r g e d To G. Time i n A c u t e H o s p i t a l H. Time i n Rehab. U n i t I . C a t e g o r y a t A d m i s s i o n _ _ _ _ _ _ _ J . C a t e g o r y a t D i s c h a r g e K. C a t e g o r y a t Three Mo. L. D i a g n o s i s a t I n t a k e M. M o t i v a t i o n a t I n t a k e N. O c c u p a t i o n 0. L e v e l o f E d u c a t i o n P. R e l i g i o n CODE VARIABLE P a t i e n t Number Age Sex M a r i t a l S t a t u s A d m i t t e d From D i s c h a r g e d To Time i n A c u t e H o s p i t a l Time i n Rehab. U n i t _ C a t e g o r y a t A d m i s s i o n C a t e g o r y a t D i s c h a r g e _ C a t e g o r y a t Three Mo. D i a g n o s i s a t I n t a k e M o t i v a t i o n a t I n t a k e O c c u p a t i o n L e v e l o f E d u c a t i o n R e l i g i o n -27-A p p e n d i x C: P a t i e n t C a t e g o r i e s f o r A c t i v a t i o n T r e a t m e n t , B.C. H o s p i t a l I n s u r a n c e S e r v i c e . In order to make somo assessment of thp value-of treatment c a r r i e d out b y . a c t i v a t i o n u n i t s , some estimate--of p h y s i c a l capacity should be recordod on the admission and separation of a l l p a t i e n t s . The f o l l o w i n g categories ( i ) to (v) provide a uoeful soale in : Koaauring p h y s i c a l oapaoity, and aldo cn indioation of the' type of accommodation required for pa t i e n t s . CATSGORY I; P h y s i c a l l y capable of l i v i n g i n room alone, preparing .own '• meals, and capable of some s u i t a b l e work. CATSCORY I I : (Rooming House Group) Capable of c a r i n g f o r s e l f i n a room or s u i t e or at home, and arranging own meals. This group i s capable of attending own doctor ,or out-patient f a c i l i t i e s f o r medical treatment. CATSGORY I I I : (Boarding Home Group) These patients are capable of s e l f - c a r e and going to bathroom and d i n i n g room by themselves, but are not able to handle the prepar-a t i o n of t h e i r meals s a t i s f a c t o r i l y . They nay also require a s s i s t a n c e i n g e t t i n g about outside the Home. Included i n t h i s group would be somewhat d e t e r i o r a t e d patients who may not take t h e i r medicine (e.g. D i g i t a l i s or i n s u l i n ) r e g u l a r l y unless supervised. In the main, these patients can obtain medical.service on an out-patient b a s i s . CATSGORY IV: (Nursing Home Group) These patients may be out of bed; part-time, but may require a s s i s t a n c e i n g e t t i n g about. They do not' require a c t i v e medical treatment, apart from the in d i c a t e d r e h a b i l i t a t i o n measures. The majority w i l l be bed patients who require nursing care and treatment. CATEGORY V: ( H o s p i t a l Group) These patients require nursing and o r d e r l y care at a l l times, or other s e r v i c e s , . o f the acute general h o s p i t a l . - 28 -Appendix D: Questionnaire to the Physicians LIONS GATE HOSPITAL ACTIVATION U l l f DATE Dear Dr. We would be very g r a t e f u l i f you would take a few minutes to complete and return t h i s questionnaire regarding the present condition of a patient we believe to be under your care. This information i s most valuable to us i n assessing the r e s u l t s of treatment. Sincerely, E„M„R„ Davies* M»D. Medical Supervisor, A c t i v a t i o n Unit. Per: Name Birthdate Hospital No. Address on admission Status upon discharge Admitting -diagnosis Date of discharge from A c t i v a t i o n Unit 1 * The condition of t h i s patient upon discharge (as compared to condition upon admission) was f e l t to be ( i ) improved _; (m) maintained (d) deteriorated . Did you agree with the assessment? Yes No 2» Date you l a s t saw patient n _______________________ _____ 3o During t h i s l a s t contact with the patient, d i d you asqesn the present condition to be ( i ) improved _______.; (-) maintained ; (d) deteriorated from the time of discharge? Please i n s e r t ( i ) , (in), or (d) i n the following "where ap p l i c a b l e ' to the patient. Get i n & out of bed? ____.„_ Get i n & out of car? Get from c h a i r to'stand? ______ Get to bed & return? . Walk up & down 3 t a i r s ? _ Get i n & out of bath? ' Get on & o f f t o i l e t ? _ _ ; Control of bowels bladder. Pick up objects from floor? Perform l i g h t a c t i v i t i e s ? Dress himself - a) clothing? _____ b) appliances? Comments rela t e d to above Feed himself? 4» Patient's l i v i n g s i t u a t i o n at present - Own home, s e l f care Care of r e l a t i v e s , Boarding Home , Nursing Home Comments May we have your permission to i n v i t e t h i s patient to the Ac t i v a t i o n Unit f o r a follow-up assessment i f t h i s can be arranged by our s t a f f ? of the date and i n v i t e d to.attend. I f so you w i l l be n o t i f i e d I f patient deceased,. Date of death Comments. Cause of death DATE SIGNATURE -29- -- : / A p p e n d i x E • Figure I Age D i s t r i b u t i o n :-0f T o t a l P o p u l a t i o n (N=284-) Age i n Y e a r s - 3 0 -Appendix E F i g u r e I I L e n g t h o f S t a y i n A c t i v a t i o n Ward 70r Number o f "; P a t i e n t s (N=282) L e n g t h o f S t a y i n Weeks P i s u r e I I I Appendix E, M e d i c a l D i a g n o s i s on A d m i s s i o n t o A c t i v a t i o n Ward D i a g n o s i s Number o f P a t i e n t s N=284 4.0 , 5,0 , 6.0 . 7,0 4C A r t h r i t i s : R h e u m a t i c D e g e n e r a t i v e O s t e o O t h e r N e u r o l o g i c a l : • M.'S. P a r k i n s o n ' s D i s e a s e u c n e r U . V.A. C.V.S. O b e s i t y O t h e r O r t h o p e d i c A r t h r i t i s T r a u m a t i c o •H &. F r a c t u r e A m p u t a t i o n N e u r o l o g i c a l O t h e r A p p e n d i x E F i g u r e IV M o t i v a t i o n a t I n t a k e (N=284) N o t G o o d F a i r P o o r R e p o r t e d M o t i v a t i o n TABLE V Patient Improvement with respect, to diagnosis Improved Maintained D e t e r i o r a t e d T o t a l A. A r t h r i t i c 9 37.5 14 58.3 1 4.2 24 ^s<^100 B. Neurological 12 ^ ^ ^ 5 4 . 5 7 32.8 3 ^ - ^ " 1 2 . 7 22 ^ ^ 1 0 0 C. Cerebral -Vascular 28 ^ ^ 4 4 . 4 n.4 4 14.2 58 ^ ^ 1 0 0 D. S u r g i c a l 35 ^ ^ 6 3 . 6 ^ ^ 2 5 . 4 '; 55 ^ x ^ l O O 84 • 61 .14 159 GRAPH A: A r t h r i t i c Patients vs. Condition at 3 months 60$ B. Neurological Patients vs. Condition at 3 months I . . M. . D. C.V.S. Patients vs. Condition at 3 months '60$ •50 40 3:0 '20 10 % - • . ' •-•••••a i ; ^ I . M. D. S u r g i c a l Patients vs. Condition at 3 months 60fo 50 40 30 20 10 BBS - ' ; ?3S ft- •• < - - • •• I . M. D. - 3 5 -BIBLIOGRAPHY 1 . Abrahamson, A.S., e t . a l . , "A T h e r a p e u t i c Community I n a G e n e r a l H o s p i t a l " , J o u r n a l o f C h r o n i c D i s e a s e s , V o l . 1 6 , p. 1 7 9 , 1 9 6 3 . 2 . Abrams, R u t h and Dana, B e s s , " S o c i a l Work i n t h e P r o c e s s o f R e h a b i l i t a t i o n " , S o c i a l Work, V o l . 2 , No. 8 , p . 1 0 , O c t o b e r , 1 9 5 7 . 3 . B l a c k e y , E i l e e n , " S o c i a l Work i n t h e H o s p i t a l : A S o c i o l o g i c a l A p p r o a c h " , S o c i a l Work, 1 :2 ( A p r i l ) , 1 9 5 6 . 4 . B r e e d l o v s , James, "Casework i n R e h a b i l i t a t i o n " , S o c i a l Work, V o l . 2 , No. f , p. 3 2 , O c t o b e r , 1 9 5 7 . 5 . C a n a d i a n A s s o c i a t i o n o f S o c i a l W o r k e r s , S o c i a l P o l i c y S t a t e m e n t on R e h a b i l i t a t i o n , O t t a w a , 6 . Committee on M e d i c a l S o c i a l Work P r a c t i c e , " R e p o r t o f Subcommittee o f t h e M e d i c a l S o c i a l Worker i n R e h a b i l i t a t i o n " , N a t i o n a l A s s o c i a t i o n o f S o c i a l W o r k e r s , New Y o r k , M a r c h , 1 9 5 7 . 7 . D e w o l f , M a r i l y n , Dawn and M a n s f i e l d , K a t h e r i n e L y n n e , A S o c i a l A s s e s s m e n t o f P o s t - D i s c h a r g e A d j u s t m e n t , S c h o o l o f S o c i a l Work, t h e U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 6 3 . 8 . D u n n i n g , A r t h u r , " R e h a b i l i t a t i o n : A New S p e c i a l i z a t i o n ? " S o c i a l Work, V o l . 2 , No. 4 , p . 3 , O c t o b e r , 1 9 5 7 . 9 . " L i o n ' s G a t e H o s p i t a l By Laws, R u l e s a n d R e g u l a t i o n " . L i o n ' s G a t e H o s p i t a l , N o r t h V a n c o u v e r , B.C. 1 0 . M a c l n n i s , M a r g a r e t R., S o c i o - E c o n o m i c F a c t o r s i n t h e R e h a b i l i t a t i o n P o t e n t i a l o f A r t h r i t i c " P a t i e n t s , M a s t e r o f S o c i a l Work T h e s i s , The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 5 8 . 1 1 . M c C o l l o u g h , C e l e s t e and Van A t t a , L o c h e , S t a t i s t i c a l C o n c e p t s , M c G r a w - H i l l I n c . , N.Y., I963. 1 2 . M c C a l l u m , Mary F., F a m i l y D i f f e r e n t i a l s i n t h e R e h a b i l i -t a t i o n o f C h i l d r e n w i t h a B r a i n I n j u r y , M a s t e r o f S o c i a l Work T h e s i s , U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1 9 6 1 . 1 3 . M c K e n z i e , M. B r u c e , " R e h a b i l i t a t i o n and S o c i a l Work", The S o c i a l Worker, V o l . 2 6 , No. 2 , J a n u a r y 1 9 5 8 . ,36-BIBLIOGRAPHY (CONT'D). 1 4 . M i l l e t t , J o h n A.P., " U n d e r s t a n d i n g t h e E m o t i o n a l A s p e c t s o f D i s a b i l i t y " , S o c i a l Work, V o l . 2, No. 4 , p.1 6 O c t o b e r 1 9 5 7 . 1 5 . Moroney, M. J . F a c t s f r o m F i g u r e s , P e n g u i n B o o k s , M i d d l e -s e x , E n g . 1 9 6 5 . 1 6 . P o l a n s k y , N. A. S o c i a l Work R e s e a r c h U n i v e r s i t y o f C h i c a g o P r e s s , C h i c a g o , 1 1 1 . 1 9 6 2 . 1 7 . P r i m e a u , B., "The M e d i c a l R e s t o r a t i o n Component i n a C o m p r e h e n s i v e R e h a b i l i t a t i o n Programme", M e d i c a l  S e r v i c e J o u r n a l , V o l . Ik, No. 1 0 , November 1 9 5 8 . 1 8 . R e a v e s , L. E . , " C o n s i d e r a t i o n s i n t h e r e h a b i l i t a t i o n o f p a t i e n t s " , J o u r n a l o f A m e r i c a n G e r i a t r i c S o c i e t y V o l . 1 2 , No. 1 0 , p. 9 9 6 , 1 9 6 4 . 1 9 . R o b i n s o n , H. A. and F i n e s i n g e r , J . 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Shana, J . e t a l . , " I n t e l l e c t u a l f u n c t i o n i n g i n h e m i p l e g i c a f t e r c e r b r o v a s c u l a r a c c i d e n t s " , J o u r n a l o f N e r v o u s &  M e n t a l D i s e a s e s . V o l . 1 4 3 , No. 2, p. 1 8 1 , 1 9 6 6 . 2 4 . S h o t l a n d , L . , " S o c i a l work a p p r o a c h t o t h e c h r o n i c a l l y h a n d i c a p p e d and t h e i r f a m i l i e s " , S o c i a l Work, V o l . 9» No. 4 , p. 6 8 , 1 9 6 4 . 2 5 . T o m a l t y , S h i r l e y F., C r i t e r i a f o r S u c c e s s f u l R e h a b i l i t a -t i o n . M a s t e r o f S o c i a l Work T h e s i s , The U n i v e r s i t y o f B r i t i s h C o l u m b i a , i 9 6 0 . 2 6 . T r a v i s , G e o r g i a C h r o n i c D i s e a s e and D i s a b i l i t y , U n i v e r s i t y o f C a l i f o r n i a P r e s s , B e r k e l e y , 1 9 6 7 . 2 7 . 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