A qualitative study of providers’ decision-making for cases involving neurobehavioral issues

摘要

Across the continuum of care, providers representing multiple professions (i.e., rehabilitation, medical, mental health) influence post-acute care planning for persons with brain injury, yet insufficient evidence informs how decisions are made. The need to understand provider decision-making is paramount, particularly for a person with brain injury whose sequelae necessitates integrated, interprofessional care. Using vignettes drawn from authentic scenarios, this qualitative study investigated case management decisions made by providers serving individuals with varying neurobehavioral needs. Responses to three open-ended scenarios concerning neurobehavioral service provision were collected, coded, and analyzed in accordance with rigorous qualitative conventions. Participants (n?=?84) represented an array of organizations serving persons with brain injury. The results revealed two courses of action: dominant and supporting. Although most respondents indicated integrated care as the ideal pathway, their concretized recommendations yielded actions focused on a single referral within the traditional medical model rather than an interdisciplinary approach. While integrated, interprofessional treatment and working across systems are considered optimal, this study suggests that in the current practice such a model is still evolving. This duel between “ideal” and “actual” highlights the need for further study, as well as resources to support best practices in rehabilitation and recovery.