A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

Background Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service. Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial. Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services

The Effectiveness of CSR’s Approaches: Before Practice or Theory? Insights from Italian Corporate Territorial Responsibility Projects

The work proposes an overview of the process and the models relative to the diffusion of CSR and sustainability based on a public-private involvement. The multilevel and multidimensional approach to CSR and sustainable growth can be interpreted as a specific model of territorial social responsibility which is based on the rise of paths of local governance and social innovation whose protagonists are members of a localized network. Starting from these premises and drawing from the reflections developed in previous works this paper intends to add new perspectives on the current debate by presenting a comparative analysis based on Italian case-studies related to CSR and sustainability-driven best practices which are being developed in two Italian areas (notably the Marches and Emilia Romagna Regions). The selected projects started even before the discussion on multilevel and territorial governance begun at the national and international level and they are highly innovative and dynamic since over the years their objectives have become progressively enriched and adapted. Using a qualitative-based approach the empirical analysis focuses on both the weaknesses and strengths, as well as on the similarities and differences of these bottom-up approaches of territorial responsibility and sustainability. Findings underline the effectiveness of approaches and tools which are not disconnected from specific local (anthropological, cultural and socio-economic) dynamics. Territorial pathways of CSR and sustainability seem more suited to lead and preserve sustainability over time. Accordingly , in the analysis of sustainable development processes, a priority should be attributed to the territorial dimension since it contains all combined factors (human and environmental resources, entrepreneurial and social creativity) which generate processes of social innovation. At the same time, these innovative pathways that are capable of generating social innovation underline the urgency of new theoretical constructs which take into account a maturity model of CSR/sustainability based on different stages and actors involved in CSR and sustainability-oriented projects. The chapter is organized into three main sections: the first presents the theoretical framework, the second describes the empirical analysis, while discussion and conclusions summarize the main theoretical propositions and empirical implications of the present research and offer insights useful for further investigation