Abstract
This qualitative study aimed to explore the implementation and key success factors of intermediate
care on patients with stroke, traumatic brain injury, and spinal cord injury according to the Ministry of Public Health’s policy. Seventeen hospitals providing intermediate care to older adults were multi-stage purposively sampled from the MOPH’s provider sampling frame of 897 hospitals covering 4 regions from the north, northeast, central and the south. Key participants comprised 30 executives at the ministry and provinces and 236 intermediate care providers of 17 hospitals. Data were collected by using in-depth interview, group discussion, field study, and were analyzed by content analysis. The findings revealed that: 1. Seventeen hospitals in 8 provinces were categorized based on service activities into 3 groups: 1) the intensive intermediate care provision (6 hospitals), 2) the moderate intermediate care provision (6 hospitals), and 3) the moderate intermediate care with limited evidence on provision (5 hospitals). Constraints were lack of staff’s understanding on policy and practice, specialist staff inadequacy, non-supportive reimbursement system, lack of logistics (budget, space, equipment, medicine and consumable), and inefficient referral and information system, and others. Key success factors of intermediate care were listed: 1) executives with visions, plan, clearly set goal and constant result monitoring, 2) service provider commitment with good teamwork, and 3) service system preparedness, and effective multidisciplinary network. 2. Policy recommendations include clear policy communications cascading with localized flexibility, seamless system integration with adequate health workforce fit with intermediate care demands (which should extend to cover more health problems), high-performance information platform facilitating referral of data among providers and payers, and appropriate and comprehensive payment systems.
