Today our Guest is Dr. Angelo Canedo and the topic is The Brady Institute at Jamaica Hospital.

[10:25:12] arc: The Brady Institute has developed a series of programs to address the needs of individuals who are in coma or in the early medical recovery from TBI
[10:27:49] arc: Our focus is to develop services for individuals in New York State and to do this in a cost effective method. The state has saved millions of dollars by serving individuals in state and not transferring them to out of state facilities. Families are more able to visit with their loved ones and the quality of services are better monitored by regulatory bodies.
[10:29:56] mod: Given limited time constraints and managed care, what are the goals and what can be accomplished during the stay on the unit?
[10:31:24] mod: another question came in from an outside person, Given the ethnic and socioeconomic status of the majority of the patients, what are the unique challenges?
[10:31:24] arc: The Brady institute has met its financial objectives even in light of current managed care initiatives. Our rehab philosophy is that the primary goal is excellent patient care. By meeting this objective we meet many of our other stated objectives. The payment system will cover our costs if we do the right thing by the people we serve. To date this philosophy has born itself  true and our programs are vibrant ,progressive and growling.
[10:35:50] arc: As to the issue of socioeconomic and ethnic composition. We certainly are an inner city facility serving a multicultural community. Our staff are folks from allover the world with diverse cultural backgrounds. Our programs are individually focused and thus each client and their family pose unique care needs which we address on a person by person basis. On the socioeconomic side we never look at payor mix. We only look at client needs. A Medicare case is no different than a Medicaid case all payors and clients are equal and in the end using this approach we have come up solvent since our openig year.
[10:44:25] mod: Rail asks: 3) What were the medical advances that lead to the TBI unit's viability?
[10:44:30] arc: The medical advances that led to the development of the institute span the breath of medical and neurosciences. They include advances in neurosurgery that increased the numbers of people surviving a traumatic injury. In addition there are advances in cognitive science and rehabilitation that allow us to better understand the sequelae of brain injury and the types of things we can do to help people recover for example techniques to remediate visual and perceptual impairments such as hemianopsial and new techniques in balance training after hemiparesis etc., The field is ever evolving and we continue to upgrade our services to bring state of the art interventions to patient care needs . New areas include vestibular rehab and cognitive behavioral strategies following construct thinking techniques
[10:47:25] mod: Rail asks: ARC- What was the incentive to establish the TBI?
[10:47:33] arc: The incentive to establish the unit was based on the needs of our service population. I have been working in this area since the 1970's and was involved in the report to Governor Cuomo developed in the mid 80's that cited the absence of services in NYS. As we developed models of service in Albany on the DOH advisory committee we began to look for programs to meet these models throughout the state. The Brady Institute is a piece of that state wide effort .

{added for clarity} [10:45:47] Rail: ARC- What role has advancing technology played in the TBI Rehab. process?

[10:50:28] arc: Advancing technology keeps us on our toes.
[10:51:03] arc: It meets the need for change but it also causes the need for scientific validation before implementation.
[10:51:17] arc: While this sounds simple it is not,
[10:51:46] arc: It requires constant review and analysis along with outcome management and risk monitoring.
[10:52:15] arc: It also at times has costs associated with it and there are lags in purchase times etc.
[10:52:48] arc: All in all technology keeps us moving forward but it is not always a answer in health care.
[10:53:45] arc: Sometimes the key components of care are the need for one on one service to the patient . The human touch cannot be replaced by technology.
[10:53:56] arc: It can only be enhanced.
[10:54:27] arc: The real core of rehab is hands on treatment covering basic tenets of clinical practice.

{added for clarity} [10:48:49] Rail: ARC- with the success of the Brady, has the State made any effort to duplicate the facility and approach in other Metro areas?

[10:56:13] arc: The state has monitored the original programs and continues to look for best practice initiatives. The Brady Institute has set many baseline measures and moved us to the level where we can focus on aftercare initiative s and other new post hospitalization programs.
[10:56:39] arc: These programs are spin offs and growth areas from units such as Brady.
[10:57:42] arc: Last week DOH held the annual Best Practices conference and I presented a paper on a medical day care model we are spearheading in collaboration with other members of our TBI network.
[10:58:33] arc: It is a model for clients who are needy of more healthcare monitoring after leaving our unit because of the severity of their original injuries.

{added for clarity} [10:45:47] Rail: ARC- What role has advancing technology played in the TBI Rehab. process?

[11:00:14] arc: Technology can address the needs of caretakers and family.
[11:10:40] arc: Health care has always focused on the client and rarely on the caretakers. It is a real shift in focus to address the caretakers but a necessary one in our world. It is critical to focus on the care network in rehab. This shift in paradigm for health care is a progressive step in our world.
[11:12:02] arc: Technology is a boost in this area and website s for caregivers such as our own allow for the carry over of health provider input into the home both for the client and their caretaker
[11:15:07] arc: I Thank you for the opportunity to realize how limited my typing skills are and to show how many typos one can make in a 15 minute segment . It has been exciting albeit humbling and the mental challenge of responding in type and not in spoken word is a shift from the way I have always presented material. A brave new world is dawning and a new way of communicating is coming on board. This is neat. Thanks again. and goodbye.