PROJECT

RehabNytte - quality

Quality and outcomes in rehabilitation

project manager

phd fellow

About the project

The proportion of people receiving specialized rehabilitation in Norway is increasing, but there is a wide variation in the content and quality of services. According to public reports, there is a need for uniform delivery and reporting of rehabilitation services, with electronic solutions that support the systematic use of good tools to evaluate the quality of services and patients' changes in goals and functioning. There is also a need for increased involvement of patients and their families, and an effective structure of cooperation that emphasizes coordinated services and continuity of rehabilitation pathways across service levels and sectors.  

In this project, 17 private rehabilitation institutions have introduced the joint use of quality indicators and patient-reported outcome measures to promote improved quality and outcomes of rehabilitation.

We investigate whether the use of a quality indicator set, developed for use in rehabilitation, improves the quality and outcome of rehabilitation. In addition, we investigate the systematic use of the Directorate of Health's proposed outcome measures in clinical practice, across institutions and diagnostic groups, at measurement points ranging from the inpatient period in the specialist health service to the follow-up period at home; after 3, 6 and 12 months.

The results from the project can contribute to quality improvement of rehabilitation services locally and nationally, and strengthen the knowledge base for future recommendations regarding standardized processes, registry data and reporting routines in the rehabilitation field. Uniform reporting of rehabilitation results can make it easier for authorities to compare quality and benefits across institutions, the institutions themselves can improve the quality and content of their services, and it can be easier for patients and relatives to choose between different rehabilitation services.

The project is part of the larger RehabNytte project, which addresses the need for more experience sharing, learning and research across rehabilitation institutions and joint efforts for uniform delivery and reporting of services.

Who can participate?

The project is a collaboration between the National Competence Center for Rheumatological Rehabilitation (NKRR) and the Research and Development (R&D) network VIRKE Rehabilitation. Recruitment of patients has been completed, and includes more than 4000 adults with various diagnoses who have received rehabilitation in the specialist health service at one of the institutions in VIRKE Rehabilitation.

Project arrangement

The study involves:

  • To measure the quality of rehabilitation service delivery, before and after feedback to institutions on the trend of fulfillment of patient-reported quality indicators. In addition, we investigate whether improved quality leads to better patient-reported outcomes. To measure quality, a quality indicator set for rehabilitation, developed with support from the Norwegian Directorate of Health, is used. The indicator set includes questions on structure, answered by the rehabilitation manager at each institution, and questions on process and rehabilitation outcome, answered by participating patients. Design: Interrupted time series design.
  • To investigate whether the data quality of electronic data collection is improved when the number of patient questionnaires is minimized. This is tested in a randomized controlled trial where patients are randomly assigned to complete a short questionnaire package that includes the outcome measure EQ5D-5L for quality of life or a long questionnaire package that includes the Patient-Specific Functional Scale (PSFS) for goal attainment, PROMIS-29 for function, and EQ5D-5L for quality of life. We compare data quality, measured by response rate and proportion of complete questionnaires, in the two groups at entry, discharge and after 3, 6 and 12 months.
  • To investigate whether the Norwegian version of the PROMIS-29 functional assessment tool is valid and suitable for measuring the status and changes in patients' function as a result of rehabilitation. This is done by following international guidelines (COSMIN) for assessing the measurement properties of instruments.
  • To investigate whether patient-reported quality indicators of rehabilitation outcomes (three simple yes/no questions on goal attainment, function and health-related quality of life) can replace more comprehensive questionnaire packages in patient groups with low data quality for the PSFS, PROMIS-29 and EQ5D-5L tools. This is also done in line with the COSMIN guidelines.

The project also includes examining patient-reported benefits of rehabilitation, measured as changes in patients' outcome measures during the year of follow-up. In addition, we investigate the socioeconomic benefits of rehabilitation, measured by an index of quality-adjusted life years. Design: longitudinal cohort study, with subgroup analyses.

Partners

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