RehabNytte - quality
Quality and benefit in rehabilitation
Project Manager
Post doc
ABOUT THE PROJECT
The proportion of people receiving specialized rehabilitation in Norway is increasing, but there is huge variation in the content and quality of the 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 appropriate measurement instruments to evaluate the quality of the services and the patients' goal and functional changes. There is also a need for increased involvement of patients and relatives, and interacting structure that emphasizes coordinated services and continuity in the rehabilitation process across service levels and sectors.
In this project, 17 private rehabilitation institutions have introduced utilization of quality indicators and patient-reported outcome measures, in order to promote increased quality and benefit from rehabilitation.
We investigate whether the use of a quality indicator set, developed for use in rehabilitation, results in improved quality and benefit in rehabilitation. In addition, we examine the systematic use of the Norwegian Directorate of Health's proposed outcome measures in clinical practice, across institutions and diagnostic groups. The longitudinal measurement time points extend from the inpatient period in secondary healthcare to the follow-up period at home; after 3, 6 and 12 months.
The results from the project can contribute to improving the quality of rehabilitation services locally and nationally, and strengthen the knowledge base for future recommendations regarding standardized processes, register data and reporting routines in the field of rehabilitation. Uniform reporting of rehabilitation results can make it easier for authorities to compare quality and benefit across institutions. Further, the institutions can improve the quality and content of their services, and it can be easier for patients and their relatives to choose between different rehabilitation services.
The project is part of the larger RehabNytte project, which addresses the need for more exchange of experience, learning and research across rehabilitation institutions and collectively efforts towards uniform delivery and reporting of services.
WHO CAN JOIN?
The project is a collaboration between the Unit for health service research and innovation, Diakonhjemmet hospital and the Research and Development (R&D) network VIRKE Rehabilitation. Recruitment of patients has been completed, and includes more than 4,000 adults with various diagnoses who have received rehabilitation in the specialist health service at one of the institutions in VIRKE Rehabilitation.
WHAT DOES THE STUDY INCLUDE?
The study involves:
- • To measure the quality of the rehabilitation service delivered, before and after feedback to the institutions, on the level 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 about structure, processes and outcomes. Design: Interrupted time series design.
- To examine whether completeness of electronic data collection is improved when the number of patient questionnaires is as few as possible. This is tested in a randomized controlled trial where patients are randomly allocated to complete a short set of questionnaries including the outcome measure EQ5D-5L for quality of life, compared to a longer set of questionnaires that added the Patient Specific Function Scale (PSFS) for goal achievement, and PROMIS-29 for function. We compare the data completeness, measured by response percentage and proportion of complete forms, in the two groups at admission, discharge, and after 3, 6 and 12 months.
- To investigate whether the Norwegian version of PROMIS-29 is valid and responsive. We follow international guidelines (COSMIN) for assessing the measuring properties of instruments.
- To examine whether patient-reported quality indicators for rehabilitation outcomes (three yes/no questions about goal attainment, function and health-related quality of life) can replace more comprehensive measurement instruments in patient groups having low response rate to PSFS, PROMIS-29 and EQ5D-5L. This is also done in line with the COSMIN guidelines.
The project also includes examining patient-reported benefits of rehabilitation, measured as changes in the patients' outcome measures during the year we follow them. In addition, we examine the socio-economic value of rehabilitation, measured by an index for quality-adjusted life years. Design: longitudinal cohort study, with subgroup analyses.