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 great 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 good tools to evaluate the quality of the services and the patients' goals and functional changes. There is also a need for increased involvement of patients and relatives, and an effective collaboration structure that emphasizes coordinated services and continuity in rehabilitation processes across service levels and sectors.
In this project, 17 private rehabilitation institutions have introduced joint use of quality indicators and patient-reported outcome measures to promote increased quality and benefits of rehabilitation.
We investigate whether the use of a quality indicator set, developed for use in rehabilitation, improves the quality and benefit of rehabilitation. In addition, we investigate the systematic use of the Norwegian Directorate of Health's proposed outcome measures in clinical practice, across institutions and diagnostic groups, at measurement times 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 improving the quality 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 benefit 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 exchange of experiences, learning and research across rehabilitation institutions and joint efforts for uniform delivery and reporting of services.
WHO CAN JOIN?
The project is a collaboration between the Unit for Health Services 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 INVOLVE?
The study involves:
- To measure the quality of the rehabilitation service provided, before and after feedback to the institutions on the trend for the 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 is used, developed with support from the Norwegian Directorate of Health. The indicator set includes questions about structure, which the rehabilitation manager at each institution answers, and questions about process and rehabilitation outcomes, which participating patients answer. Design: Interrupted time series design.
- To investigate whether data quality in electronic data collection improves when the number of questionnaires to the patient is as few as possible. This is tested in a randomized controlled trial in which 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 Functioning Scale (PSFS) for goal achievement, 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, exit, and after 3, 6, and 12 months.
- To investigate whether the Norwegian version of the functional assessment tool PROMIS-29 is valid and well suited for measuring 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 about goal achievement, 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 examines patient-reported benefits of rehabilitation, measured as changes in patients' outcome measures over the year we follow them. In addition, we examine the socioeconomic benefits of rehabilitation, measured by an index of quality-adjusted life years. Design: longitudinal cohort study, with subgroup analyses.