Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 45

Clinical quality management for rehabilitation in Malaysia
and vocational rehabilitation, as well as the basis
for qualitative linking and quantitative mapping
of data that is collected using a wide range of
data collection tools, including clinical tests and
outcome instruments (11). Since scaling up of
rehabilitation across the health system relies on
functioning information at all levels, it is essential
that functioning information is mainstreamed in
national health information systems (7).
However, the successful implementation of
a standardized documentation of functioning
information at the clinical, services and national
rehabilitation programming levels poses a unique
challenge, since it depends on the possibility
of forging a link between healthcare practice,
science and governance (12). In the context of
the current collaborative work-plan of the Inter-
national Society of Physical and Rehabilitation
Medicine (ISPRM) and WHO there are increa-
sing efforts toward system-wide implementation
of functioning information documentation at
the regional and country levels, specifically in
Europe (12, 13), China (14, 15), Japan (16) and
Switzerland (17).
What is currently missing is a countrywide de-
monstration project involving the implementation
of a clinical quality management system for the
continuous improvement of rehabilitation, both
at the level of clinical care for individual patients
and at th e level of rehabilitation service provision.
Consequently, the Department of Rehabilitation
Medicine at the University of Malaya (UM) and
University Malaya Medical Centre (UMMC),
together with the Cheras Rehabilitation Hospital
of the Ministry of Health, and the Social Security
Organisation (SOCSO) Rehabilitation Centre
in Malacca have initiated a project to develop
a Malaysian-wide clinical quality management
system for rehabilitation (CQM-R). This project
is understood as a direct response to WHO’s
”Rehabilitation 2030: A Call for Action”, and is
intended to serve as a model for clinical quality
management for rehabilitation worldwide.
The objective of this paper is to present the de-
tails of the Clinical Quality Management System
for Rehabilitation in Malaysia (CQM-R Malay-
sia). First, a brief conceptual description of what
constitutes a clinical quality management system
based on the ICF is set out. Then, the methods,
results and conclusions of a situation analysis
of rehabilitation service provision conducted in
January 2017 are reported. Finally, the building
blocks and implementation action plan develo-
ped for CQM-R Malaysia, based on the insights
gained from the situation analysis, are presented.
347
ICF-BASED CLINICAL QUALITY
MANAGEMENT FOR REHABILITATION
Quality management is a process of ensuring
continuous improvement in care, and optimization
of health outcomes, through a process of learning
from successes and increasing the likelihood that
these successes will make for stable improvements
in clinical decision-making (18). As functioning
is the key health indicator for rehabilitation, clini-
cal quality management in rehabilitation is the
process of continuous improvement toward the
achievement of the outcome of interest, namely
optimal functioning. The key to continuous qua-
lity management in rehabilitation and elsewhere
is standardized information that unambiguously
communicates functioning outcomes across
episodes of care, as well as between research and
clinical practice. For rehabilitation, continuous
quality management relies on standardized re-
porting of functioning information and all relevant
aspects of clinical practice and service provision.
Functioning information that supports continuous
outcome improvement is the basis for a ”learning
health system”, encompassing not only clinical
care, but programming and ultimately national
policy (19). Table SI 1 shows how functioning
information can inform CQM-R Malaysia.
SITUATION ANALYSIS
Objective
The goal of the situation analysis was to gain a
shared understanding of provision of rehabilita-
tion services along the continuum of care and
across the perspective of the 3 ministries that
provide rehabilitation services. The 3 ministries
are: the Ministry of Higher Education (academic
centres); the Ministry of Health (Cheras Rehabi-
litation Hospital and the rehabilitation services at
state hospitals, district hospitals and in primary
care); and the SOCSO (with its vocational reha-
bilitation service at Malacca).
Methods
The situation analysis was planned and coordina-
ted by the head of the Department of Rehabilita-
tion Medicine at UM and UMMC (LAL) and the
consultant physical and rehabilitation medicine
(PRM) physician responsible for the project (JPE)
http://www.medicaljournals.se/jrm/content/?doi=
10.2340/16501977-2283
1
J Rehabil Med 50, 2018