Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 49

Clinical quality management for rehabilitation in Malaysia
IDENTIFYING A MEANINGFUL NAME
FOR THE PROJECT: CLINICAL
QUALITY MANAGEMENT SYSTEM FOR
REHABILITATION MALAYSIA
As the goal of the project is to implement a lear-
ning system at the individual level of clinical
decision-making, at the level of individual reha-
bilitation services, and by means of benchmarking
across comparable rehabilitation services, the
term ”quality management” rather than the term
”quality assurance” was deemed suitable. To
optimize the project’s visibility and to foster
identification with the project by clinicians from
the various disciplines engaged in rehabilitation,
the terms clinical and rehabilitation were added
resulting in the name ”Clinical Quality Manage-
ment System for Rehabilitation for Malaysia” or
simply ”CQM-R Malaysia”.
FRAMEWORK FOR THE DESCRIPTION
OF REHABILITATION SERVICES AND
THE SPECIFICATION OF CLINICAL
ASSESSMENT SCHEDULES
A prerequisite for the development of an ICF-
based CQM-R is a shared understanding of cur-
rent rehabilitation services provision and recom-
mendations for the documentation of functioning.
This requires the standardized description of
rehabilitation services by applying a classification
such as the International Classification of Services
Organization in Rehabilitation (ICSO-R) (26,
27) and consensus on CLASs (25) that specify
”what ICF categories to document, for whom,
and when”.
Table II shows the framework for the classifica-
tion of rehabilitation services and the specification
of CLASs developed by the steering group (LAL,
YMY, HH), the chair of the scientific commit-
tee (JPE), the general coordinator (SA) and the
advisor (GS).
Comprehensive description of rehabilitation
services in Malaysia
From a health system perspective, 7 types of re-
habilitation services were identified, ranging from
rehabilitation in acute care to general and specia-
lized rehabilitation in post-acute and outpatient
care, rehabilitation in primary care and vocational
rehabilitation. For specialized post-acute rehabili-
tation 7 subtypes of rehabilitation services and for
specialized outpatient rehabilitation 8 subtypes
were identified (Table II).
351
The description of rehabilitation services
including both a classification-based and a nar-
rative description of the 7 main types and 7 plus
8 subtypes of rehabilitation services will be deve-
loped in 2017 under the auspices of the steering
group in close collaboration with the developers
of ICSO-R (26, 27). The proposed descriptions
will be discussed and possibly modified in con-
sensus conferences in 2018. It is envisioned that
7 conferences will be held to reach agreement
on the descriptions of the 7 main types and the 7
subtypes for specialized post-acute rehabilitation
and 8 subtypes for specialized outpatient rehabili-
tation. The conferences for specialized post-acute
rehabilitation and specialized outpatient rehabili-
tation will include consensus-building for 7 and
8 subtypes, respectively. To achieve a coherent
set of CLASs it is envisioned that experts across
specific health conditions will be involved in the
consensus building for a specific health condition.
Framework for the specification of clinical
assessment schedules
Table II presents the proposed ICF categories to
be included in CLASs (25) for the 7 types and
7 plus 8 subtypes. The proposed domains for
CLASs, as shown in Table II, will be discussed
and possibly modified in the consensus confe-
rences in 2018. Th ese conferences will apply a
method developed by the ICF Research Branch
in cooperation with the UEMS PRM Section and
Board (12, 25).
In addition to reviewing and potentially modi-
fying the proposed ICF categories to be included
in CLASs, participants will be asked to reach
agreement on the time-points at which the propo-
sed ICF categories should be documented and to
develop recommendations for data collection in
specialized rehabilitation beyond documentation
of the ICF Generic-30 Set.
Tables SIII and SIV 1 show the description of
use and ICF categories of the ICF Generic-6 Set,
the ICF Generic-7 Set and the ICF Generic-30
Set, respectively. To illustrate the combined
documentation applying the ICF Generic-30
Set together with ICF Core Sets for specialized
rehabilitation, Table SIV 1 illustrates the example
of Spinal Cord Injury. The proposed documenta-
tion for vocational rehabilitation, the Brief ICF
Core Set for Vocational Rehabilitation with 13
categories, and the Derived ICF Core Set for
WORQ with 44 categories, that served as basis
for the development of the Work Questionnaire
(WORQ) (28, 40) are shown.
J Rehabil Med 50, 2018