Clinical quality management for rehabilitation in Malaysia 353 cators cover a wide range of aspects , including documentation as to whether functioning is being assessed in a timely manner . Therefore , CQM-R is complementary to MSQH , as it provides a measurement-improvement system for functioning .
At UMMC the situation analysis also resulted in the identification of reporting requirements for ongoing cohort studies in the area of tuberculosis . While we identified no direct overlap , the potential redundancy of information needs to be considered in the implementation phase .
RESEARCH OPPORTUNITIES ARISING FROM THE IMPLEMENTATION OF A CLINICAL QUALITY MANAGEMENT SYSTEM FOR REHABILITATION MALAYSIA
Based on the presentations by the various teams at UMMC it became clear that many data collection efforts in the context of research projects could greatly benefit from a standardized documentation of functioning information .
Firstly , standardized documentation for rehabilitation services using CLASs allows for clinical epidemiological analysis of functioning outcomes in relation to person and health condition characteristics as well as inputs in terms of rehabilitation interventions and modifications of the environment and strengthening of the resources of the person .
Secondly , it allows for quasi-experimental studies ; for example , a year-by-year comparison of outcomes occurring , with documented changes in clinical rehabilitation care provision . It will be possible to make concrete changes in clinical rehabilitation care by adding , for example , a new intervention and to compare the outcomes with the outcomes of previous years .
Thirdly , it will be possible to efficiently implement nested projects ; that is , more in-depth data collection in addition to the standard data collection required as dependent or independent variables for a specific project with a concrete hypothesis . Also , randomized trials become feasible with this model .
IMPLEMENTATION ACTION PLAN FOR THE TIME-PERIOD 2017 – 20 AND AN OUTLOOK BEYOND 2020
Table SI 1 shows the implementation action plan integrating the key elements described above . The most important consideration for implementation is a stepwise process at the clinical and service level , as summarized in Table III .
At the clinical level , the first goal is to systematically implement standardized data collection with the ICF Clinical Tool across rehabilitation services , as shown in Table II for the time-points specified in the consensus conferences in 2018 .
The implementation of rehabilitation management , including a rehabilitation plan with sequential rehabilitation cycles , will be achieved through a demonstration project for SCI rehabilitation in close collaboration with a similar project at Swiss Paraplegic Research ( SPF ) and the Swiss Paraplegic Center ( SPZ ). Informed by this project , other multi-disciplinary teams engaged in specialized post-acute and outpatient rehabilitation will be encouraged to implement an ICF-based rehabilitation management programme .
Following the implementation of CQM-R at the clinical level , planned for 2017 – 2020 , it is envisioned that measurement-for-improvement systems for individual rehabilitation services will be implemented . This will be coordinated with the possible governmental efforts to develop and implement benchmarking across rehabilitation programmes with the goal of learning how to achieve best-functioning outcomes . To inform these developments , SOCSO is considering a demonstration project on implementing a measurement-for-improvement system for an individual rehabilitation service , as it can rely on an already implemented ICF-based documentation system .
DISCUSSION
The project presented here provides a sound basis for the system-wide implementation of CQM-R in Malaysia at all levels , ranging from clinical decision-making to continuous improvement of individual rehabilitation services and benchmarking across Rehabilitation Service Programmes .
To the best of our knowledge the implementation of CQM-R Malaysia is the first of its kind worldwide , as it aims to develop a countrywide and ICF-based measurement improvement system at both the clinical and service level . The CQM-R Malaysia project is also unique as it comprehensively integrates rehabilitation services under the auspices of the Ministry of Higher Education , the MOH , and the Ministry of Human Resources with its Social Security Organisation .
As this is a pioneer project it will encounter a number of challenges . The first challenge is the application of ICSO-R ( 26 , 27 ), a classification that is currently being refined . The collaboration
J Rehabil Med 50 , 2018