Journal of Rehabilitation Medicine: Special Issue 50-4bokBW | Page 52

354 J . P . Engkasan et al .

Table III . Clinical quality management at the clinical and rehabilitation service level ( informed by Table I in Stucki G , Bickenbach J . Functioning information in the learning health system . Eur J Phys Rehab Med 2017 ; 53 : 139 – 143 )

Health system level Clinical quality management

Data management foreseen for CQM-R in Malaysia

Clinical Level Rehabilitation of an individual patient along the continuum of care

Standardized documentation of functioning

Rehabilitation management

Documenting a person ’ s functioning as specified in CLASs across consecutive rehabilitation services along the continuum of care

• Monitoring of functioning outcomes

• Assignment of patients to suitable rehabilitation services

Devising and adjusting functioning-informed rehabilitation plans across consecutive rehabilitation services

• Monitoring of functioning outcomes along the continuum of rehabilitation services

• Assignment of the patient to consecutive rehabilitation services Implementation of the rehabilitation plan in a specific Rehab- Cycle ( 23 , 24 ) by a multidisciplinary team

• Assessment of functioning and specification of functioning goals for the long-term ( expected functioning level of a person returning to or living in the community ), mid-term ( expected functioning level at the end of the stay at a designated rehabilitation service ) and short-term ( expected functioning upon completion the current Rehab-Cycle )

• Assignment of rehabilitation professionals to clinical interventions ( can be coded with the International Classification of Health Interventions ( ICHI ); http :// www . who . int / classifications / ichi / en /) aimed at intervention targets related to the short-term functioning goals

• Intervention ( s ) are conducted by the designated member ( s ) of the multidisciplinary team

• Evaluation of short- , mid- and long-term functioning goal achievement .

The individual patient functioning trajectory can also be evaluated against a predicted functioning trajectory ( calculated with cumulative data of patients with similar health conditions and , functioning- and person characteristics ) The results of this evaluation informs the planning of subsequent Rehab-Cycles in light of mid-term and long-term goals , as specified in the rehabilitation plan

Documentation with standards for different situations

• Rehabilitation in acute care : ICF Generic-6 Set

• General rehabilitation : ICF Generic-30 Set

• Specialized rehabilitation : ICF Generic-30 Set + applicable ICF Core Sets

• Rehabilitation in primary care : ICF Generic-7 Set

• Vocational Rehabilitation : ICF Vocational Rehabilitation Set

Data collection

• With the ICF Clinical Tool 1 ( 11 , 13 , 15 )

• According to CLASs ( national consensus )

• Option for data entry directly into electronic health records

Reporting

• Functioning profiles , functioning item maps and ICF- Generic-6 Scores 2 for each CLAS-time-point

• Functioning trajectories for functioning scores along CLASs time-points of consecutive rehabilitation services ( realized vs predicted trajectories )

Documentation with ICF-based tools including

• Categorical Profile ( functioning profile with long-term , mid-term , and short-term goals as well as specific goals for each intervention target )

• Intervention table ( intervention targets , interventions , responsible rehabilitation professional )

• Evaluation display ( profile over time , goal achievement , trajectories showing the results of an evaluation at 3 time-points )

Data collection

• With the ICF Clinical Tool ( for the ICF Generic-24 Set )

• Recommended data collection tools that provide information on all categories of the applicable ICF Core Set 3

Data transformation

• Data collected with the ICF Clinical Tool and the recommended data collection tools will be transformed according to transformation tables and reported on the respective common metric

Reporting

• Functioning goals , functioning targets , functioning profiles , functioning item maps and functioning scores for each time-point

• Functioning trajectories for functioning goals and functioning targets , functioning scores , along the continuum of care ( predicted vs realized )

Rehabilitation service programs

Optimizing the operational management of Rehabilitation Service Programs ( see Table SII 1 ) through adjustments in light of

• Functioning outcomes of Rehabilitation Service Programs over time

• Factors associated with superior and poor functioning outcomes across comparable services ( anonymous feedback to individual services )

• New scientific evidence on best practices of rehabilitation service provision

• Results of quasi-experimental studies examining the impact of defined changes in service provision

Monitoring and benchmarking of Rehabilitation Service Programs

• Monitoring of functioning outcomes of Rehabilitation Service Programs along the continuum of care and for subsequent time windows ( at least yearly )

• Comparison of functioning outcomes across comparable rehabilitation services controlling for ” case-mix ” ( person- , health condition- , and functioning characteristics )

1 In Malaysia the term ” ICF Clinical Tool ” will be used rather the original name ” ICF Clinical data Collection Tool ”.

2 Functioning scores for the

ICF Generic 6 Set and ICF Generic 24 Set are initially calculated based on transformation tables developed in China . Transformation tables modified for Malaysia will be developed and used for reporting . 3 Data collection tools are recommended by CQM-R steering committee based on evidence-informed proposals by the scientific committee . The ICF categories specified in the respective data collection tool can be rated using either the Numerical Rating Scale ( 0 – 10 ) or established clinical tests ( e . g . the Berg-Balance Scale ( 55 )), expert assessments ( e . g . the Spinal Cord Independence Measure ( 54 ), the Modified Barthel Index ( 20 ), ICF-based Questionnaires ( ie the Work Questionnaire WORQ ( 28 ), the Ankylosing Spondylitis Health Index ( 56 ) or other questionnaires ( e . g . the SF-36 ( 21 ), the Oswestry Questionnaire ( 57 ) or the KOOS Questionnaire ( 22 )).

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