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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