A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing

Abstract

Background Systems for monitoring effectiveness and quality of rehabilitation services across health care levels are needed. The purpose of this study was to develop and pilot test a quality indicator set for rehabilitation of rheumatic and musculoskeletal diseases. Methods The set was developed according to the Rand/UCLA Appropriateness Method, which integrates evidence review, in-person multidisciplinary expert panel meetings and repeated anonymous ratings for consensus building. The quality indicators were pilot-tested for overall face validity and feasibility in 15 specialist and 14 primary care rehabilitation units. Pass rates (percentages of “yes”) of the indicators were recorded in telephone interviews with 29 unit managers (structure indicators), and 164 patients (process and outcome indicators). Time use and participants’ numeric rating of face validity (0–10, 10 = high validity) were recorded. Results Nineteen structure, 12 process and five outcome indicators were developed and piloted. Mean (range) sum pass rates for the structure, process and outcome indicators were 59%(84%), 66%(100%) and 84%(100%), respectively. Mean (range) face validity score for managers/patients was 8.3 (8)/7.9 (9), and mean answering time was 6.0/5.5 min. The final indicator set consists of 19 structure, 11 process and three outcome indicators. Conclusion To our knowledge this is the first quality indicator set developed for rehabilitation of rheumatic and musculoskeletal diseases. Good overall face validity and a feasible format indicate a set suitable for monitoring quality in rehabilitation. The variation in pass rates between centers indicates a potential for quality improvement in rheumatic and musculoskeletal rehabilitation in Norway. Electronic supplementary material The online version of this article (10.1186/s12913-019-4091-4) contains supplementary material, which is available to authorized users.

A Quality Indicator Set for Rehabilitation Services for People With Rheumatic and Musculoskeletal Diseases Demonstrates Adequate Responsiveness in A Pre–Post Evaluation

“…As far as we know, this QI set is the rst indicator set developed for use in rehabilitation for people with RMDs, covering structure, process, and outcome quality [21]. In the pilot study, the QI set was proven feasible, with satisfactory face and content validity [21]. Our results support that the QI set also can be used in longitudinal evaluations of quality in or between rehabilitation services.…”

“…This QI set offers a timely opportunity to establish quality-of-rehabilitation benchmarks, promote important steps toward high-quality rehabilitation, and track trends over time. As far as we know, this QI set is the rst indicator set developed for use in rehabilitation for people with RMDs, covering structure, process, and outcome quality [21]. In the pilot study, the QI set was proven feasible, with satisfactory face and content validity [21].…”

“…In this study, we used a construct approach to examine responsiveness [33] because no gold standard is available. Based on current evidence, previous pilot testing [21], and the BRIDGE delity checklist, three of the authors (IK, GB, and ALSS) developed a priori hypotheses regarding the expected direction and magnitude of PR changes between T1 and T2. We discussed our hypotheses in a research group with nurses, patient research partners, and a physiotherapist.…”

“…Motivational interviewing was used in the goal-setting talks and the telephone follow-up calls, in accordance with guiding booklets designed for both clinicians and patients. Table 2 Main themes and indicators in a quality indicator set for use in rehabilitation [21] Main C8b. …at the beginning and the end of the rehab period.…”

“…Developers and users of the instrument used the Rand/UCLA Appropriateness Method to agree on content validity [21]. In the pilot testing, the QI set was appraised as feasible for monitoring quality in rehabilitation in primary and secondary care, and face validity was regarded as good [21], but further investigation of measurement properties was suggested.…”