Rehabilitation indicators

Transcription

1 Rehabilitation indicators Erzsébet Boros Erika Takács Health Services Management Training Centre Semmelweis University, Budapest

2 Literature review USA UK AUSTRALIA HUNGARY R Guile at all. Validation of a tool assessing appropriateness of hospital days in rehabilitation centres. International Journal for Quality in Health Care, 2009

3 UK Suggested process indicators Waiting times Referral to assessment Assessment to admission Provision of equipment Length of stay Set of defined goals for each patient At least one outcome measure recorded on admission and discharge

4 UK Suggested outcome indicators Single concept outcome measures % discharged home % returned to work Scales Validated instruments for measurement of disability and/or handicap (depend on the patient s condition and disability, their rehabilitation needs, and the nature of the programme) Goal-attainment scores

5 Australasian rehabilitation indicators 1. No functional assessment within seven working days of admission 2. No functional assessment before cessation of an inpatient rehabilitation program 3. No appropriate discharge plan on separation 4. Unplanned interruption to rehabilitation program 5. Rehabilitation patient deaths 6. Rehabilitation patient deaths audit 7. No multidisciplinary rehabilitation plan within seven working days of admission

6 Rehabilitation indicators - Hungary Rehabilitation Professional Advisory Board Patient death Unplanned patient transfer Participation on team meeting Patient death audit Functional assessment at admission and before discharge Lajos Kullmann, Rehabilitáció 14(2):18-22.)

7 Candidate indicators for PATH 1. Rehabilitation in-patient death 2. Audit of rehabilitation patient death 3. Functional assessment at admission and prior to discharge 4. Multidisciplinary rehabilitation plan 5. Unplanned interruption to rehabilitation program 6. Length of stay

8 1. Rehabilitation in-patient deaths Patients admitted to a rehabilitation unit/facility would not normally be expected to die (unless as a consequence of a normal disease process) Numerator Total number of rehabilitation patient death within the rehabilitation unit Denominator Total number of patients within and admitted to a rehabilitation unit Dimensions: Appropriate, Safe Desirable level: Low

9 2. Audit of rehabilitation patient death All inpatient deaths should be addressed through an internal audit process/quality improvement study Numerator Total number of rehabilitation patient deaths adressed within an audit process/quality improvement study Denominator Total number of rehabilitation patient death within the rehabilitation unit/facility Dimension: Effective Desirable level: High

10 3/A Functional assessment at admission The implementation of an effective rehabilitation program is dependent upon the early assessment of patient function. Numerator: Total number of patients admitted to a rehabilitation unit/facility for whom there is documented evidence of a functional assessment within defined working days of patient admission Denominator: Total number of patients admitted to the rehabilitation unit/facility with a minimum length of stay of defined working days Dimension: appropriate Desirable level: high

11 3/B Functional assessment prior to discharge Functional assessment prior to separation is a useful tool to ensure adequate discharge planning and to minimize the risk of patient readmission Numerator: Total number of patients for whom there is documented evidence of a functional assessment prior to cessation of an active inpatient rehabilitation program Denominator Total number of inpatients who cease an active inpatient rehabilitation program Dimension: appropriate Desirable level: high

12 4. Multidisciplinary rehabilitation plan Multidisciplinary rehabilitation plan is nessesary within defined working days of admission The establishment of a rehabilitation plan with regular review is necessary for effective patient rehabilitation Numerator Total number of patients admitted to a rehabilitation unit/facility for whom there is documented established mutidisciplinary rehabilitation plan within defined working days of patient admission Denominator Total number of patients admitted to a rehabilitation unit/facility with a minimum length of stay of defined working days. Dimension: Effective; Desirable level: High

13 5. Unplanned interruption to rehabilitation program Any unplanned interruption may significantly impact upon treatment outcomes This indicator serves as a flag for interruption to a rehabilitation program and also serves as a flag for further analysis. Numerator Total number of patients having an unplanned interruption to their rehabilitation program Denominator Total number of patients commenced on a rehabilitation program Dimension: Effective Desirable level: Low

14 6. Length of stay Duration of the length of stay depends on the patient s needs Nominator: summation of patients-days during the last year Denominator: number of patients during the last year Dimension: appropriate Desirable level: high

15 Questions What is the current practice in your country in connection with rehabilitation indicators? Is there data collection for rehabilitation indicators? What kind of indicators are developed and/or used in your country? Is your country interested in rehabilitation indicators in PATH'09 project? How many hospitals would join data collection for rehabilitation indicators? Are these special rehabilitation hospitals or public hospitals with rehabilitation unit?