SCI-HIGH: Moving Best Practices with Indicator Implementation for Individuals with Spinal Cord Injury during Rehabilitation Care and in the Community
1Craven C, 2Alavinia M, 2Flett H, 2Farahani F, 3Bayley M
1University of Toronto, Toronto, Ontario, Canada; 2University Health Network, Toronto, Ontario, Canada; 3Division of Physiatry, University of Toronto, Toronto, Ontario, Canada
Objective: Health quality indicators (QI) are key to understanding the quality of care and to identify actionable opportunities for improving health system performance. Although QIs development is advancing in stroke and diabetes, there is still a paucity of QIs for Spinal Cord Injury Rehabilitation Care (SCI/RC), tools to evaluate SCI/RC, and research regarding applicability and validity of the existing tools. The aim of the SCI Rehabilitation Care High-Performance Indicators (SCI-High) project was to establish a framework of structure, process and outcome indicators within 11 domains of care to improve standards of SCI/RC from rehabilitation admission to 18 months post-rehab admission.
Design/Method: Indicator development involved a multi-step process: 1) engage and assemble content experts; 2) determine domain prioritization; 3) review the best evidence; 4) Root Cause Analysis, selection and development of QIs; and, 5) design outcome specifications and initiate preliminary testing. An external advisory committee of stakeholders was assembled to rank the top 10 of 37 RC domains using an established prioritization method (i.e. Hanlon method) and feasibility scoring. Eleven RC domains were identified and 11 national working groups formed to develop and implement QIs relevant to each RC domain. Guided by the Root Cause Analysis, a graphic illustration conveying the relationship between SCI rehabilitation care domain and factors that influence the outcome, and applying the RAND/UCLA method, each national working group proposed at least one structure, one process and one outcome QIs for each of RC domain. Potential indicators were piloted at participating sites to assess the feasibility, inform Standard Operating Procedure (SOP) development and formulation of preliminary benchmarks.
Results: During this course, an overview of the prioritization process, the 33 indicators identification and development of the 11 RC domains (Bladder Continence, Cardiovascular Integrity, Community Participation and Employment, Emotional Wellbeing, Informed Self-Management, Reaching, Grasping, and Manipulation, Sexual Health, Skin Integrity, Urinary Tract Infection, Walking, and Wheeled Mobility.), and the pilot testing processes will be presented. Intended processes to support indicator implementation and linkage of the indicators with Accreditation Canada SCI standards will be highlighted.
Conclusion: Course participants will have the opportunity to provide the SCI-HIGH project team with feedback regarding the proposed indicators and projected implementation plans prior to national implementation. Course attendees will become familiar with the quality indicators and their associated benchmark.
Support: The SCI-HIGH is supported by the Rick Hansen Institute, Ontario Neurotrauma Foundation, and Toronto Rehabilitation Foundation (Grant #G2015-33).
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