Compliance with standards of practice for health-related rehabilitation in low and middle-income settings: development and implementation of a novel scoring method

Abstract

Purpose: To (A) develop a method for measuring compliance with standards, and (B) implementation of the method in 12 rehabilitation centers in six low and middle-income countries (LMICs). Methods: In part A, existing standards were compiled and operationalized into scores, organized into 5 'scorecards' and 15 'sub-scorecards', then tested and refined in an iterative process. In part B, 12 rehabilitation centers in 6 countries implemented the standards using the new method, revealing relative performance between centers, and across different standards. Internal consistency of scores within domains was computed using Chronbach's alpha. Results: A standardized method for scoring compliance with standards for rehabilitation was developed. The method evaluated compliance with standards in five domains of practice: user focused approach, service outputs, finances, staff, and general management. Multiple standards within domains were strongly related, with Chronbach's alpha >0.80 for all but the equipment and supplies domain. Overall, in the 12 rehabilitation centers examined, 36% of standards were met or exceeded. Compliance within each scoring domain was 56% (user-focused approach), 38% (service outputs), 27% (financial management), 30% (staff management), and 33% (general management). Two out of 12 (17%) of centers met more than two-thirds of the standards, 3 (25%) met more than one-third of standards, while the remaining 7 (58%) met less than one-third of standards. Conclusions: A new, standardized method for measuring performance of rehabilitation services in LMICs was developed. The method examines standards in five rehabilitation practice domains, and can be used to understand barriers to quality performance, particularly in resource-constrained settings. Implementation of the method demonstrated that current compliance with standards is modest. Ongoing interest in new standards for rehabilitation practice should be accompanied by measures to ensure they are used to strengthen quality in an emerging rehabilitation sector. ä IMPLICATIONS FOR REHABILITATION We developed a method for measuring compliance with standards for rehabilitation, and implemented the method in 12 rehabilitation centers in low and middle income countries. We demonstrate modest compliance with an adapted list of known standards of practice. New standards, scoring methods and evidence of current performance may assist service providers and policy makers to implement standards, and methods to strengthen rehabilitation services. Modest compliance with current standards suggest new emphasis on quality performance of healthrelated rehabilitation is needed New emphasis on standards for rehabilitation should be accompanied by consideration of how performance against those standards can be measured and improved.

Construção e validação de modelo lógico para Centros Especializados em Reabilitação

“…A falta de uma cultura de avaliação é uma constante no sistema de saúde brasileiro 29 . À inexistência de avaliação interna da qualidade dos processos e serviços prestados se soma a insuficiência de profissionais que atuam na reabilitação.…”

“…dos profissionais e serviços de saúde agravam a situação da assistência às pessoas com deficiência, que tem apresentado qualidade abaixo da ideal 29,30 .…”

“…Quando se habilitam serviços de referência apenas para alguns tipos de deficiência (ainda que com base em diagnóstico territorial), a atenção se fragmenta, desconsiderando as múltiplas deficiências. As necessidades de saúde das pessoas não são padronizadas e podem variar dentro de um mesmo território de saúde, de modo que seria necessário flexibilizar as regulamentações, para que cada território adeque o serviço a sua realidade e ao mesmo tempo garanta acesso aos serviços de reabilitação de modo oportuno, sem que o paciente precise percorrer grandes distâncias 22,29 .…”