Development of Emotional Well-Being indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

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Context Dedicated implementation efforts are critical to bridging the gaps between current practices and best practices. A quality improvement collaborative (QIC), the Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC), was established to meet this need, bringing together a network of clinicians and administrators to systematically improve the quality and equity of tertiary spinal cord injury or disease (SCI/D) rehabilitation care in Ontario, Canada. Methods Clinicians and leaders from five tertiary SCI/D rehabilitation centers and two not-for-profit SCI/D advocacy groups comprised a network dedicated to supporting implementation of the SCI-High quality indicators in prioritized domains of SCI rehabilitation and related best practices by: (1) building capacity through implementation science education of frontline clinicians; (2) providing resources and support to empower frontline clinicians to lead quality improvement efforts within their institutions; (3) promoting wider learning through a network for sharing ideas, efforts, and experiences; and (4) collecting indicator data to facilitate provincial evaluation of goal attainment. Results Network members and sites collaborated to implement best practices within six priority domains; in 18 months, significant progress has been made in emotional wellbeing, sexual health, walking, and wheeled mobility despite disruptions due to the COVID-19 pandemic. These efforts encompass heterogeneous challenges and strategies, ranging from developing clinical skills programs, to streamlining processes, to manipulating physical space. Conclusion A QIC targeting SCI/D rehabilitation demonstrates promise for advancing the implementation of best practices, building implementation science capacity across multiple sites, and for promoting collaboration amongst SCI/D rehabilitation centers and organizational partners.

Section: Resultsmentioning

confidence: 99%

Improving practice through collaboration: Early experiences from the multi-site Spinal Cord Injury Implementation and Evaluation Quality Care Consortium

Bateman

Sreenivasan

Farahani

et al. 2021

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“…Similar to the processes followed by other SCI-High Working Groups, 44 the initial process for ensuring that the development and selection of indicators would be grounded in either theory and/or evidence was to review the construct definition and to use the Driver diagrams to critically reflect upon it. Following review of the systematic searches, discussions of other conceptualizations/definitions of community participation, and multiple refinements of the Driver diagram, the group agreed that ensuring individuals living with SCI/D are healthy, able and provided opportunities to participate fully in the life situations they deem important was the driver most likely to advance SCI/D rehabilitation care in the near term.…”

Section: Resultsmentioning

confidence: 99%

“…The decision to focus on these aspects on the Driver diagram were further reinforced by the decision to create a separate set of indicators for employment, and there was already a set of indicators on emotional wellbeing. 44 Table 2 summarizes the denominators, type of indicator and timing of measurement for each of the indicators selected by the Community Participation Working Group.…”

Section: Resultsmentioning

confidence: 99%

“… 6 Arguably, the community participation domain will be the most meaningful in demonstrating impactful change for SCI/D rehabilitative care since it will be indicative of the collective impact and efficacy of the other SCI-High domains ( i.e. Cardiometablic Health, Emotional Well-Being, Sexual Health, Tissue Integrity, Urinary Tract Infection, Walking, Wheeled Mobility, Self-Management, Reaching, Grasping and Manipulation, and Employment) 44 , 48 , 83–90 being implemented across Canada.…”

Section: Discussionmentioning

confidence: 99%

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Development of community participation indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

Hitzig

Jeyathevan

Farahani

et al. 2021

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Context Community participation following spinal cord injury/disease (SCI/D) can be challenging due to associated primary impairments and secondary health conditions as well as difficulties navigating both the built and social-emotional environment. To improve the quality of SCI/D rehabilitation care to optimize community participation, the SCI-High Project developed a set of structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods A pan-Canadian Working Group of diverse stakeholders: (1) defined the community participation construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with community participation; and (4) prepared a process map. Facilitated meetings allowed selection and review of a set of structure, process and outcome indicators. Results The structure indicator is the proportion of SCI/D rehabilitation programs with availability of transition living setting/independent living unit. The process indicators are the proportion of SCI/D rehabilitation inpatients who experienced: (a) a therapeutic community outing prior to rehabilitation discharge; and, (b) those who received a pass to go home for the weekend. The intermediary and final outcome measures are the Moorong Self-Efficacy Scale and the Reintegration to Normal Living Index. Conclusion The proposed indicators have the potential to inform whether inpatient rehabilitation for persons with SCI/D can improve self-efficacy and lead to high levels of community participation post-rehabilitation discharge.

“…This manuscript is the second in a series of 14 SCI-High Project manuscripts. A detailed description of the process for domain prioritization 26 and the development of Domain-specific indicators [27][28][29][30][31][32][33] are described in related manuscripts in this issue.…”

Section: Introductionmentioning

confidence: 99%

Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project

Craven

Alavinia

Wiest

et al. 2019

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Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes . This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada. Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators. Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020. Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.