21 Standardised assessment and reporting system for functioning information supports quality reports and individual rehabilitation

In a first step, existing functioning data was harmonized based on the international standard for health outcomes. Subsequently, these data were then used to identify the ways in which people’s functioning develops in the course of rehabilitation and factors that influence these developments. Moreover, the current state of research in the field of prediction models of functioning in rehabilitation was explored using spinal cord injury as case in point. Building upon the results of the project, a stakeholder dialogue with relevant stakeholders in the Swiss health system was conducted to develop strategies toward implementing the findings in clinical rehabilitation and national quality management. The active involvement of stakeholders allowed the use of practical knowledge and strengthened knowledge transfer and thinking towards implementation.

The primary aim of rehabilitation for people with chronic diseases is not to achieve cure but to optimize functioning in everyday life. Functioning information forms the basis of clinical decisions and the assessment of outcome quality and is systematically tested using various data collection tools. Thus, functioning information is often compiled in different formats and likely also in different systems, which challenges the direct comparability of functioning information across settings and time points.

This project aimed to develop a standardised assessment and reporting system for functioning information of patients with a chronic health condition that builds upon harmonized data based on an international standard for health outcomes. Such a system ensures that data is available for research and practice while enabling the continuous use of existing functioning measures. Moreover, strategies were developed for establishing this reporting system in national quality management and in clinical decision making.

The project revealed that it is possible to develop a functioning reference metric for comparing data from clinics that used different assessment tools. The reporting based on this interval-scaled reference metric in comparison to the ordinal-scaled reporting showed that the reported outcomes tended to be smaller but more precise. The project also examined the development of functioning in persons with spinal cord injury undergoing initial rehabilitation and identified four classes of functioning trajectories during rehabilitation and their potential predictors. Moreover, a literature review underscored that the potential of prediction modelling of functioning in the field of spinal cord injury rehabilitation is by far not exploited. The principles and methodologies used in this project, have been made available through the free online course "ICF-StARS".

Significance of the results for research and practice

The StARS project demonstrates the foundational methodological elements for developing a standardised assessment and reporting system for functioning information for use in rehabilitation. Moreover, it shows that functioning data collected with established assessment tools can be harmonized into a standardised reporting system. Such a StARS enhances the monitoring of individual rehabilitation as well as the reporting of quality in rehabilitation.

Enhancing continuous quality improvement and supported clinical decision making by standardized reporting of functioning