Integrierte Forschung ICF Unterstützung für den Veränderungsprozess im Alltag

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1 Integrierte Forschung ICF Unterstützung für den Veränderungsprozess im Alltag 6. ICF Anwendertagung: Von der Theorie zur Praxis 19. April 2016, Schweizer Paraplegiker-Zentrum Nottwil Dr. med. Anke Scheel-Sailer Ärztliche Leiterin Forschung Rehabilitation Qualitätsmanagement - FRQM March 9th of

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3 Implementation Science Survey, interviews, and case descriptions 1. collaborate with other organizations; 2. establish strong links with policymakers and involve stakeholders in the work; 3. be independent and manage conflicts of interest among those involved in the work; 4. build capacity among those working in the organization; 5. use good methods and be transparent in the work; 6. start small, have a clear audience and scope, and address important questions; and 7. be attentive to implementation considerations, even if implementation is not a remit. Four recommendations emerged for the World Health Organization (WHO) and other international organizations and networks: 1) support collaborations among organizations; 2) support local adaptation efforts; 3) mobilize support; and 4) create global public goods Lavis, 2008, BMC March 9th of

4 Hypotheses: Different steps of implementation: The quality of goal based interventions can be seen and compared. Presentation of the extend of the problem (Qualifier, quantitative aspects). The classification structure is visible (ICF Core Sets, harmonization of categories/ codes; first indicator of quality The concept of ICF is implemented (general understanding). Wiegand, 2012, Am. J. Phys. Med. Rehabil. & Vol. 91, No. 7, July 2012 June 19th of

5 Swiss ANQ Politische, national und institutionale Hintergründe Implementation ICF SPZ WHO ICF Konzept und Codes ICHI Entwicklung ICD 11 Entwicklung Entwicklung von Core Sets DRG Vorbereitung und Implementierung ST Reha SwiSCI Kohortenstudie Konzept ICF, Rehab Neuron Rehab Cycle, goal, phase Rehabilitation der Zukunft, Prozessorganisation Forschung RQM 5

6 Schnittstellen Forschung RQM SPZ Prozessgruppenverantwortliche Ärzteteam CTU SPZ Direktor CEO Unternehmensentwicklung RQM Oberärztin FRQM Assistenzärzte ICF Team SPF Universität Luzern Master Health Science Master Studenten March 9th of

7 - Health Communication (Prof. Sara Rubinelli) - Health Behavior and Management (Prof. Gisela Michel ) - Health Economics and Health Policy (Prof. Stefan Boes ) - Health Services Research (Prof. Armin Gemperli ) - Research Methods (Prof. Stefan Boes) March 9th of

8 leader IT fundament The institute: Case Study SPC, Implementation ICF culture/ values specification Research RQM survey survey teaching: ICF model implementation Job organization, IT goal, phase, case study Concept ICF, Rehab Neuron Rehab Cycle, goal, phase Future rehabilitation, process 9

9 Life long care Rehabilitation Quality Management Ethics Politics/ Law Patient health condition ICF based model of functioning Treatment process Outcome Secundary Prevention Outcome Institution history Health services Equipment Professionals 10 Meyer Th, ISPRM Discussion Paper: proposing a conceptual description of health related rehabilitation services, J Rehabil Med 2014, 46: 1-6

10 Rehabilitation Cycle Individualized process ICD-10 Inter natio nal Statis tical Class ificati on of Dise ases Assignment Goal setting Diagnosis (ICD) Assessment Rehab cycle Intervention Therapy (ICHI) Functioning (ICF) Evaluation Outcome Strengthening quality of care through standardized reporting based on the World Health Organization s reference classifications, Dorjbal, Prodinger, 16, submitted

11 Strengthening quality of care through standardized reporting based on the World Health Organization s reference classifications: Process of assigning information to the Rehab-Cycle and then into standardized codes January 23rd of

12 A Survey of the translation from clinical goal formulation in inpatient youth-rehabilitation program into the functioning profile of the ICF: Lustenberger N, Prodinger B, Dorjbal D, Schmitt K, Rubinelli S, Scheel-Sailer A DO 13

13 Assessment Background and setting: Evaluation of goal achievement ICF Core Set Goal Setting Intervention Assignment Schematic description of a post-acute stationary rehabilitation according to the rehabilitation cycle: June 19th of

14 Pracitcal, Mental & Social Coping Hygene & Health Mobility Display of standardized codes occured for 8 youths in a post-acute rehabilitation program Rehabilitation cycle goal codes Namings Accompanied with clarifying codes of goal itself, assessments and evaluations Median clarifying codes per goal 1 d465 Moving around using equipment 8x b114, b156, b210, b710, d440, d445, d460, d470, e115, e120, e150, e340, e (1/6) 2 b730 Muscle power functions 8x b130, b730, b740, b735, b755, d155, d420, d430, d450, e115, e340 1 (0/3) 3 d420 Transferring oneself 6x b140, b730, d137, d220, d410, d520, e115, e120, e340 3 (3/6) 4 d450 Walking 5x b260, b710, b715, b730, b740, b735, b770, s750, d230, d455, d465, e115, e120, e155, e340, e580 6 (3/7) 5 b710 Mobility of joint functions 5x b280, b735, b780, s740, s750, d230, d450, d540, e115 3 (1/4) 6 d415 Maintaining a body possition 4x b130, b735, e115, e120, e (0/3) 7 d410 Changing basic body positions 3x b126, b280, b710, s760, d415, d420, e115, e340 3 (1/5) 8 d440 Fine hand use 3x b164, b730, b735, d230, d445, d825, e340, e355, e580 4 (1/5) 9 e120 Prod.for pers.in-+outdoor mob.+transp. 3x d415, s810, e115, e510, e570 2 (0/5) 10 b735 Muscle tone functions 2x b755, b760, d920 2 (1/3) 1 d530 Toileting 10x b144, b525, b620, b710, d230, d420, d540, d510, d920, s760, d240, d415, d560, d570, e110, e115, e310, e340, e580 4 (1/8) 2 d520 Caring for body parts 8x b164, b210, b260, b265, b270, b430, b710, b735, b810, b840, s760, s810, d155, d410, d415, d440, s810, e115, e310, e340 5 (2/7) 3 d570 Looking after one's health 6x b530, b540, b555, b710, b735, d230, d530, d550, d560, e115, e310, e340, e580 4 (3/7) 4 d540 Dressing 6x b265, b730, b735, d230, d410, d415, d440, d445, e115, e120, e340, e355 3 (1/6) 5 d510 Washing oneself 3x d415, e115, e155, e310, e340 2 (1/5) 6 b440 Respiration functions 3x b180, b450, s120, s760, e115 2 (1/3) 7 d230 Carrying out daily routine 2x b164, d510, d520, d530, e115, e340 3 (1/5) 8 e115 Products for pers.use in daily living 2x b560, b715, e510, e570, e (2/3) 9 b445 Respiratory muscle functions 1x b440, b b180 Experiance of self and time functions 5x b117, b126, b130, b140, b164, b210, b260, b760, d155, d210, d220, d230, d240, d475, d710, d720, d920, e115, e340 5 (3/5) 2 b164 Higher-level cognitive functions 4x b126, b140, b144, b164, b210, b730, d175, d210, d230, d440, d630, d640, e115, e340, e580 6 (4/7) 3 d250 Managing one's behavior 3x b126, b144, b620, d230, d240, d455 3 (2/4) 4 d840 Apprenticeship 3x b117, d220, d475, e355 2 (2/2) 5 d470 Using transportation 3x b114, b156, d155, d730, e120, e340, e (2/5) 6 d640 Doing housework 2x b164, b735, d440, d630, 2115, e (2/5) 7 d720 Complex interpersonal interactions 1x b126, d177, e b122 global psychosocial functions 1x b117, b120, b130, b180, 4 9 b126 Temprament and personality functions 1x 0 June 19th of

15 ICF documentation template of health information ICF GOAL CODE WITH CONTEXT GOAL CLARIFYING ASSESSMENTS GOAL CLARIFYING EVALUATIONS MMC5 d465 Moving around using equipment (e120 Products for personal.in- and outdoor mobility) (b156 Perceptual functions, b114 Orientation functions, b210 Seeing functions, e340 Personal care provider) improvement of driving with the electric drive (d460 Moving around in different locations, d470 Using transportation, b156 Perceptual functions, e340 Personal care provider) reduced experience of the space, visually limited, driving electric engine is not possible without help x needs only little help to go into the town of Lucerne by bus, x has partially difficulties when space is narrow with assessment of proximity and distance Lustenberger, N, JR&D, submitted 2016, Compiling standardised information from clinical practice: Using content analyses and ICF Linking Rules in goal-oriented youth rehabilitation June 19th of

16 Assessment instruments during first rehabilitation of patients with Spinal Cord Injury What has been assessed, for whom and when? Methods: A retrospective chart review of patients after SCI, aged 18 and older, admitted between December 2014 and December 2015 was performed. Results: 53 assessments from a codebook were screened, 40 assessments were conducted in which only 16 appeared in less than 20 patients. Most applied instruments were the SCIM (n=918), skin assessments (n=427), manual muscle test (lower extremity n=427, upper extremity n=294) and radiology (n=279). The AIS was applied 220 times and missed in two patients. Lampart P, Prodinger B, Schmitt K, Bersch I, Baumberger M, Gemperli A, Scheel A 17

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18 Rehabilitation Quality Management standardized reporting, rehab cycle and goal setting Individual Assessments and diagnosis (ICD 10) AIS SCIM Comorbidity Scale Urodynamics X-ray spine SEP+ENG GRASSP Functioning Profile (ICF) Generic Core Set Disability Core Set SCI post acute Core Set Expected Outcome Metric qualifier Predictories Goal setting Prodinger B, Ehrmann C, Tennant A, Scheel A, Schmitt K, Stucki G Intervention

19 Summary and next steps: The quality of goal based interventions can be seen and compared. Presentation of the extend of the problem (Qualifier, quantitative aspects). The classification structure is visible (ICF Core Sets, harmonization of categories/ codes; first indicator of quality The concept of ICF is implemented (general understanding). Optimize management of rehabilitation in Spinal Cord Injury by integration of ICF in the daily routine. Plan ongoing education for health professionals validate Core Sets in practice Adapte linking rules Create an ICF functioning profile out of the usual documentation Respect acute care and rehabilitation perspectives Keep IT based documentation simple Define the gap between practice and theory Explain it to politician Bring simple or complex documentation to an international standard June 19th of

20 Herzlichen Dank June 19th of