Delivery of a quality improvement program in team-based rehabilitation for patients with rheumatic and musculoskeletal diseases: a mixed methods study

Abstract

Purpose

To investigate how a quality improvement program (BRIDGE), designed to promote coordination and continuity in rehabilitation services, was delivered and perceived by providers in routine practice for patients with rheumatic and musculoskeletal diseases.

Methods

A convergent mixed methods approach was nested within a stepped-wedge, randomized controlled trial. The intervention program was developed to bridge gaps between secondary and primary healthcare, comprising the following elements: motivational interviewing; patient-specific goal setting; written rehabilitation-plans; personalized feedback on progress; and tailored follow-up. Data from health professionals who delivered the program were collected and analyzed separately, using two questionnaires and three focus groups. Results were integrated during the overall interpretation and discussion.

Results

The program delivery depended on the providers’ skills and competence, as well as on contextual factors in their teams and institutions. Suggested possibilities for improvements included follow-up with sufficient support from next of kin and external services, and the practicing of action and coping plans, standardized outcome measures, and feedback on progress.

Conclusions

Leaders and clinicians should discuss efforts to ensure confident and qualified rehabilitation delivery at the levels of individual providers, teams, and institutions, and pay equal attention to each component in the process from admission to follow-up.

Implications for Rehabilitation

• Quality in rehabilitation should be characterized by a continuous and coordinated process from goal setting to follow-up.

• To improve the quality, sufficient involvement of next of kin and external services is needed.

• Clinicians may need training to build confidence in motivational interviewing, action- and coping planning, feedback on progress, and follow-up.

• Leaders should organize education sessions, optimize schedules, insert standardized outcome measures, and facilitate collaboration across levels of care and services.

Keywords:

• Quality in healthcare
• rehabilitation
• delivery of healthcare
• quality improvement
• rheumatic and musculoskeletal diseases
• goal setting
• self-management
• mixed methods

Acknowledgements

The authors would like to thank all of the health professionals at the participating rehabilitation centers for their contribution to the original data.

Authors contributions

ALSS drafted the article. All authors were involved in revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication. ALSS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analyses. Study conception and design: ALSS, GB, GJA, MA, AMB, TND, CE, IJ, HLV, HD, IK. Acquisition of data: ALSS, TND, IJ, HLV, IK. Analysis and interpretation of data: ALSS, GB, GJA, MA, AMB, TND, CE, IJ, HLV, HD, IK

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by The Research Council of Norway (2017/260661).