Person-centred rehabilitation: Implementation and evaluation of a rehabilitation specific patient experience survey
Medibank Health Research Fund
Duration: February 2015 – March 2016
The concept of patient-centred care has emerged over the past decades as a central principal of safe and high-quality care, alongside the principles of care which are driven by information and organised for safety. Subacute care, including rehabilitation, is defined as specialised multidisciplinary care in which the primary need for care is optimisation of the individual patient's functioning and quality of life.
Measuring patient experience is regarded as an important component of assessing whether a healthcare system is delivering safe and high-quality health care. However, in Australia, rehabilitation specific patient experience surveys are not in common use.
What we did
A literature review was conducted to inform the project and identify any existing rehabilitation specific patient experience surveys. Only one, the Client-Centred Rehabilitation Questionnaire (CCRQ), was identified.
The seven domains included in the CCQR are client participation in decision-making and goal-setting, client-centred education, evaluation of outcomes from client’s perspective, family involvement, emotional support, co-ordination/continuity and physical comfort. Reliability and validity of the CCQR have been demonstrated in a peer-reviewed journal article.
The research was conducted in three phases, with appropriate ethics and research governance approvals. In Phase 1, five focus groups were conducted at four rehabilitation facilities in NSW, including public and private patients, to assess different aspects of the CCRQ, for example whether the language used was easily understood, the length of the questionnaire and whether the items included were relevant in the Australian context. Based on the focus groups’ feedback, minor modifications to the CCRQ were made.
In Phase 2, the modified CCRQ was implemented in 20 Australian facilities providing adult inpatient rehabilitation across a range of impairments, for example strokes, joint replacements and orthopaedic fractures. Of the 2,053 surveys distributed, 409 were returned. Statistical analysis provided support for a number of modifications to further improve the reliability of the survey. Project data was linked to the usual AROC data submitted by each rehabilitation facility to enable exploration of the relationship between patient experience and rehabilitation outcomes. Analysis showed that the survey item responses were independent of patient demographics, facility sector and patient outcomes.
Reports based on the project survey data were developed and distributed to each of the participating facilities. Phase 3, conducted in March 2016, consisted of a telephone interview with senior rehabilitation staff at these facilities, seeking feedback on the utility of these reports. They reported that the detailed information presented enabled the opportunity for reflection on any gaps between clinicians’ perceptions of the care they provided and patients’ reported experience of that care. They confirmed that the reports provided useful information in an easily understood format which could be used to inform their quality improvement activities.
In summary, the study found that the modified CCRQ is a reliable and valid instrument that organisations can use to support and inform their commitment to person-centred care.