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190 Musculoskeletal & Neurological Rehabilitation KCE reports 57
8.7.3 Quality
An overview of quality and outcome measures for rehabilitation can be found xx .
The Federal Agency for Healthcare Research and Quality (AHRQ) of the Department
of Health and Human Services is responsible for measuring the quality of health care in
the United States. Since 2003, a yearly report, ‘the National Healthcare Quality Report‘,
has been issued on quality of services. At this stage, the clinical conditions discussed in
the reports are not specifically linked to rehabilitation (e.g. cancer, diabetes, end-stage
renal disease, HIV and AIDS, mental health) but it is intended to update the set of
measures.
Quality of care in rehabilitation is not uniformly assessed across the United States and a
variety of measurements is in use. The American Academy of Physical Medicine and
Rehabilitation suggested five performance measurements which are focused on the level
of the setting or the health care professional and are organized by external institutesyy
The Commission on Accreditation of Rehabilitation Facilities (CARF), accredits the
services of an organization based on preset standards. These differ by pathology (e.g.
spinal cord, brain injury) and facility (e.g. hospital, outpatient). In total, 23 different
programs are identified in the area of medical rehabilitation for which accreditation can
be requested. Medical Rehabilitation programs include treatments for people who have
had a stroke, brain or spinal cord injury, or pain that cannot be controlled by
medication alone. Medical rehabilitation also includes return-to-work programs or
occupational rehabilitation, which helps people regain skills they need so that they can
return to work after an injury or illness. An organization seeking accreditation for a
medical rehabilitation program must demonstrate the following:
• Service design and delivery that focus on the needs of the persons
served.
• Assignment of designated, qualified, competent personnel to provide
medical rehabilitation services.
• Program accessibility and designation of space for the provision of
medical rehabilitation services.
• Accomplishment of predicted outcomes.
• Partnership with the persons served in decision making and the
development of goals.
• A system of accountability that measures the success of the medical
rehabilitation program by evaluating the outcomes achieved by the
persons served.
• External communication to a variety of stakeholders regarding
program performance.
The organization is asked to demonstrate to a survey team conformance to standards
highlighting the organization's values and approaches in these areas. CARF standards are
developed and revised through a series of panels, national advisory committees, focus
groups, and field reviews:
• Core values and mission.
• Input from the persons served and other stakeholders.
• Individual-centered planning, design, and delivery.
• Rights of the persons served.
xx http://www.emedicine.com/pmr/topic155.htm
yy http://www.aapmr.org/hpl/perfmeasure/pmr.htm