Will quality ever become patient centric?
Now that spring has arrived, the warming is anticipated and the heat of summer will soon follow. Likewise, the rehab blogs are also heating up with discussions of quality and performance. The stir no doubt being generated by pending quality measures for inpatient rehabilitation providers. It’s interesting to read how clinicians are responding to these issues with comments about how their practice and facilities are attempting to track, monitor and otherwise be compliant with payer requirements. Medical necessity, 3 Hour Rule, pre-admission assessments and timing of intake procedures are referenced as the preferred quality measures. It is apparent that the industry is focused on the process of getting paid and ensuring the steps are followed precisely. Of course, this is absolutely necessary, but it is only the price of admission to the quality-value debate. Beyond compliance with the rules of engagement comes the next consideration of effectiveness.
I often get the chance to ask clinicians “How effective are you in what you do?” Their responses never cease to amaze me, ranging from “I don’t know” to “extremely.” What usually follows is a discussion of, “It all depends on whose expectations are being used.”
In rehabilitation, our mandate is to restore patients to the optimal level of self actualization for physical, mental and social functions. Depending on the particular venue of care we practice in, our efforts and resources vary according to the continuum of recovery for each patient. Getting the patient goals of care correct serves to guide the process, resources and expectations to a “realistic” achievable outcome for the patient. And while we may assume that our outcome measures of satisfaction, FIM™ change or ambulatory status, are appropriate measures of change, they may or may not directly answer the question of quality.
I have come to define quality as the degree to which expectations are met. The degree implies a valid, reliable measure and expectations are the expression of desired outcomes described by these measures. Now I know patients don’t usually speak in these terms, but shouldn’t we?
When it comes to comparing quality of healthcare, what will your answer be when faced with the question, “What percent of your patients achieve their rehab goals upon discharge?”