Abstract
There is substantial interest in mechanisms for measuring, reporting, and improving
the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately,
current activities generally are either too narrow or too poorly specified to reflect
PAC rehabilitation quality of care. In part, this is caused by a lack of a shared
conceptual understanding of what construes quality of care in PAC rehabilitation.
This article presents the PAC-rehab quality framework: an evidence-based conceptual
framework articulating elements specifically pertaining to PAC rehabilitation quality
of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model
furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided
the evidence base to specify elements within the SPO model and ICF-derived framework.
A set of macrolevel-outcomes (functional performance, quality of life of patient and
caregivers, consumers' experience, place of discharge, health care utilization) were
defined for PAC rehabilitation and then related to their (1) immediate and intermediate
outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement
processes, and (4) underlying care structures. The role of environmental factors and
centrality of patients in the framework are explicated as well. Finally, we discuss
why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab
quality framework provides a conceptually sound, evidence-based framework appropriate
for quality of care activities across the PAC rehabilitation continuum.
Keywords
List of abbreviations:
HHA (home health agency), HRQOL (health-related quality of life), ICF (International Classification of Functioning, Disability and Health), PAC (postacute care), SNF (skilled nursing facility), SPO (structure, process, and outcomes)To read this article in full you will need to make a payment
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Jesus TS, Silva IL. Toward an evidence-based provider-patient communication in rehabilitation: linking communication elements to better rehabilitation outcomes. Clin Rehab; in press.
Article info
Publication history
Published online: December 23, 2014
Footnotes
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
