Implementing Participation-level Goals to Improve Patient-Centeredness in Pediatric Rehabilitation.

Area of Science:

• Pediatric Rehabilitation
• Quality Improvement in Healthcare
• Child Participation in Life Activities

Background:

• The primary objective of pediatric rehabilitation is to improve children's engagement in meaningful life activities.
• Rehabilitation services lacking participation-centered goals may not achieve optimal impact.
• A participation component was defined as any reference to external people or places within the therapy context.

Purpose of the Study:

• To increase the implementation of participation-level goals in pediatric rehabilitation from 50% to 80% within the Division of Clinical Therapies.
• To sustain this increased level of participation-centered goals for at least six months.
• To evaluate the effectiveness of quality improvement methods in enhancing goal setting.

Main Methods:

• Implementation of Plan-Do-Study-Act (PDSA) cycles based on the Institute for Healthcare Improvement's Model for Improvement.
• Tailored interventions for six distinct departments, including audit and feedback, targeted communication, and the use of departmental champions.
• Analysis of patient charts using statistical process control charts to track goal attainment.

Main Results:

• The target of 80% of charts containing rehabilitation goals with a participation-level component was achieved after 24 months of intervention.
• The new centerline for participation-level goals reached 82%.
• The achieved level of 80% compliance was sustained for six months post-intervention.

Conclusions:

• Quality improvement methodologies successfully increased the use of participation-centered goals across multiple pediatric rehabilitation departments.
• Both general strategies and tailored interventions were crucial for achieving and maintaining compliance.
• The study demonstrates the feasibility of implementing and sustaining participation-focused goal setting in diverse clinical settings.