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

The global goal of pediatric rehabilitation services is to increase the ability of children to participate in meaningful life activities. Services that do not include a participation-centered goal are unlikely to achieve this impact. In this study, a participation component was operationally defined as a reference to a person or place outside the therapy context, regardless of the practice setting or discipline. The aim was to increase the use of participation-level goals among patients seen across all departments in the Division of Clinical Therapies from 50% to 80% by December 31, 2022, and sustain this level for 6 months.

We implemented Plan-Do-Study-Act cycles in accordance with the Model for Improvement endorsed by the Institute for Healthcare Improvement. We tailored interventions for 6 participating departments. Strategies included audit and feedback, targeted communication with teams, and the use of champions. Then, we sampled charts across departments. We analyzed data using a statistical process control chart with a baseline mean of 32.5% and a target of 80%.

The goal of 80% of charts containing a rehabilitation goal with a participation-level component was achieved after 24 months of interventions, reaching a new centerline of 82% and sustaining this level for 6 months.

We implemented patient goals with a participation component across multiple rehabilitation departments within a large division of a major pediatric hospital, using quality improvement methodology. Departments benefited from general strategies (eg, reminders) and tailored interventions (eg, targeted communication) to achieve and maintain 80% compliance.