Delivery of a quality improvement program in team-based rehabilitation for patients with rheumatic and musculoskeletal diseases: a mixed methods study

To investigate how a quality improvement program (BRIDGE), designed to promote coordination and continuity in rehabilitation services, was delivered and perceived by providers in routine practice for patients with rheumatic and musculoskeletal diseases. A convergent mixed methods approach was nested within a stepped-wedge, randomized controlled trial. The intervention program was developed to bridge gaps between secondary and primary healthcare, comprising the following elements: motivational interviewing; patient-specific goal setting; written rehabilitation-plans; personalized feedback on progress; and tailored follow-up. Data from health professionals who delivered the program were collected and analyzed separately, using two questionnaires and three focus groups. Results were integrated during the overall interpretation and discussion. The program delivery depended on the providers’ skills and competence, as well as on contextual factors in their teams and institutions. Suggested possibilities for improvements included follow-up with sufficient support from next of kin and external services, and the practicing of action and coping plans, standardized outcome measures, and feedback on progress. Leaders and clinicians should discuss efforts to ensure confident and qualified rehabilitation delivery at the levels of individual providers, teams, and institutions, and pay equal attention to each component in the process from admission to follow-up. Quality in rehabilitation should be characterized by a continuous and coordinated process from goal setting to follow-up.To improve the quality, sufficient involvement of next of kin and external services is needed.Clinicians may need training to build confidence in motivational interviewing, action- and coping planning, feedback on progress, and follow-up.Leaders should organize education sessions, optimize schedules, insert standardized outcome measures, and facilitate collaboration across levels of care and services. Quality in rehabilitation should be characterized by a continuous and coordinated process from goal setting to follow-up. To improve the quality, sufficient involvement of next of kin and external services is needed. Clinicians may need training to build confidence in motivational interviewing, action- and coping planning, feedback on progress, and follow-up. Leaders should organize education sessions, optimize schedules, insert standardized outcome measures, and facilitate collaboration across levels of care and services.

本研究旨在探究一项旨在提升康复服务协调性与连续性的质量改进项目（BRIDGE），在风湿免疫与肌肉骨骼疾病患者的常规临床实践中的实施情况与实施者的认知评价。本研究采用嵌套于阶梯楔入式随机对照试验的收敛性混合方法研究设计。本干预项目旨在弥合二级与基层医疗卫生服务间的鸿沟，包含以下核心要素：动机访谈（motivational interviewing）、个体化目标设定、书面康复计划、进度个性化反馈以及定制化随访。研究通过两份问卷与三个焦点小组访谈，分别收集并分析了参与项目实施的医护人员相关数据，并在整体解读与讨论阶段整合研究结果。项目的实施效果取决于实施者的技能与能力，同时也受其所在团队与机构的情境因素影响。研究提出的改进建议包括：获得近亲属与外部服务的充分支持以开展随访、实践行动与应对计划、采用标准化结局指标以及完善进度反馈机制。医疗机构管理者与临床医师应共同探讨相关举措，以确保个体实施者、团队及机构层面的康复服务能够稳妥且高质量地开展，并同等重视从接诊到随访全流程中的各个环节。康复服务的质量应体现为从目标设定到随访的连续协调过程。为提升康复服务质量，需让近亲属与外部服务充分参与其中。临床医师可能需要接受相关培训，以提升其在动机访谈、行动与应对计划制定、进度反馈及随访工作中的自信心。医疗机构管理者应组织教育培训课程、优化排班、纳入标准化结局指标，并推动不同层级照护与服务间的协作。康复服务的质量应体现为从目标设定到随访的连续协调过程。为提升康复服务质量，需让近亲属与外部服务充分参与其中。临床医师可能需要接受相关培训，以提升其在动机访谈、行动与应对计划制定、进度反馈及随访工作中的自信心。医疗机构管理者应组织教育培训课程、优化排班、纳入标准化结局指标，并推动不同层级照护与服务间的协作。