Description

The problem.

During conduct of the 2012 Environmental Scan of tertiary SCI rehabilitation services in Canada (http://rickhanseninstitute.org/e-scan-atlas), it became evident that rehabilitation services are neither equitable nor optimal. Significant gaps were noted between new knowledge generation and clinical practice implementation, which diminishes rehabilitation effectiveness. In addition, some silos of excellence were noted across the country within specific domains of SCI rehabilitation care.

The solution.

The SCI-High project was created to fill the gaps between knowledge generation and clinical practice implementation in order to improve rehabilitation effectiveness. This aim will be achieved by prioritizing the top 11 domains of rehabilitation care and working collaboratively with domain-specific working groups comprised of relevant stakeholders to select and implement indicators of quality SCI rehabilitation care. Quality of care indicators can be divided into structure, process and outcome indicators, each intended to address specific aspects of care:

• Structure indicators describe the infrastructure, personal and organizational characteristics of the institution where care is provided. Examples of structure indicators are the number of health specialists’ at an institution or number of beds in a hospital.
• Process indicators represent the actions taken by a health care providers to achieve a given or specific care goal. The percentage of cancer patients receiving chemotherapy within 30 days of tumour diagnosis is an example of a process indicator.
• Outcome indicators describe the effect of care on the patients’ health and wellbeing. Outcome indicators explore the patients’ clinical (e.g. insulin requirement), functional (e.g. grasping ability) and satisfaction (e.g. sadness, angry, happiness) measurements.

The core methodology behind the SCI-High project involves evidence-based identification of one structure, process and outcome indicator from within the 11 SCI rehabilitation care domains for a total of 33 indicators. These indicators will be used to develop benchmarks to evaluate, improve, equalize the quality of rehabilitation care for Canadians living with SCI.

Who will participate?

Many stakeholders are participating in the development and implementation of the SCI-High project, including: health care providers, scientists, administrators, leaders, policy makers, consumers and representatives from Accreditation Canada, the Rick Hansen Institute, Spinal Cord Injury Ontario and the Ontario Neurotrauma Foundation.

What is the current stage of the project?

Most of the working groups have now completed the identification of their domain-specific indicators (see the Domains page for the current stage of each working group). The process of evaluating the potential indicators with rapid Plan-Do-Study-Act (PDSA) cycles is underway at the Toronto Rehabilitation Institute. This will allow for an initial evaluation of the feasibility of the indicators and proposal of initial benchmarks for SCI-High project implementation.

What will we achieve?

The SCI-High project is a bold endeavor to improve and standardize the quality of rehabilitation care in Canada for a patient's first 18 months following rehabilitation admission by 2020. We anticipate that successful project implementation will enhance recovery, and the health and quality of life of people living with the consequences of SCI in the community. A report outlining the initial rehabilitation care indicators will be presented during the 7^th National SCI Conference in Niagara Falls, November 9^th, 2017 (www.sci2017.com).