Improving quality in stroke rehabilitation.
Given the numerous quality improvement (QI) initiatives that have been undertaken in various medical fields, it is clear that inpatient rehabilitation services, particularly those geared toward stroke rehabilitation, can also benefit from these programs. To effectively evaluate the quality of rehabilitation services, indicators measuring structure, process, and outcomes must be included as part of any QI initiative. In addition to measuring quality, these indicators can be used to describe and address disparities in the provision of rehabilitation services on the basis of race, socioeconomic status, geography, disability status, and a multitude of other demographic factors. To improve quality and address health disparities associated with stroke rehabilitation, QI initiatives must be scientifically driven, continuing the trend of evidence-based practice in medicine. They must also remain flexible, because the science of quality improvement is an ever-changing field. It will be a challenge to convince physicians and other health care professionals that QI initiatives are a worthwhile investment of their limited time and resources, and further research is required to move the field of quality in stroke rehabilitation forward.
Dowla
Nizar
N
Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA.
Chan
Leighton
L
D003710:Demography / Q000379:methods; D004185:Disability Evaluation; D006801:Humans; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D020521:Stroke / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D017749:Total Quality Management
Health Serv Res. 1997 Jun;32(2):197-221; discussion 223-7
9180616
PM R. 2009 Nov;1(11):997-1003
19942185
Arch Intern Med. 2003 Sep 22;163(17):2085-92
14504123
N Engl J Med. 1999 Oct 7;341(15):1147-50
10511617
Am J Phys Med Rehabil. 2009 Apr;88(4):308-21
19190486
Arch Phys Med Rehabil. 1999 Jun;80(6):642-6
10378489
PM R. 2009 Jan;1(1):29-40
19627870
Int J Rehabil Res. 2007 Dec;30(4):339-42
17975455
JAMA. 2009 Apr 15;301(15):1515-6
19366762
JAMA. 2000 Nov 8;284(18):2325-33
11066182
Top Stroke Rehabil. 2010 Jul-Aug;17(4):252-61
20826413
Med Care. 2002 Nov;40(11):1036-47
12409849
J Am Coll Surg. 2007 Apr;204(4):527-32
17382210
JAMA. 2007 Mar 14;297(10):1121-5
17356035
Int J Qual Health Care. 1999 Feb;11(1):73-9
10411292
JAMA. 2007 Feb 28;297(8):831-41
17327525
Disabil Rehabil. 2010;32(19):1604-11
20158376
J Rural Health. 2006 Spring;22(2):140-6
16606425
J Health Serv Res Policy. 2008 Jul;13(3):129-30
18573759
Health Serv Res. 2006 Aug;41(4 Pt 1):1258-75
16899006
Arch Phys Med Rehabil. 2002 Oct;83(10):1335-41
12370864
Top Stroke Rehabil. 2010 Jul-Aug;17(4):239-51
20826412