title: Postacute rehabilitation quality of care: toward a shared conceptual framework.
abstract: There is substantial interest in mechanisms for measuring, reporting, and improving the quality of health care, including postacute care (PAC) and rehabilitation. Unfortunately, current activities generally are either too narrow or too poorly specified to reflect PAC rehabilitation quality of care. In part, this is caused by a lack of a shared conceptual understanding of what construes quality of care in PAC rehabilitation. This article presents the PAC-rehab quality framework: an evidence-based conceptual framework articulating elements specifically pertaining to PAC rehabilitation quality of care. The widely recognized Donabedian structure, process, and outcomes (SPO) model furnished the underlying structure for the PAC-rehab quality framework, and the International Classification of Functioning, Disability and Health (ICF) framed the functional outcomes. A comprehensive literature review provided the evidence base to specify elements within the SPO model and ICF-derived framework. A set of macrolevel-outcomes (functional performance, quality of life of patient and caregivers, consumers' experience, place of discharge, health care utilization) were defined for PAC rehabilitation and then related to their (1) immediate and intermediate outcomes, (2) underpinning care processes, (3) supportive team functioning and improvement processes, and (4) underlying care structures. The role of environmental factors and centrality of patients in the framework are explicated as well. Finally, we discuss why outcomes may best measure and reflect the quality of PAC rehabilitation. The PAC-rehab quality framework provides a conceptually sound, evidence-based framework appropriate for quality of care activities across the PAC rehabilitation continuum.
authors.affiliation: Health Psychology Department, Medical School, University Miguel Hernández, Elche, Spain. Electronic address: jesus-ts@outlook.com.
authors.forename: Tiago Silva
authors.initials: TS
authors.lastname: Jesus
authors.affiliation: Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: Helen
authors.initials: H
authors.lastname: Hoenig
mesh_terms: D000203:Activities of Daily Living; D019317:Evidence-Based Medicine; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge; D017060:Patient Satisfaction; D018802:Patient-Centered Care; D026741:Physical Therapy Modalities / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D011788:Quality of Life; D020127:Recovery of Function
keywords: Quality indicators, health care; Quality of health care; Rehabilitation