Date Presented 03/23/24
Patients may not achieve participation-level outcomes if they do not have participation-level goals. We used quality improvement methodology to implement participation-level goals across multiple departments and disciplines at one pediatric hospital.
Primary Author and Speaker: Kelly Jane Tanner
Additional Authors and Speakers: Sara O’Rourke, Shelley Coleman Casto
Contributing Authors: Rachel Bican, Michelle Byars, Jamie Boster
PURPOSE: Participation in daily life activities across environments is a key element of the International Classification of Functioning, Disability, and Health. Many families of children with special healthcare needs desire meaningful participation; however, goals documented by rehabilitation professionals are not always aligned with goals of the family. To maximize patient outcomes, clinicians collaborate on meaningful goals that span the ICF. The objective of this study was to implement participation-level goals for inpatient and outpatient occupational, physical, and speech therapy services at one pediatric hospital.
DESIGN: This quality improvement study employed a time-series review of electronic medical record charts.
METHOD: We implemented a bundle of interventions tailored to each included department and collected data through monthly chart audits. Using small cycles of change, we addressed barriers for each department and continuously monitored our progress using statistical process control charts. The primary outcome measure for the study was the percentage of charts containing at least one participation-level goal, with a target of 80%.
RESULTS: Following staff education we observed a centerline shift from 32.5% (baseline) to 41.8%. After several months of more targeted intervention, we observed a centerline shift to 81% which was sustained for 10 months.
CONCLUSION: Participation-level goals can be implemented for pediatric occupational physical, and speech therapy services across both inpatient and outpatient departments. Quality improvement interventions should be tailored to meet the specific needs of departments to ensure their application to clinical practice.
IMPACT STATEMENT: Occupational therapy practitioners and other rehabilitation professionals can ensure that their treatments produce outcomes that are likely to be meaningful to families by writing goals that incorporate participation-level components.
References
Angeli, J. M., Harpster, K., Huijs, L., Seid, M., Sheehan, A., & Schwab, S. M. (2019). Patient-centered goal setting in developmental therapy: Discordance between documented goals and caregiver-perceived goals. Pediatric Quality & Safety, 4(4), e199. https://doi.org/10.1097/pq9.0000000000000199
Reedman, S. E., Boyd, R. N., Trost, S. G., Elliott, C., & Sakzewski, L. (2019). Efficacy of participation-focused therapy on performance of physical activity participation goals and habitual physical activity in children with cerebral palsy: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 100(4), 676–686. https://doi.org/10.1016/j.apmr.2018.11.012
World Health Organization. (2001). International Classification of Functioning, Disability and Health: ICF. World Health Organization.
