Criteria for evaluating the quality of medical rehabilitation and medical and social assessment in healthcare organizations

Abstract

Abstract.

Objectives. To justify and develop criteria for assessing the quality of medical and social expertise and medical rehabilitation using the expert assessment method.

Material and methods. The study was conducted using the Delphi method. The expert group consisted of 16 specialists with higher medical education, at least 10 years of work experience in the field of medical and social expertise or medical rehabilitation, and experience in the organization, implementation and quality assessment of relevant areas of medical activity. The expert assessment covered 23 areas (10 in MSEs and 13 in MRs), each of which was analyzed along two axes: significance and applicability. The survey was conducted remotely with the 100% response rate. Statistical processing of the results included the calculation of median values, rank positions, and criteria for consistency of opinions (χ², Wilcoxon’s z-test, ICC).

Results. Based on the assessment results, the list of priority areas was formed and detailed criteria for assessing the quality of MSEs and MRs were developed. The most significant problems in the field of MSEs were identified as: compliance with the examination procedure, legal justification of decisions, staffing, quality of documentation, and objectivity in assessing persistent functional disorders. In the field of MR, the leading positions were taken by the compliance with the procedure for conducting rehabilitation, routing, assessment of violations on scales, compliance with the clinical and functional diagnosis, and the effectiveness of programs. The developed criteria (structural, procedural, and performance) were tested in healthcare institutions and showed high applicability of assessments. The final list is included in Resolution No. 13 of the Ministry of Health of the Republic of Belarus dated 23 January 2023 «On the assessment of the quality of medical care and medical examinations, and the examination of the quality of medical care».

Conclusions. The developed criteria for assessing the quality of medical rehabilitation and medical and social expertise ensure the objectification of key areas of MR and MSE quality, the identification of systemic problems and the formation of an evidence base for management decisions. The use of the proposed quality assessment criteria will improve the effectiveness of MR and MSEs, minimize errors and strengthen the healthcare system’s focus on clinical effectiveness and a patient-centered approach.