Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
Swiss National Association of Occupational Therapy (EVS/ASE), Bern, Switzerland.
BMC Health Serv Res. 2024 Sep 12;24(1):1054. doi: 10.1186/s12913-024-11548-1.
Occupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose.
We conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members.
The screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients' subjective view and their experience with occupational therapy interventions.
All identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.
职业治疗师越来越多地被要求向资助机构展示其干预措施的有效性、适当性和效率。然而，这种做法的程度以及这种做法所处的卫生政策环境在国际上有所不同。本研究旨在确定国际上为此目的使用的哪些质量指标。
我们进行了范围界定审查，将搜索范围仅限于欧洲和英语国家。为了搜索合适的文献，我们使用了来自医学、健康科学和相关领域的专业数据库，包括 CINAHL Complete 和 MEDLINE，以及通过 Google 进行免费的互联网搜索。此外，我们联系了来自几个国家的国家职业治疗师协会，要求获取仅对协会成员开放的搜索范围内找到的文件。
筛选过程确定了来自六个国家背景的 32 项研究和文件。我们确定并描述了过程水平指标、功能结果指标、一个基于个人目标实现的结果指标（目标实现量表，或 GAS），以及 PRO-Ergo，一种患者报告的体验测量（PREM）。在欧洲和英语国家，很少有关于使用质量指标向资助机构展示职业治疗服务的有效性、适当性和效率的信息是公开可用的。确定的过程指标在大多数情况下并非特定于职业治疗干预措施。功能结果指标高度针对特定的客户群体或健康状况，部分适用于职业治疗。发现 GAS 是一种高度可定制的测量方法，允许在身体结构和功能水平以及活动和参与水平上进行评估。PRO-Ergo 专注于客户的主观观点及其对职业治疗干预的体验。
所有确定的质量指标都有其优点和缺点。特定于职业治疗的过程水平指标可能是促进最佳实践方法使用的机会。GAS 和 PRO-Ergo 似乎是最通用的评估方法，允许对活动和参与水平进行评估。涵盖广泛客户问题领域的功能结果指标可能对某些实践领域是有用的附加质量指标。
