Implementing SCI-QOL into Clinical Practice to Enhance Patient Engagement

Standard measures of health and function provide the foundation upon which rehabilitation clinicians make sound clinical decisions, provide high quality of care, and determine therapy effectiveness. Patient‐reported outcome (PRO) measures are an important adjunct because they reflect patients’ experience; clinician knowledge of patients’ experience allows them to address issues of greatest patient concern. The Patient Reported Outcomes Measurement Information System (PROMIS) represents the state‐of‐the‐science in health outcome measurement; it was developed for general population use and assesses physical, emotional, and social aspects of quality of life. The Spinal Cord Injury Quality of Life measurement system (SCI‐QOL) customizes PROMIS for persons with SCI. This measurement system is suited ideally to inform clinicians about patient progress during SCI rehabilitation. It assesses the consequences of SCI from patients’ perspectives. SCI‐QOL allows clinicians to monitor progress and communicate with patients and families. It is composed of 22 instruments in 3 domains: Physical and medical health, emotional health, and social health. Patients can complete SCIQOL item banks using paper short forms or computer adaptive testing, reducing patient burden. Several barriers interfere with PRO use in SCI rehabilitation such as competing time commitments, no access to these measures, and limited knowledge to select instruments and use the findings. Clinicians’ knowledge gaps limit practice change and their ability to evaluate rehabilitation effectiveness from patients’ perspectives. Structural barriers in rehabilitation facilities may impede the adoption and sustained use of standardized PROs. For example, facilities may not provide access to PRO or use electronic medical records that do not facilitate PRO collection and reporting. This proposal adopts implementation science methods to evaluate the effectiveness of knowledge translation strategies to select, integrate, and use SCI‐QOL measures in clinical decision‐making. The aims are to: 1. Identify barriers and supports to the use of SCI‐QOL measures and identify strategies to reduce barriers during inpatient rehabilitation, 2. Develop an implementation strategy designed to facilitate the adoption and sustained use of SCI‐QOL measures during inpatient rehabilitation, and 3. Implement an intervention to support routine collection of SCI‐QOL measures, evaluate their use on patient activation and team communication, assess sustainability, and determine generalizability of the intervention to other spinal cord injury rehabilitation providers. Clinical