Measurement of health related quality of life (HRQoL) in a home based community rehabilitation service

[Truncated abstract] Purpose: Outcome measurement informs the development and delivery of rehabilitation services, and provides a means of evaluating the impact of a service on client outcomes. This study explored the use of a Health related quality of life (HRQoL) tool that incorporated all domains of the International Classification of Functioning, Disability and Health (ICF) and provided meaningful data for all stakeholders, as a measure of change associated with participation in a Rehabilitation in the Home (RITH) program, in Monash Health, Victoria. Method: The study had two phases, with each phase having a number of components. In phase 1 A, a qualitative focus group process was used to identify appropriate HRQoOL tools for the RITH service to trial as a team based outcome measure. A participatory process was utilised to select the most appropriate tool for the service, and to promote clinician engagement with the process and use of the selected tool. In phase 1 B, the views of RITH clinicians regarding outcomes measurement were investigated using the Clinicians Readiness for Measuring Outcomes Scale (CreMOS). In phase 2 A, a pilot study was conducted using the selected HRQoL tool (AQoL 4D) to explore change in HRQoL in a cohort of clients admitted to RITH over a six month period. In phase 2 B, additional focus groups were conducted to explore RITH clinicians' experiences of the participatory approach in selecting and implementing the tool and to determine whether RITH clinicians and managers perceived any benefit from the information which the selected tool provided. Finally, in phase 2 C, any changes in the views of RITH clinicians regarding outcome measurement were reviewed using repeat administration of the CreMOS. Results: RITH clinicians who participated in this study had clear opinions about the ideal qualities that an outcome measure should have, namely that it should reflect multidisciplinary team involvement, use simple language, be available in a range of languages, be easy to administer and have demonstrated validity and reliability. Engagement of clinicians in a participatory process to select the most appropriate HRQoL tool for the RITH program did appear to change clinicians' attitudes to outcome measurement, including an improved knowledge in and increased likelihood of selecting, critiquing and using outcome measures to monitor client progress. The AQoL 4D was feasible to use in the RITH clinical setting, but the way in which data gathered from an individual client were integrated into clinical practice (case conference) was variable across the service. During the six month pilot, data were gathered on 109 clients admitted to RITH...