Web-database “remilelolesione”: a useful tool for sci patients rehabilitation management

Introduction: The current and future climates in health care require increased accountability of the health care organizations for the quality of the care they provide. There is a need for collecting more health care data, for monitoring outcomes over time and for the implementation of modern international classification systems such as the ICF core set for SCI. This report describe the development of a web-based interactive database, called “remielolesione” that was designed to facilitate and to standardize data collection in daily practice as a support for practice development, research and audit projects specifically in the SCI field. This work represents the development of an appropriate, usable tool for data collection on functional outcomes and on ICF Core set for SCI to improve clinical practice. This report will review the planning and funding of the initial start-up as well as the data elements being used in the database. Materials and methods: A multidisciplinary team worked collaboratively to design the database in order to ensure that it incorporated features which made it easy for the end user. The key steps to realize this database were: 1. A systematic literature review about the validated outcome measures in SCI patients. 2. A review of the most important International Spinal Cord Data Sets. 3. A review of Italian and International guidelines for SCI. 4. A review of the studies about ICF Core Set for SCI. 5. A discussion with the components of the multidisciplinary team about the best outcome measures and the evaluation items that describe at best the SCI patients rehabilitation process. Results: The web-database “remielolesione” is made up of 6 different sessions: recovery menagement, ICF management, report, project management, login management and benchmarking. Project management and benchmarking sessions have not yet been realized at the present. Recovery management session is made up of 7 different evaluation form: admittance form, clinical form, anamnestic form, nurse’s form, physiotherapist’s form, occupational therapist’s form, social form and discharge form. ICF management session is made up of 2 other different sub-sessions: the first about ICF Core set for SCI in early post-acute contest, and the second about ICF Core set for SCI in long-term contest. Each ICF core set is divided into 4 evaluation forms: function, structure, activity and participation and environment. Each member of the multidisciplinary team complete the evaluation form of the recovery management session and of ICF management session relatively to his own specific competences. Discussion: To make this basic data set as useful as possible in a clinical setting, the working group kept the items that cover the most clinically relevant information regarding individuals with SCI. At the present time the web-database “remielolesione” is used by two Spinal Unit (one in Bergamo and one in Milan), we hope to extend soon the use of this tool to other Spinal Unit in order to improve data collection, ICF using, benchmarking and, above all, SCI rehabilitation process. Benchmarking is a useful way to compare outcomes among health care institutions. Future potential for benchmarking outcomes by expansion of the web-database “remielolesione” beyond the current participating sites to the others Spinal Units. The subsequent implementation across the organization involved promoting database, helping practitioners in developing skills to access information and evaluate its use. The development of the database has highlighted that time, the availability of computers in clinical areas and skills development are important consideration when taking forward information technology (IT) initiatives. Conclusions: Web-database “remielolesione” could represent a monitoring system that is sensitive to changes over time in outcomes, provide interpretable data and could result in cost benefits and patient care improvements in organizations.