Implementing Patient-Reported Outcome Measures in Inpatient Rehabilitation: Challenges and Solutions.

A project with the goal of implementing electronic health record (EHR)-based patient-reported outcome measures (PROMs) into a large inpatient spinal cord injury (SCI) rehabilitation program took twice as long as expected. This report details the lessons learned from the barriers, successes, and unexpected issues that arose during this prolonged, but now successful, project. The goals of this implementation project were to (1) identify barriers and supports to the use of PROMs; (2) develop an implementation strategy to incorporate the use of PROMs into inpatient rehabilitation; and (3) implement the strategy and evaluate its effects on team communication. In brief, we conducted an initial pilot phase outside of the EHR and used our findings to guide procedural and EHR incorporation during a demonstration phase. We encountered multiple barriers. Procedural issues were significant; although grant funding covered the cost of writing the code for integration of the PROMs into the EHR, our institution's competing priorities slowed progress. Institutional inertia was reflected in the reluctance of some clinical staff members to assume new duties that would take away from direct patient care responsibilities. Therefore, we needed to obtain additional staffing. Detailed planning upfront, guided by changes when necessary; cooperation and interaction with our institution's Information Systems department; and identification of key players and Implementation Champions proved essential to our success. We now have an up-and-running system and are sharing our experience, observations, and recommendations to assist other health care organizations incorporate PROMs into their EHRs.

Job Accommodations, Return to Work and Job Retention of People with Physical Disabilities: A Systematic Review.

Purpose We aimed to identify job accommodations that help persons with physical disabilities maintain or return to work and explore the barriers and facilitators that influence the provision and reception of job accommodations. Methods We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in PROSPERO (CRD42019129645). The search strategy incorporated keywords describing physical disabilities, employer-approved job accommodations, and employment retention or return to work approaches. We searched MEDLINE, the Cochrane Library, Embase, CINAHL, PsycINFO, Web of Science, and ProQuest Theses and dissertations. Reviewers independently selected studies for inclusion. We used Hawker et al.'s method to assess study quality. Results We identified 2203 articles, of which 52 met inclusion criteria, developed a table of job accommodations commonly used by persons with physical disabilities, summarized the percentages of job accommodations used by persons with disabilities, synthesized evidence of the effectiveness of job accommodations, and identified the factors that influence job accommodation use. The most frequently reported accommodations were as follows: modification of job responsibilities, change of workplace policy, supportive personnel provision, flexible scheduling, and assistive technology. We summarized four types of facilitators and barriers that affect job accommodation use: employee-related factors, accommodation-related factors, job-related factors, and social workplace-related factors. Conclusion The absence of randomized controlled trials and prevalence of cross-sectional surveys provides inconclusive evidence regarding the effectiveness of specific job accommodations for people with particular functional limitations. Our system of categorizing job accommodations provides a guide to investigators seeking to evaluate the effectiveness of job accommodations using experimental methods.