Standardised Assessment and Reporting System for functioning information (StARS) - Erarbeitung einer Implementierungsagenda für ausgewählte Anwendungsbereiche im Schweizer Gesundheitssystem

Background: Functioning is, in addition to mortality and morbidity, one of the most important health indicators. Health indicators are important across all levels of the healthcare system: For clinical patient management on the micro level, for performance measurement and comparisons of clinics on the meso level, as well as for cantonal and national planning on the macro level. In particular in the field of rehabilitation, the focus lies on optimizing a person's functioning. However, the assessment and reporting of functioning information in practice is often not standardized and there exists a large variety of related clinical assessment instruments. This makes comparability and learning from functioning information in terms of continuous improvement at all levels of the health system difficult. Therefore, the aim of the NRP74 StARS project was the development of a Standardized Assessment and Reporting System (StARS) for functioning information in order to support targeted and high-quality rehabilitation. The project dealt with two application examples of a StARS: Part A) The Swiss national quality reports of the ANQ (National Association for Quality Development) in rehabilitation, Part B) Clinical decision-making in rehabilitation after spinal cord injury. In order to develop strategies together with relevant stakeholders on how a StARS can be implemented in the two application examples, a stakeholder dialogue including a stakeholder brief was carried out as part of the NRP74 StARS project implementation strategy.

Methods:  To inform stakeholders about a StARS for functioning information, a stakeholder brief, a short preparatory document, was developed and distributed amongst the participants of the stakeholder dialogue prior to the event. The stakeholder brief was designed to inform about the project, its findings and application areas in a user-friendly language. The stakeholder brief included SWOT (Strengths-Weaknesses-Opportunities-Threats) analyses for four application areas of a StARS in Switzerland and was developed based on nine key informant interviews. The stakeholder dialogue was designed to inform relevant stakeholders about the NRP74 StARS project and to mutually discuss and develop strategies for implementing a StARS for functioning information in different application areas in Switzerland. The stakeholders who participated in the one-day dialogue were identified in consultation with the project's advisory board. Both, the stakeholder brief and the stakeholder dialogue, were evaluated by the participating stakeholders through an anonymous online survey.

Results: Twenty-four stakeholders participated at the NFP74 StARS stakeholder dialogue in November 2019. The participating stakeholders represented the federal offices of public health and statistics, health care departments of cantons, patients, rehabilitation clinics and health professionals, quality organizations, financing institutions, rehabilitation asso-ciations and research. The output of the stakeholder brief and stakeholder dialogue was an implementation agenda in which the stakeholders decided on the next steps for implementing the developed StARS, including three main points: i) The preparation of a final project report for the ANQ about the application of a StARS for functioning information with regards to all ANQ rehabilitation areas; ii) The clarification of financial possibilities in connection with the new national quality commission and the related new quality contracts; iii) the creation of a StARS consortium for further cooperation and exchange of the stakeholders. The online evaluation revealed that the stakeholders were satisfied with the brief and their involvement in the dialogue and that the related objectives were met.

Conclusion: The NRP74 StARS stakeholder dialog, including the stakeholder brief as preparatory document, supported the development of strategies in the form of an implementation agenda together with relevant stakeholders for a possible implementation of a StARS for functioning in the four application areas in Switzerland. The participating stakeholders highly valued the opportunity for exchange and discussion with the other stakeholders and the research team and described the dialogue as meaningful, stimulating and interesting.