Unicare aces at documenting rehabilitation results

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Unicare offers specialist health services in interdisciplinary specialized rehabilitation, in addition to treatment in the field of substance abuse and addiction. The health trust's services are rooted in knowledge-based practice, and it is important for them to document how patients feel before, during and after the rehabilitation process. For a large health trust with nine units, there was a clear need to leave cumbersome manual measure processes behind. In addition, reducing the risk margins of errors related to manual transfer from paper to a journal system was of particular importance.

It required a lot of resources for nine clinics to send measure by mail, and to have all patients fill them out manually. Unicare did not always receive the measure forms in return and constantly had to remind patients to return them. The data was fragmented, and the answers had to be inserted into other computer systems manually.

In order to compile data from nine units to ensure adequate documentation, and to provide the best treatment, it was necessary to procure an integrated solution. In addition to retrieving information about the patients, Unicare wanted to extract data that met the national requirements for quality measurement in patient-reported data.

Unicare

Established in 2008, Unicare is one of Norway's largest private health enterprises that provides specialist health services in interdisciplinary specialized rehabilitation, in addition to treatment in substance abuse & addiction.

For municipalities, they provide services within habilitation and assistance in the areas of round-the-clock housing, day centers, respite care, and user-controlled personal assistance

Unicare.no

They found their solution with CheckWare

By using CheckWare, the previous time-consuming manual processes for retrieving patient-reported data were replaced with a digital process, in which patients themselves reported directly into the solution. This enabled obtaining information about the patient before the first appointment with a clinician and gave Unicare the opportunity to compile data to measure post-treatment changes over time. The results could thus be used to improve treatment for patients across the units.

In addition to collecting patient-reported data, Unicare uses CheckWare to allocate information material to its patients to make them feel safe in their own state of health. CheckWare is also used in research projects to strengthen the knowledge base.

- We save resources with shorter administration time, more time allocated to treatment and better access to the information.

Harald Kåre Engan

Senior researcher and RD manager, Unicare

The data can be used for national research

- We wanted to use a computer system that provided an overview and enabled us to provide the best possible health care. We were looking for a digital tool that would be easily accessible to clinicians and at the same time easy for patients to access and report in. We found this tool with CheckWare, says senior researcher and Research and Development manager, Harald Engan, at Unicare.

The data collected through CheckWare can be reported to the Norwegian national quality registers, as well as being used in a research context.

- Primarily, our need was to gain a good clinical decision-supporting tool. At the same time, there are many gaps in the knowledge base in the sector, and the data we collect here will be of great value in answering the right research questions together with several of our national and international research partners, he explains.

Hence, Unicare has added consent forms to the patients, so that the information can be used for research purposes.

- We want to promote knowledge for the benefit of the patient and the health service, and we have the advantage of collaborating with several other institutions, such as Norwegian and foreign universities, municipalities, and research institutes. We can carry out research projects based on the quantity and quality of patient data we collect using CheckWare. We can connect this data to other national registers, such as the cancer register and the social security register. This gives us a great potential for investigating the effects of rehabilitation and conditions that affect the health of many patient groups, Engan explains.

Fever errors, better information and efficient solutions

Unicare was established in 2008 and is one of Norway's largest private health trusts with 1,200 employees. In addition to providing specialist health services, Unicare also have agreements with several Norwegian municipalities.

Through these agreements, Unicare provides services within habilitation and assistance in the areas of round-the-clock housing, day centers, respite care, and user-controlled personal assistants. According to Engan, quality deliveries to patients and users are constantly in focus:

- Our knowledge-based services are based on research-based results, clinical experiences and feedback from our patients and users.

Unicare's use of CheckWare

Customer since 2019.

Approximately 91,500 surveys through CheckWare distributed among approximately 7,000 patients in 2020.

Collection of patient-reported data to ensure quality and make the patient safer in treatment.

Allocation of information and information material to patients.

Integration with Extensor.

Unicare has been a CheckWare-customer since 2019. To this date, 12,000 Unicare patients have submitted more than 200,000 measures through CheckWare. About 45,000 of these measures have been completed so far in 2021. For the private health trust, the main goal has been to streamline the patient-related work, but at the same time increase the quality and reduce the margin of error in the information collected.

- Healthcare professionals appreciate seamless integration with other computer systems, and not having to spend so much time entering patient information and looking up medical records. It is all about having access to the correct information in a secure way at the right time. We save resources with shorter administration time, more time allocated to treatment and better access to the information, he says and believes that CheckWare's solution meets what Unicare has demanded from a digital solution.

The time spent registering patients has been reduced from 21 minutes using pen and paper, to 9 minutes with CheckWare’s digital solution. This corresponds to a time saving of 57.4 percent per registration.

- CheckWare's solutions are in accordance with our needs. The digital solution makes correct and useful information easily accessible to healthcare professionals, and we avoid binders and paper-based measures. Before, obtaining this patient information could involve a lot of work and logistics. Now, with the digital solution, this work has been significantly reduced.

l have a clear impression that healthcare professionals see the benefit of having information about the patient easily accessible and having more time freed up for patient work. Then it is also more motivating to use the system, he says.

Harald Kåre Engan

Senior researcher and RD manager, Unicare

Improved quality of life

A scientific study published in the renowned journal of Disability and Rehabilitation by Engan and co-authors at the current Unicare Røros, shows that 78% percent of their patients would choose a digital treatment method rather than a manual one using pen and paper. The study also showed that the digital solution led to fewer incorrect answers and a significant reduction in administration costs.

- We introduced CheckWare at a favorable time. People have become accustomed to digital services through online banking, the welfare system and Norwegian health services, and most people know how to handle a PC or smartphone. Patients nowadays will start wondering if they receive a pile of measures in the mail. Today, computer technology is considered a safe and secure way to communicate personal information.

Unicares results using CheckWare

Administrative costs related to working hours and consumables reduced by 60%.

Time savings on patient registration: From 21 minutes using pen and paper, to 9 minutes digitally. This corresponds to a time saving of 57.4% per registration.

Response rate from patients of over 90% at treatment start-up.

1. Engan HK, Hilmarsen C, Sittlinger S, Sandmael JA, Skanke F, Oldervoll LM. Are web-based questionnaires accepted in patients attending rehabilitation? Disabil Rehabil. Dec 2016;38(24):2406-12. doi:10.3109/09638288.2015.1129449

That's what Ingeborg Landstad at Unicare Friskvern says. She is a trained physiotherapist and has been given a special role in the implementation of CheckWare. Among other things, she has created a manual for her colleagues and assists with the introduction and operation of the system.

- I think the system works well, but that is because I use it all the time. It is such a large computer system that I have had to teach myself in order to help others to understand. There were several questions from the users in the start-up phase, but now I think it is going very well, she says.

She highlights one of the benefits of CheckWare's solution in particular.

- Patients are different, and they react differently to tasks they are given in connection with their treatment. We need to be aware of this, and we conduct evaluations quite often. Regardless, the information and measures we send digitally is a good start on a good dialogue with patient participation, where patients are seen and heard. If a problem is complex, we can capture it using measures that focus on physical and mental health in different ways, Landstad says.

Ingeborg Landstad believes that the very best thing about the system is the easy integration and access to the patient’s medical record. It gives clinicians a common starting point for a good conversation during the treatment, and not least at the end of the treatment.

CheckWare provides the ability to extract data and statistical overviews of patients' response at the start and end of rehabilitation:

- Figures from our measures show that patients on average increases between 5-10 points on EQ-5D-5L, which is a measure for self-reported health. The scale ranges from 0-100, so this is a good progress based on what is realistic in the relatively short period the patients are with us in rehabilitation.

- All patients are asked about their quality of life, regardless of the diagnosis. It is nice to see that the score improves along the way. It is also motivating for employees and clinicians to be able to see the effects on a group-level, and that the figures show that the rehabilitation leads to a meaningful and positive change, she says and continues:

- The patients understand how important this is for them in order to receive the best possible treatment. They feel seen and taken care of, and we get the opportunity to conduct a thorough process with measures. Not least, CheckWare's solution is an educational tool used in the closing appointment with the patient where we see if the score increased or decreased. It is not certain that the pain has changed, but the quality of life and some daily functions may have improved during the treatment, she says.

- Today, computer technology is considered a safe and secure way to communicate personal information.

Ingeborg Landstad

Physiotherapist and R&D coordinator, Unicare

Good cooperation and further development with CheckWare

The response rate from patients at the start of treatment is over 90 percent! Both Engan and Landstad, who both work with research and development, think this rate is very good.

- The system we have now established with digital measures have great potential in research. As a research institution and a significant contributor within rehabilitation, we can take advantage of the economies of scale we have by collecting data from all our nine rehabilitation institutions. We want to use the digital solutions in specific research projects to evaluate the rehabilitation services and promote new knowledge in an important area. We want to carry out measures during the rehabilitation, and also examine the development over time. However, it is a challenge to obtain good enough data in the time after the end of rehabilitation to find out whether the rehabilitation has had a lasting effect. It requires solid communication, and we want to look at solutions on how this data collection can be strengthened together with CheckWare, says Harald Engan.

Both Engan and Landstad believe that the overall impression of CheckWare is very good.

- We get easy access to very important patient information that we can use to conduct good management and use further in research contexts. Rights to validated questionnaires are in place, there is a short way to support, and we receive assistance if we are to tailor additional forms for our own purposes.

Unicare's use of CheckWare

Data export:

Raw data export

Integrations:

Partner API: Extensor
Data extraction module

Content distribution:

Content packages

Assessments:

Treatment roles
Assessments
Plans
Clinical reports
Assessment store

Authentication:

Log-in methods

System management:

System settings
Access control
System log
System reports
Respondent management
Clinician management
Card & tile configuration