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Background: The use of measurement instruments has become a major issue in physical therapy, but their use in daily practice is rare. The aim of this paper is to describe adherence to standardized assessments by physical therapists using a complexity-based model for categorizing rehabilitation (CMCR) at the Clínica Alemana of Santiago, an acute hospital in Chile.Methods: This retrospective cohort study used 145,968 participant records that were stored in the inpatient database between July 2011 and December 2015. Adherence to the CMCR by 31 physical therapists working with intensive care unit (ICU) and non-ICU inpatients was assessed every quarter using the electronic patient records (EPR). This instrument (CMCR) linked clinical functional assessment to the degree of severity, thereby setting a score used to categorize patients as low, medium and high complexity. 96,400 instances of inpatient care where the physician recommended physical therapy were categorized. This was from a total of 145,968 instances of inpatient care recorded throughout the duration of the study (17 quarters). Trends in adherence were analyzed using a Prais-Winsten regression (a first-order autoregressive model). The trends were compared using a repeated measures ANOVA for mixed models with a significance level of 0.05. The use of the CMCR was included as one of the organization's quality indicators associated with the hospital's accreditation processes.Results: Adherence increased by 1.48% every quarter (p = 0.005) for both ICU and non-ICU patients. On average, adherence with ICU patients was 16.98% greater than with non-ICU patients. Although adherence was always greater with ICU patients, the rate of increase with non-ICU patients was significantly greater: 1.62% (p = 0.007) vs. 1.28% (p = 0.003), respectively.Conclusion: The CMCR facilitated adherence to standardized assessments by physical therapists working with ICU and non-ICU inpatients in an acute hospital, while linking this instrument to the organization's quality management process proved to be an effective strategy for the duration of this study (17 quarters). [ABSTRACT FROM AUTHOR]

Background: The project selection process is a crucial step for healthcare organizations at the moment of implementing six sigma programs in both administrative and caring processes. However, six-sigma project selection is often defined as a decision making process with interaction and feedback between criteria; so that it is necessary to explore different methods to help healthcare companies to determine the Six-sigma projects that provide the maximum benefits. This paper describes the application of both ANP (Analytic Network process) and DEMATEL (Decision Making trial and evaluation laboratory)-ANP in a public medical centre to establish the most suitable six sigma project and finally, these methods were compared to evaluate their performance in the decision making process.Methods: ANP and DEMATEL-ANP were used to evaluate 6 six sigma project alternatives under an evaluation model composed by 3 strategies, 4 criteria and 15 sub-criteria. Judgement matrixes were completed by the six sigma team whose participants worked in different departments of the medical centre.Results: The improving of care opportunity in obstetric outpatients was elected as the most suitable six sigma project with a score of 0,117 as contribution to the organization goals. DEMATEL-ANP performed better at decision making process since it reduced the error probability due to interactions and feedback.Conclusions: ANP and DEMATEL-ANP effectively supported six sigma project selection processes, helping to create a complete framework that guarantees the prioritization of projects that provide maximum benefits to healthcare organizations. As DEMATEL- ANP performed better, it should be used by practitioners involved in decisions related to the implementation of six sigma programs in healthcare sector accompanied by the adequate identification of the evaluation criteria that support the decision making model. Thus, this comparative study contributes to choosing more effective approaches in this field. Suggestions of further work are also proposed so that these methods can be applied more adequate in six sigma project selection processes in healthcare. [ABSTRACT FROM AUTHOR]