At CSM 2017, I attended a session and wrote a post called A Neuro Outcome Measures Toolbox. I spoke toward a coming CPG. Lo and behold, it’s here hot off the press!
If you want the background and methods of how this CPG was put together, please see the above first post as I don’t intend to re-hash that.
The purpose of this CPG was to basically consolidate what the EDGE task forces had put together. The EDGE task forces had each taken a common diagnosis treated by physical therapists– stroke, multiple sclerosis, Parkinson disease, traumatic brain injury, spinal cord injury and vestibular dysfunction– and, after synthesizing all the current scientific literature, made recommendations for outcome measures to use with their diagnosis across the continuum of care. Which was great, except they came up with 243 different outcome measures. Who’s got time to learn to use 243 outcome measures? Yeah, no one. So the vision for this CPG was born: just a couple of outcomes to use with every patient in the neuro realm in every setting.
So first, which outcome measures made the cut?
They also made a recommendation that got a little swept aside in the rest. They recommended using a patient goal assessment, such as the Goal Attainment Scale. This type of measure helps to quantify a patient’s goals and expectations and compare those goal states of function to the current functional status. I haven’t used the GAS. I will add that I like using the Patient-specific Functional Scale in this category. It doesn’t seem quite as in depth as the GAS, but it also doesn’t involve doing algebra. (I fear I will never feel confident in my math skills.)
I would also encourage you to look these up at Rehab Measures to get important score interpretation information, like cut off scores, minimal important difference, etc.
So what’s the point? Why should be even bother with doing these outcome measures? I mean, some of them are totally useless in my setting– acute inpatient rehab…. Listen up!
“[Outcome measures] can be used to monitor changes in patient’s status over time, quantify observations and patient-reported function over time, enhance communication between care settings, and increased efficiency of the delivery of patient care. [Outcome measures] can also help managers measure costs, identify ‘at-risk’ patients, enhance reimbursement, and compare outcomes among clinicians and setting. Use of a common set of [outcome measures] promotes best practice by allowing direction comparisons of outcomes associated with different interventions. Widespread adoption of a core set of [outcome measures] across clinical settings would support the Institute of Medicine recommendations, and may enable robust data collection efforts to rapidly advance clinical practice through the development of practice-based evidence.”
What clinician doesn’t want every single bit of that? This one does!
This is a habit level change, which is the hardest kind of change to make. So how do we go about it?
As always, it starts with YOU.
- An individual physical therapist has to make a commitment to themselves and to their patients to go on this journey of process improvement.
- You’ve read this summary, so maybe read the rest of the CPG at the link above.
- Download all the recommended outcome measures above and make sure you understand how to give them by taking a look at the recommended protocols for each listed at the bottom of this CPG summary page from the Academy of Neurologic Physical Therapy.
- Give them! Maybe add one a month or one a quarter until you’ve got a solid system in place.
- If your person can’t do one, like will happen a lot with my people, you can just give them a score of 0 for that test.
- Identify barriers to testing your people at your place.
Here are some implementation recommendations the article authors made:
— make a copy of the CPG and put in an easily accessible place to reference at your work place
— develop a, again, easily accessible location set-up with all the equipment necessary for these tests
— use the outcome measures as a manner to describe patient progress when discussing with other health care professionals on their team
— the forms above should be adapted to your place with specifics about any modifications you must do or location of any equipment, etc
— consider having a training on using the core set outcome measures, how to use the score interpretation information to make clinical decisions and how to discuss outcome measures and how they inform care with patients. This might be appropriate to add into new employee orientation.
— work using the core set into annual performance appraisals to incentivize using them
— add a blank for their scores into your electronic medical record to prompt usage
There is a committee within the Academy that is working on specific tools, methods, etc. for getting these implemented in clinics nationwide. Keep an eye on their website for more information.
This core set isn’t meant to replace the EDGE findings, only be a ‘starting point.’ As described in the CSM 2017 posts, you’d still want to select a diagnosis specific measure as well.
What do ya’ll think? Doable? Beneficial to therapist? To the patient?