Using Outcome Measures To Improve ... - Fox Rehabilitation

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SALVADOR BONDOC, OTD, OTR/L, BCPR, CHT Associate Professor of Occupational Therapy, Quinnipiac University Hamden, CT Holly Alexander, OTR/L, CDRS Director, Fox Rehabilitation Driving Program, Fox Rehabilitation Cherry Hill, NJ Valerie Hill, MS, OTR/L Research Occupational Therapist, Neuromotor Recovery & Rehabilitation Laboratory University of Cincinnati at The Drake Center Cincinnati, OH Education Article This CE Article was developed in collaboration with AOTA’s Physical Disabilities Special Interest Section. ABSTRACT Outcome measures represent different things for different fields and areas of practice. In general, we may define outcome measures as a collective term for tools that measure the output of a systematic process related to a goal or aim. In occupational therapy, the intervention process is directed toward “supporting health and participation in life through engagement in occupation” (American Occupational Therapy Association [AOTA], 2008, p. 652). Related to this aim are interconnected domains of health and occupational performance made explicit through the Occupational Therapy Practice Framework: Domain and Process, 2nd Edition (Framework-II; AOTA, 2008). These domains include healthrelated quality of life, participation, performance patterns, performance skills, and client factors. We delineate change in these domains that are a direct result of occupational therapy interventions as clinical outcomes, as opposed to system outcomes that are born out of organizational processes designed to improve quality and efficiency of service delivery (Bondoc & Burkhardt, 2004). In this article, we will focus primarily on the application of clinical outcome measures as an essential component of evidence-based physical rehabilitation practice. LEARNING OBJECTIVES After reading this article, you should be able to: 1. Recognize the significance of outcome measures to physical rehabilitation practice. 2. Select applied outcome measures used in the domain of occupational therapy. Earn .1 AOTA CEU (one NBCOT PDU/one contact hour) See page CE-7 for details. Using Outcome Measures To Improve Occupational Therapy Practice in Physical Rehabilitation JUNE 2011 n OT PRACTICE, 16(11) ARTICLE CODE CEA0611 3. Define general clinometric properties of outcome measures. 4. Identify pragmatic considerations in selecting outcome measures. INTRODUCTION The use of outcome measures has increasingly become a significant part of physical rehabilitation practice. In this era of evidence-based health care, many third-party payers are requiring therapists and facilities to use outcome measures as a criterion for reimbursement or pre-authorization for occupational therapy services. Outcome measures are also used for benchmarking a health care organization’s performance against a standard. That standard may be against one’s own best performance, performance during a point in time (e.g., quarterly performance in the previous year), or the industry’s gold standard. An example of a widely used outcome measure for benchmarking inpatient physical rehabilitation is the Functional Independence Measure (FIM; Wright, 2000). The FIM is an 18-item assessment tool that measures independence in selfcare, sphincter control, mobility, locomotion, communication, and social cognition (Heinemann, Linacre, Wright, Hamilton, & Granger, 1993) and is the basis for the Inpatient Rehabilitation Facility–Patient Assessment Instrument (IRF–PAI; UB Foundation Activities, 2002). Although a global instrument such as the IRF–PAI is well integrated in physical rehabilitation settings, there are inherent limitations to the instrument that may further warrant the use of additional outcome measures. For instance, the IRF–PAI uses FIM scores and other patient variables to categorize a patient into a diagnostic category for the purpose of prospective payment. The FIM as an outcome measure is known to have a ceiling effect or limited sensitivity to change as a client progresses to his or her highest level of function. Finally, the FIM was designed not to be discipline specific and cannot fully capture the direct benefits of occupational therapy intervention. With these limitations in mind, practitioners should consider examining other tests and measures to document outcomes. By knowing the outcomes of occupational therapy, practitioners are able to objectively discern whether interventions are effective for their clients. SELECTING AN OUTCOME MEASURE Selecting the most appropriate outcome measure for incorporation in physical rehabilitation practice is the crucial first step; however, it may be the most daunting. Over the past 2 decades, we have seen exponential growth in the scientific CE-1
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