Large Scale Implementation of a Core Set of Outcome Measures is Possible

Abstract

<h3>Research Objectives</h3> To implement a core set of standardized tests to: 1) measure individual patient outcomes, 2) aggregate data for analysis, and 3) build the foundation for practice-based evidence study. <h3>Design</h3> Stakeholders from physical (PT) and occupational (OT) therapy determined important constructs to measure and identified tests through evidence review. A set of tests was piloted in 6 facilities and modified secondary to feasibility constraints. The final set was: Short Physical Performance Battery (SPPB), 6-minute Walk Test (6MWT), grip strength (Grip), and the Continuity Assessment Record Evaluation (CARE) mobility and self-care item set. The St. Louis Mental Status Examination (SLUMS) was implemented to stratify patients. A data pipeline was established through electronic health record (EHR) customization, extraction and transformation rules, data warehouse creation, and dashboard visualization using PowerBI (TM) software. <h3>Setting</h3> Infinity Rehab is a post-acute therapy provider. This project was initially implemented in 180 skilled nursing facilities (SNF) treating approximately 15000 patients/year. <h3>Participants</h3> 480 PT and 279 OT clinicians completed the initial web-based training over 4-months. A new-hire process was developed to ensure ongoing training. <h3>Interventions</h3> Clinical knowledge tools were developed: guides for set-up, best practices, interpretive comments, data sheets, support for goal writing, fact sheets, frequently asked questions, chart audits, and adherence reporting. Operational and clinical incentives were aligned, and company leaders engaged in an enthusiasm campaign. <h3>Main Outcome Measures</h3> Clinician grouped adherence to each required outcome measure. <h3>Results</h3> Initial adherence was 38.3%, 28.4%, and 51.7% for SPPB, 6MWT, and Grip respectively. (Reporting for SLUMS and CARE was not available). Adherence improved over the following 11 months and stabilized at 70% (SPPB), 60% (6MWT), and 80% (Grip). Adherence targets were established at 70% for SPPB and 6MWT and 80% for Grip. These targets are now a routine operational metric. <h3>Conclusions</h3> It is possible to implement and sustain collection of a core set of standardized tests on a large scale. Currently, data are used for the first 2 stated objectives with plans for the 3rd. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.