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Outcome studies
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Outcome studies - February 7, 2008 11:34:37 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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In my clinic, we use an evaluation and discharge summary to track patient outcomes. This form was copyrighted in 1994 by Patricia D. Lemcke. I can't find a reference for this form (as far as a validation study, etc). Has anyone ever used it or heard of Patricia Lemcke?
Form is set up with a 5x4 box with the side markers being Functional Limitations, AROM, Strength and Pain. Across the top is "None", "Mild", "Moderate", and "Severe". Where they intersect is some subjective discriptor.
Anyway, the problem is when the "boss" runs the survey results, it is showing that our patients have only improved by an average of 55-60 percent. If he uses this for marketing, it is no good. I am just checking the validity of the outcome tool and the minimum clinical significant change.
Any help?
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RE: Outcome studies - February 7, 2008 2:04:36 PM
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Shill
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Joined: February 13, 2003
From: Madison WI USA
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I think the reason these numbers might sound bad is that you might be assuming they are starting at zero. A 55% improvement is actually quite nice, if someone reports a beginning functional level of 45% as compared to what is normal for them. Starting percentage would need to be formulated as well. Still, this can be a bit ambiguous. I could not find any info on the name Patricia Lemcke on Pub med, or even google.
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RE: Outcome studies - February 7, 2008 2:40:25 PM
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TexasOrtho
Posts: 540
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I also couldn't find this outcome study, but agree with Shill. 50-60% may be pretty significant but it depends what the baseline measure was. I can't think your boss is very bright if he/she measures quality or markets this way. How about using some of the clinical standards of functional progress like the DASH, Oswestry, NDI, etc...?
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: Outcome studies - February 7, 2008 11:30:36 PM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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We use the ODI, NDI, SPADI, etc. We are just starting to get the results from these outcome studies as it has just become commonplace for everyone to use them here. He wants something to show to docs that will be quick and to the point. I did all of the searching I could do on pubmed, medline, google, etc and I can't come up with the study or background info on this "outcome measure". My idea was to do away with this "phantom outcome tool" and go with the standards, but then he's worried about comparing to "x" clinic.
I have found that marketing is a sore spot with this facility. They have been in the area for 10 years and no marketing plan has ever been done (AKAIK). Right across the street is a POPT practice that is running spots on the radio, tv, etc. For some reason, the hospital is afraid to market to patients, the powers that be want to focus on the docs. I guess they forget that Ohio had Direct Access. No one even knows what it is around here. It think it is our (PT's) responsibility to educate the masses when it comes to their choice.
Definitely a reason why a director of a PT clinic should have some PT clinical experience.
< Message edited by ysumpt2006 -- February 7, 2008 11:33:26 PM >
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RE: Outcome studies - February 8, 2008 11:20:35 AM
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Shill
Posts: 1092
Joined: February 13, 2003
From: Madison WI USA
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We use something called Care Connections, which used to be known as Therapeutic Associates Outcomes System (TAOS). I am not a huge fan of it, as some of the ways the questions are worded could be improved. However, what you get with this system is a comparison of your clinic to all other facilities who use it (as a whole) in terms of outcomes. It helps show if you are above or below these other facilities, which COULD end up working in your favor.
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RE: Outcome studies - February 10, 2008 1:25:07 PM
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SJBird55
Posts: 2430
Joined: May 10, 2004
From: Michigan
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ysumpt... I'm not sure what you mean by "improved 50-60%." Typically, results will be reported as a change in score and then it is important to know the minimal clinical important difference. If you believe that the original tool you mention is not capturing change that may simply be due to the fact that it is a "general" outcome tool. The more general the tool (meaning use it on every patient for any condition) the less responsive it will be in capturing change for particular conditions. The condition specific tools you mention above will be more responsive for the specific situations in which they should be used.
You hit the nail on the head... we are going to have a huge problem in outcomes. Everyone is going to be scared to compare their outcomes to company XYZ... which means there are going to be companies out there that skew their reporting or skew their results or cherry pick the patients they do report. There is no standardization for reporting outcomes... hardly anyone is doing it... no standardized tools are used (which I don't believe should be the case because there should be flexibility for measuring change in condition)... but we have huge issues on the horizon in this area. As we really move forward and begin to use this type of information to compete (especially in direct access situations), I can forsee major problems. Marketing doesn't allow for explaining how we achieved/acquired the outcomes statistically.
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RE: Outcome studies - February 10, 2008 1:38:57 PM
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blast7
Posts: 114
Joined: July 28, 2005
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quote:
ORIGINAL: SJBird55
You hit the nail on the head... we are going to have a huge problem in outcomes. Everyone is going to be scared to compare their outcomes to company XYZ... which means there are going to be companies out there that skew their reporting or skew their results or cherry pick the patients they do report.
I think the important point is that you are at least trying to track outcomes. This is a quality assurance program that patients should appreciate. If it gets to a point where there is comparison between clinics then that is can be solved as well. For example, we have local hospitals who compete and will say they have better outcomes compared to the larger hospital. However, the larger hospital supports their lower outcomes d/t their sicker and more complex patient population.
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RE: Outcome studies - February 10, 2008 8:06:38 PM
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SJBird55
Posts: 2430
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From: Michigan
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And blast... put yourself into the shoes of a prospective customer. How will a prospective customer decide which hospital or which provider is THE provider to choose for his/her particular circumstance? I doubt if we'll ever be on a perfect apple to apple comparison all across the board, so inherently, the prospective customers will need to be savvy in their ability to choose. Should we as a profession put a prospective customer in that position?
There will be risk-adjusted outcomes and outcomes not risk-adjusted. There will be some companies reporting outcomes, but in the language of outcome studies, truly having low completion rates (and obviously not reporting the completion rate). Low completion rates could indicate cherry picking. Some organizations will choose to utilize general, broad outcome tools... others may choose to not use valid and reliable tools.... others may choose to use tools created by electronic outcome vendors in which the scores can't be easily interpreted... some organizations may choose to create a mixed report of a self-report tool with say a functional assessment. How can comparisons be made with such variability?
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RE: Outcome studies - February 11, 2008 12:07:58 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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SJ, the "improvement" percentage that I speak of is in this particular tool (which I can not find any research as to the development of the tool), which is used for any diagnosis, the rating is 1-4 (with 4 being highest category). If a person scored a 2, then a 4 on a question, it is tallied as a 50 percent improvement/change. Of course the different categories are: Pain, ROM, Strength, Function and are scored according to the following percentages: >95%, 75-95%, 50-75% and <50%.
From my above example, an improvement from a 2 to a 4 would rate as a 50% improvement, even though in reality is significantly better. Like I said, I can't find the research that indicates this "outcome tool" is even valid.
I'm tired, not sure if this post even makes sense.
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