OUTCOME MEASURES FOR REHABILITATION

1
OUTCOME MEASURES FOR REHABILITATION

• Brian Petheram
• Pam Enderby
• Alex John

2
BACKGROUND

• new methods of audit and resource allocation
  introduced into NHS
• originally purchaser/provider
• now evidence based medicine
• evaluation based on outcome measures
• Concern that rehabilitation professions will not
  be able to compete in this environment

3
OUTCOMES PROJECT

• AIM
• to develop a system that will enable
  rehabilitation services to justify an appropriate
  allocation of resources
• ACTORS
• Department of Health (sponsors)
• Rehab services - managers and clinicians
• healthcare commissioners (RHA)
• research team
• METHODS
• SSM
• Data Analysis
• medical science approaches

4
KEY ISSUES

• Fear that an activity will only be funded if it
  is measured
• much rehab is inherently problematic to measure
• concern that assessment will take time from
  treatment
• any measures used need to be credible/legitimate
  to all parties
• wide range of cultures involved
• high standard of evidence demanded in healthcare

5
INFORMATION SYSTEM

• Evolved into an Access database
• Relatively simple data structure
• demographic data
• resource data
• treatment data (outcome measures)
• Complex reporting needs
• different professions
• multiple aetiologies
• multiple disorders
• variations in practice between services
• emergent requirements

6
OUTCOME MEASURES

• Based on WHO categories
• impairment
• disability (activity)
• handicap (participation)
• plus distress/wellbeing (added by PE)
• each measure allocated a 5 point scale
• precise descriptors of condition at each point
• half points to allow for slightly
  better/slightly worse than description (11
  points in all)
• assessment made by clinician with patient and
  carer if possible

7
CREDIBILITYthese measures are merely
subjective - a neurology consultant

• Validity
• face validity
• relevant
• suitable basis for decision making
• content validity
• measures reflected the domains that are claimed
• addressed all necessary factors
• adequately sensitive to change
• Reliability
• inter observer reliability
• intra observer reliability

8
PROJECT STATUS

• System in use in many clinics in UK
• official standard for physiotherapists in Ireland
• interest from many other countries
• May be part of minimum data set in NHS
• Further projects
• benchmarking
• comparability of services is problematic
• identifying and addressing healthcare
  inequalities

9
RELEVANCE TO I.S. DISCIPLINE

• Public policy re accountability of services and
  resource allocation (education law and order)
• Use of IS/IT in audit and governance
• Information, culture, and legitimacy
• Case study of methods in action
• Information system from initial idea to
  widespread use