Lessons from Sweden: next steps after measuring and benchmarking clinical indicators
AROC Clinical Benchmarking Workshop Review
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Transcript of AROC Clinical Benchmarking Workshop Review
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AROC Clinical Benchmarking Workshop Review
Craig Evans and Tony Fitzsimons19th March 2010
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What is AROC?
“Australasian Rehabilitation Outcomes Centre” – University of Wollongong
• Provide a national benchmarking system to improve clinical outcomes
• Collect outcome information - rehab centres across Australia (155) and NZ (12); ~ 1200 amputee rehab episodes
• Annual Reports (The AROC Annual Report: the state of rehabilitation in Australia in 2008 – http://chsd.uow.edu.au/Publications/2009_pubs/son_2008.pdf)
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So what happened at the workshop?
• Greg Bowring – Practice guidelines for amputee management– VA/DoD Clinical Practice guideline for Rehabilitation of
Lower Limb Amputation (http://www.healthquality.va.gov/amputation/amp_sum_508.pdf)
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VA – Amputation Rehabilitation Health-Related Outcomes and confounders
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Current Guideline Outcome Measures
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Models of Care
Highly variable between centres making benchmarking a difficult task!
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Model Variation Factors• Availability of staff /teams• Inpatient rehabilitation admission criteria• Geographic location (metro/regional/remote)• Ability to slot clients into community services• Lack of local specialty expertise• Ability to access funding for home mods• “Parking” patients• Timing of prosthetic clinics and visits• Timing and type of prosthetic intervention.• Ability/funding to access technology to assist in healing, pain management,
& prosthetic phases• Prosthetic funding models• Patient Type changing
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AROC Data
• Inclusions – full data sets• Exclusions – Ambulatory, outpatients, mortality
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AROC Impairment Codes
Amputation of limbo 5.1 – Single Upper Extremity Above Elbowo 5.2 - Single Upper Extremity Below Elbowo 5.3 - Single Lower Extremity Above Kneeo 5.4 - Single Lower Extremity Below Kneeo 5.5 - Double Lower Extremity Above Kneeo 5.6 - Double Lower Extremity Above/Below Kneeo 5.7 - Double Lower Extremity Below Kneeo 5.8 – Partial Foot Amputationo 5.9 – Other Amputation
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AN-SNAP Version 2 Classes
• Amputation of Limb– 2-224 Motor 72-91– 2-225 Motor 14-71*
*Cohort groups too broad. Smaller Cohort groups = smaller samples Functional vs “adequate sample” groups
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SYNATIX Data Collection Form
Examples of Data Presentation
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Hurdles to achieving outcome benchmarks
• Consequences of prolonged immobility• Presence of medical co-morbidities• Cognitive function• Adjustment issues• Learning capacity• Inappropriate accommodation• Intransigent attitudes
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Agreed Stages of Amputee Management
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New AN-SNAP Codes?FIM admission Motor
Count (n) Avg FIM change Avg LOS
14-40 91 23.66 47.96
41-60 242 21.01 41.17
61-71 206 12.63 34.54
72+ 111 5.74 23.74
Ceiling effect in higher FIM scores
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New Data Collection
• Date of Surgery• Date ready for casting• Date of first prosthetic fitting – reason for delay• Clinically ready for discharge• Discharge Delay Reason
• Home mods• Equipment • Community support• ACAT / Residential Care availability
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New Outcome Measures
• Ambulatory Data – FIM not sensitive enough• 6 min walk test• TUG• ?? 10mWT, Amppro, 4SST, K-classification, LCI, mobility aide and
assistance
• Other• Clinical Frailty index• MMSE ? – as a screening tool
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What does it mean for us?
• Data collection
• What else should we be collecting that could make a difference or improve our practice?