Guiding clinical practice using outcomes data: A how to approach

Guiding clinical practice using outcomes data: A how to approach

Abstracts involve the cerebral cortex. This approach may lead to the identification of high risk populations which can than be targeted for interventi...

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Abstracts involve the cerebral cortex. This approach may lead to the identification of high risk populations which can than be targeted for intervention. Admission urinalysis is a rational and probably cost-effective evaluation tool. On-site Videofluoroscopic Swallow Studies in Rehabilitation M e d i c i n e - - Q u a l i t y Care Issues. Alexanne Kennedy, Erin M. Knoepfel (Allied Services, The John Heinz

Institute of Rehabilitation Medicine, Wilkes-Barre, PA) Videofluoroscopic swallowing studies (VFSS) are an integral part of a competent and successful Dysphagia Rehabilitation program. This presentation describes the quality care and cost effectiveness issues of utilizing an on-site VFS evaluation. A comparison of 40 inpatients who were transferred for off-site swallowing studies and 39 inpatients who were evaluated using on-site videofluoroscopic equipment was completed. Findings revealed a decrease from 7.32 to 1.77 average days a patient waits for their VFSS. Subsequently, aspiration was identified earlier with the expedition of medical and therapeutic (dysphagia) intervention. Additionally, medical and other rehabilitation team members became more actively involved in the overall care of these dysphagia patients. By utilizing on-site VFS procedures, staff time management had improved. On-site VFSS consumed 12.5% of the Speech Language Pathologist's working day versus a range of 29 to 50% for off-site studies. A comparison study revealed improvement in patient attendance for other therapies (Physical Therapy and Occupational Therapy) when utilizing on-site VFSS equipment. Transportation safety, patient transfers, and liability issues were eliminated. On-site VFSS have proven to be 51% more cost-effective to this rehabilitation hospital than off-site VFSS. Structuring a Stroke Education Program Based on Patients' and Families' Perceived Needs. Mary Jean Kotch, Jane Novinger (John Heinz Institute of Rehabilitation Medi-

cine, Wilkes-Barre, PA) In our changing health care system which emphasizes shorter lengths of stay at both acute and rehabilitation facilities, patients who have experienced a stroke and their families are at risk for having knowledge deficits regarding some aspects of the stroke. Both may not fully comprehend the meaning of the event until the return home. A dynamic, interdisciplinary approach to stroke recovery is in place at John Heinz Institute of Rehabilitation Medicine. Key concerns are to support and educate patients and families as they make the transition from an inpatient setting into their home. Features of the Stroke Program include a Stroke Orientation Class presented by the Patient Education Nurse which informs patients/ families about stroke rehabilitation, treatment, recovery,

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stroke warning signs and risk factors. Other major components of the Program are Family Conferences, a follow-up Outpatient Stroke Clinic and a Community Stroke Support Group. To assist in further program development, attendees of the Stroke Orientation Class were surveyed four weeks after the patient's discharge to home. The main goal of this project was to identify, from a patient/family's retrospective view, the topics related to stroke which they now realize they need more information on. The data collected assisted in establishing interdisciplinary education topics for inpatients, outpatients and the community based on patients' and families' perceived needs. Guiding Clinical Practice Using Outcomes Data: A H o w to Approach. Leigh Ann Black, P.T. (NovaCare, Inc., Castle

Rock, CO) Rehabilitation outcomes data--many therapists can rate patients using the Functional Independence Measure (FIM) or other standardized functional status measures; few use the data to guide their daily practice. This paper describes a strategy for using aggregated, facility-based outcomes data to guide clinical decision-making and caseload management decisions. Staff therapists in managed care environments have applied this strategy to successfully advocate for essential therapy services for stroke patients. Case managers have responded positively to reqUests for therapy which were supported by statistical evidence of the benefits of service. Specifically, findings related to length of stay, cost of rehabilitation, placement at discharge and change in functional status after rehabilitation have been used to guide clinical practice as well as successfully advocate for an appropriate course of therapy. During the lecture, case examples will be drawn from the long-term care environment to clarify key points. Learning Objectives Participants attending this lecture will be able to: 1. Explain the significance of outcomes data to staff therapists. 2. Identify FIM variables that are of particular significance to therapists 3. Summarize a strategy for using outcomes data to prioritize treatment interventions and advocate for appropriate patient care Community Re-entry Treatment For the Stroke Patient. Lareen K. Chonzena, M.S., CCC, CCM (Program Director, Learning Services Northern California at Gilroy, GiIroy, CA)

Stroke victims can be well served in a program environment design. An ideal rehabilitation environment would be a program which has varying levels of staff support in which the persons are to reside such as a group living,