Recap from APTA CSM 2015: The Power of Data: Achieving Consistent Health Outcomes
Dianne Jewell, DPT, PhD
Heather Smith, PT, MPH
Mary Stilphen, DPT
Outcomes were a hot topic at APTA CSM 2015, and not surprisingly as CMS just announced that by 2018 50% of Medicaid payments would be through new value-based payment outcomes with value defined as the relationship between outcomes and costs.
This session presented a basic primer on outcomes, how to evaluate them, and the differences between functional and patient-reported outcomes before jumping into the meat of the topic, presented as a case study of some interesting new work done at The Cleveland Clinic to drive better decision making in post-acute care.
Embarking on a new model is not for the faint of heart and the case study outlined in this session is still under-development and refinement even though the journey was started in 2010 with a definition of which outcomes they wanted to collect.
To explain this, presenters quoted Eleanor Roosevelt:
“Each time you learn something new you have to adjust the whole framework of your knowledge”
For The Cleveland Clinic, Step 1 back in 2010 was to implement an EMR so that consistent data could be tracked for every patient visit, and then start to use this data to effect care, with the main goal to make better decisions about appropriate discharge from acute care.
In order to collect data consistently however, they had to define a tool, and wanted to ensure that it was not cumbersome. They modified Boston University’s 24 question “Activity Measure for Post Acute Care” or “AMPAC” to a shorter survey they named“6 Clicks” to represent the number of mouse clicks to complete the survey. While acronyms are often all the rage in research studies, a catchy and evocative name is better if you want someone to actually use something, and “6 Clicks” definitely fit the bill.
The goal of completing the “6 Clicks” survey was to measure longitudinally across patient care and eventually be able to predict the best discharge setting based on this information. The ultimate goal was to improve outcomes without increasing costs and the flip-side decrease costs without impacting outcomes.
The 6-Clicks consists of 12 questions, 6 each for PT and OT accessment. For PT the questions are related to Mobility and for OT to Self-Care. The ultimate use of the data is to ensure the best care for the patient and the optimal use of resources within the hospital.
The 6-Clicks tool raised the visibility of the physical therapists within the hospital as they were able to make the best recommendations for patient discharge setting based on analyzing the data, and the data-driven approach gave all staff a way to talk about these decisions. Prior to using the tool, it wasn’t clear whether in-patient physical therapists were spending time with the right patients or whether the patient would thrive in the discharge setting.
Based on the patient’s 6-Clicks score they could determine whether to discharge to home with no services, with services, to skilled nursing facility, or to long-term care facility. 6-Clicks could also be used to determine the appropriate in-hospital care based on eventual discharge. For example, if a patient was predicted to be best discharged to home with no services, the in-patient physical therapists would focus on mobility and self-care to make sure the patient was self-sufficient on discharge.
As The Cleveland Clinic continues on this outcome journey, which has been rolled out across all of their hospital locations, the next step is to provide outcome analysis for the continuum of care: that is what happens when patients are discharged to these different settings. To do this they will repeat 6-Clicks on each care transition and continue to amass and analyze data. Other extensions will be adding additional outcome measures based on patient issues, and potentially beginning to communicate this data back to patients.
For those daunted by this impressive but long journey, presenter Mary Stilphen offered a few tips to get started on an outcomes journey:
- Rally stakeholders
- Determine what you want to measure
- Understand what change you want to effect
- Choose your instruments
- Collect data
- Share and socialize data
And we would add, keep it simple as evidenced by the thinking behind the 6-Clicks tool.
If you’d like to read more about the 6-Clicks Tool, there’s a great description in this publication.