Transcript AROC Clinical Benchmarking Workshop Review

AROC Clinical Benchmarking
Workshop Review
Craig Evans and Tony Fitzsimons
19th March 2010
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)
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_5
08.pdf)
VA – Amputation Rehabilitation HealthRelated Outcomes and confounders
Post-operative Pain
• Pain Service Availability
Physical Health
• Allied Health availability
Function
Psychological support and Well-being
Patient Satisfaction
Reintegration
Healthcare Utilisation
• Deconditioning / frailty
• Cognition
• Social isolation, psyche service availability and Past Hx
• Adjustment issues
• Alone
• Accommodation suitability, Home mods
• Wound Healing
• Co-morbidities
Current Guideline Outcome
Measures
Post-operative Pain
Physical Health
Function (ADLs and QOL)
• FIM / Discharge FIM
Psychological support and Well-being
Patient Satisfaction
Reintegration
• Discharge Destination
Healthcare Utilisation
• LOS and FIM efficiency
Models of Care
Pre Op / High
Risk Foot
Clinics
Acute
inpatient
Inpatient
Rehab
Highly variable between centres
making benchmarking a difficult task!
Parking /
Transitional
Care
Prosthetic
Management
– inpatient
and
outpatient
Discharge
Model Variation Factors
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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
AROC Data
• Inclusions – full data sets
• Exclusions – Ambulatory, outpatients, mortality
AROC Impairment Codes
Amputation of limb
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5.1 – Single Upper Extremity Above Elbow
5.2 - Single Upper Extremity Below Elbow
5.3 - Single Lower Extremity Above Knee
5.4 - Single Lower Extremity Below Knee
5.5 - Double Lower Extremity Above Knee
5.6 - Double Lower Extremity Above/Below Knee
5.7 - Double Lower Extremity Below Knee
5.8 – Partial Foot Amputation
5.9 – Other Amputation
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
SYNATIX Data Collection Form
Examples of Data Presentation
Hurdles to achieving outcome
benchmarks
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Consequences of prolonged immobility
Presence of medical co-morbidities
Cognitive function
Adjustment issues
Learning capacity
Inappropriate accommodation
Intransigent attitudes
Agreed Stages of Amputee
Management
Pre-op
Immediate
Post
Operative
Pre
Prosthetic
Prosthetic
Follow up
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
New Data Collection
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Date of Surgery
Date ready for casting
Date of first prosthetic fitting – reason for delay
Clinically ready for discharge
Discharge Delay Reason
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Home mods
Equipment
Community support
ACAT / Residential Care availability
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
What does it mean for us?
• Data collection
• What else should we be collecting that could make a
difference or improve our practice?