White L, Duncombe A; University of Illinois at Chicago Medical Center, Chicago, IL, USA. duncombe@uic.edu.

PURPOSE: The purpose of this project was to identify a set of outcome measures for orthopedic physical therapy services provided in an outpatient hospital setting. The goal was to use outcome measures that were supported by evidence in peer-reviewed literature and that could be used in an ongoing quality improvement process. FOUNDATION: A systems theory approach was used to assure that the outcome measures identified fit our framework for defining quality. Outcome measures were deemed acceptable if the therapists felt they had utility and they were suitable for data collection and analysis within an overall program evaluation. DESCRIPTION: First, outcome measures with evidence supporting their validity were accepted as the standard measures used in our clinic. Second, the outcome measures were validated for use with our patient population. Third, completed outcome measures were analyzed to determine the magnitude of change on each measure and to determine if the change varied by number of visits, therapist, payer or diagnosis. Effect size (difference between initial and discharge scores) was calculated. Fourth, results were included in semiannual quality review and the conclusions used in quality improvement processes. OBSERVATIONS: Development of templates including the outcome measures facilitated the implementation of standardized examinations. Therapist compliance with evidence based outcome measures was high. Therapists consistently used outcome measures at the beginning of an episode of care and found them useful in initial intervention planning but less useful during ongoing treatment. Forty-two percent of outcome measures completed at the beginning of care were not used at discharge. Results are available from two outcome measures: the Lower Extremity Functional Scale (LEFS), and the Oswestry low back pain questionnaire. For patients using the LEFS, the effect size varied by diagnosis, and was lowest for hip diagnoses and highest for ankle diagnoses. The mean number of visits by payer ranged from HMO=8.1 to self-pay=11.8, although a few patients had a significantly higher number of visits. For patients using the Oswestry, the mean number of visits by payer ranged from HMO=5.4 to Medicare=11.2. For both outcome measures the effect size varied by payer. CONCLUSIONS: Use of standardized, evidence based outcome measures helped therapists to identify individual patients’ functional limitations. Neither the average number of visits nor effect size varied by therapist. A decision was made to review all patients being seen for more than 15 visits, regardless of diagnosis. A plan to facilitate completion of discharge outcome measures is needed. FUNDING SOURCE: None.

Copyright 2004 by the American Physical Therapy Association

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