This book has two main goals:
Goal 1: To Introduce Readers to the Terminology and Processes of Outcome Measurement
This first goal may seem straightforward enough. At the time I began this project (mid-1990s), there were very few books that addressed outcome measurement in rehabilitation. In fact, most of the literature available was, and continues to be, in the domains of medicine, nursing, and quality assurance. Pulling definitions together, finding threads to tie processes together, and finding links to the educational and experiential backgrounds of physical therapists have and continue to be an iterative process of new discovery, reorganization, and refinement.
This book does not purport to be an exhaustive review of the literature. Rather, it uses literature to credit ideas, provide examples, and demonstrate the range of strategies available to address outcome measurement processes. I have tried to pick examples from the literature that illustrate ideas and that also represent the wide variety of practice venues of physical therapists.
Many of the ideas and suggestions provided in this book are my own, having evolved from conducting outcome studies and teaching courses on outcome measurement. I have had the privilege of teaching these courses to professional and post-professional physical therapy students. Many explanations that have been included are there because students needed “dots” to be explained or “dots” to be connected. I am grateful to the many students who have asked questions and shared their confusions, as they have helped to ground the application of information in practical terms.
I have also learned that while the academic community is immersed in such frameworks and terminology as disablement models, evidence-based practice, and measurable outcomes, there are many practicing clinicians who have not applied or observed these frameworks or terms in their daily clinical practice. Recognizing the categories of a disablement model appears to be a different skill than categorizing examination measures according to that model or using the model to create hypotheses about patient care. Consequently, I have included chapters about service delivery models, disablement models, and statistics. Academic programs teach this content in greater depth, so current students and recent graduates may not need these chapters. They have been included to help those practicing clinicians who have not had the same academic exposure and to enable clinicians from other professions to use that information.
Goal 2: To Provide Clinicians with Strategies for Using Their Own Documentation to Evaluate Their Practice Patterns or Effectiveness Retrospectively
This second goal was the harder of the two to address, and I am hopeful that Part 2 of this book successfully delivers on the goal. Outcome measurement/management is the convergence of two traditional curricular tracks found in most professional PT programs: the scientific inquiry/research track and the administration/health policy track. In traditional scientific inquiry/research tracks, students learn about research designs, statistics, and critical literature review processes. They apply these skills to clinical questions, using the steps of evidence-based practice or the traditional thesis process. Administration courses address federal and state regulations, service delivery models, and the nuts and bolts of running a department or private practice. Outcome measurement is the process of applying scientific inquiry skills to service delivery challenges in the hopes of improving patient outcomes. This convergence of the two curricular tracks is not often explicit in professional curricula; however, the realities of the current practice environment are requiring clinicians to access data for clinical decision-making, performance benchmarking, and developing or evaluating clinical pathways and guidelines.
This book introduces the beginning of the process—a means for objectively evaluating a clinician’s own practice and of validating assumptions about how clinicians document what is done with patients and at what levels of effectiveness. The purpose of the exercises is to have clinicians use their own patient pool as a laboratory for self-analysis. When a clinician is sensitized to the challenges of objective, repeated, and complete documentation, the clinician will be better prepared to look at the quality of available data and what they can say about patient care.
Note: This Book will not Teach Readers about Designing or Conducting Prospective Studies
This book is not designed to teach the reader how to conduct prospective research with patient populations. Designing studies before collecting data requires many more layers of preparation, knowledge, and process than do retrospective chart reviews for informing clinical decision making. Clinicians who have been “bitten by the research bug” are highly encouraged to pursue advanced training through collaboration with clinical researchers or academic programs.