Chapter 13: Considerations for Conducting Outcome Studies

INTRODUCTION

Conducting outcomes studies can seem like a daunting process to the individual clinician. Even the simplest studies require careful thought, diligence, and time to identify the question, collect the data, and interpret and use the results. The efforts are not immune to Murphy’s Law (“if anything can go wrong, it will”), so that missing data, computer viruses, and hindsight about what could have been collected can unravel the nerves of the most ardent data collectors and committed clinicians. Nevertheless, the only way to move the quality and accountability of physical therapy services forward is through the thoughtful process of comparing objective evidence collected before, during, and after changes in practice patterns. Once a study is completed, the next study seems less daunting.

Until now, this book has dealt with evaluating the outcomes of a single clinician. When outcome studies expand to include data generated by multiple clinicians, there are factors that need to be considered to maximize success. This chapter will review the logistics of conducting a retrospective study on multiple therapists.

OUTCOME ADDICTION

The insights realized about practice and documentation patterns can be quite powerful for the individual clinician, causing the sanest person to charge into a staff meeting with mandates to implement a list of changes. This transition from the reflective clinician to the militant outcomes guru sometimes occurs with data from a small pilot study or a sample from a single diagnostic group. The data hardly represent the full breadth of the clinician’s practice; however, the lessons learned from the process of conducting the study leave such strong impressions that the clinician feels compelled to share them. Such is the emotional reaction that completing a study can have.

The assumptions and memories about how service is delivered and what is recorded prior to an outcomes study are often challenged by the actual data that are available to harvest. Sometimes there is pride (and relief) in the strength of the documentation process because a data set was easy to assemble or because the results confirm the expected outcome. Sometimes the clinician is frustrated by the data harvesting process, embarrassed by the inconsistencies in the data, or surprised by results that conflict with expectations. Regardless of whether the clinician’s assumptions about practice and documentation are supported or whether the results lead to significant changes in practice behaviors, there is a strong realization that conducting the study was the only way to see the situation objectively. And the clinician is hooked!

To avoid misapplication of a study’s results and to temper the desire to recruit other clinicians to accept ...