Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

Promoting Outcomes Management in Prosthetics Practice

Principal Investigators: Allen Heinemann, PhD, and Dudley Childress, PhD

Funded by: National Institute on Disability and Rehabilitation Research (NIDRR) of the U.S. Department of Education under Grant No. H133E030030.

Purpose

The need to measure and evaluate rehabilitation practice in general and P&O practice specifically has received growing recognition in the past several years. Fuhrer (1995) outlined recommendations for medical rehabilitation outcomes research generated at a 1994 conference organized by the National Center for Medical Rehabilitation Research (NCMRR). Critical to NCMRR's agenda, and reiterated throughout the report, is the need for valid, reliable and change-sensitive outcome measures to evaluate the efficacy and effectiveness of rehabilitation practices. The American Board for Certification in Prosthetics, Orthotics and Pedorthics (ABC) echoes this call for certification by encouraging outcomes measurement and clinical pathways within the context of a continuous quality improvement process (Hoxie, 1995, 1996).

Patient perspectives on devices and services as well as satisfaction with services are widely recognized as important areas of rehabilitation and in healthcare generally. However, the greatest challenge is the lack of standardization in measures that would allow outcomes to be compared across programs. Outcome measurement has been the subject of several articles in P&O trade publications (American Orthotics and Prosthetics Association, 1998; Otto, 1999). A recurring concern is the industry's need to quantify outcomes as a means of justifying the cost of services to payers and of responding to growing pressure from consumer groups. The industry would benefit from a set of instruments that can accurately and conveniently measure important and relevant outcomes. Such an assessment could provide many benefits: assist the field develop evidence-based practice and clinical pathways, assure client satisfaction, supplement earnings reports, enhance payer relations, and provide a means of implementing program accreditation.

During a previous RERC funding cycle, we developed a set of outcome measures to ascertain the effectiveness of rehabilitation care for patients who receive prosthetic services. We developed a prototype database that describes wearer characteristics, device characteristics, outcomes, and costs in order to help providers document and evaluate the benefits of their services and improve user outcomes. We disseminated the database to service providers across the U.S., Canada and Australia. We also developed a set of self-report instruments that assess functional status, quality of life, and satisfaction with devices and services that can be used within a P&O clinic: the Orthotics and Prosthetics Users' Survey (OPUS) (Heinemann et al., 2003). OPUS includes four instruments that differentiate patients with varying levels of lower extremity function, quality of life, and satisfaction.

The four components of OPUS provide clinicians with a useful tool to evaluate individual client and program outcomes. The psychometric properties are promising as the instrument demonstrates the ability to detect a wide range of function, quality of life, and satisfaction and possesses good internal consistency and construct validity. The development of the OPUS allows providers to monitor and improve their services and to fulfill accreditation requirements developed by ABC. Despite the availability of standard measures to assess functional status, quality of life and satisfaction with services and devices, the expense of outcomes monitoring diminishes provider enthusiasm for routine outcomes monitoring and improvement. We propose to develop an outcomes monitoring, data collection and reporting service that gives providers the information they need to improve patient care. We will establish a data entry system that provides secure and confidential outcomes information to ABC accredited programs. We will evaluate the utility of this system and the actions providers take to enhance the quality of their patient outcomes. The data entry and reporting system is likely to be of considerable value to P&O facilities. We will explore the possibility of licensing the software so as to assure that a consistent data reporting system is available after the completion of this project. We have worked with Northwestern University's Technology Transfer Program (NU-TTP) to assure a copyright for OPUS and have gained familiarity with the procedures involved.

References

Fuhrer, M.J. (1995). Conference report: an agenda for medical rehabilitation outcomes research. American Journal of Physical Medicine & Rehabilitation, 74:243-248.

Hoxie, L.O. (1995). Outcome measurement: a primer for orthotic and prosthetic care. Journal of Prosthetics and Orthotics, 7:132-136.

Hoxie, L.O. (1996). Outcome measurement and clinical pathways. Journal of Prosthetics and Orthotics, 8:93-95.

American Orthotic and Prosthetic Association (1998). Outcomes in the prosthetics and orthotics profession. O & P Almanac, December.

Otto, J. (1999). Outcomes insights: a current perspective Parts 1 and 2. O & P Business News Dec. 15, 1999 and Jan. 1, 2000.

Related Publications

Burger, H, Franchignoni, F, Heinemann, AW, Kotnik, S, Giordano, A. (2008). Validation of the orthotics and prosthetics user survey upper extremity functional status module in people with unilateral upper limb amputation. J. Rehabilitation Medicine, 40(5):393-9.

Heinemann, AW, Fisher, W, Gershon, R (2006a). Improving Healthcare Quality with Outcomes Management. Proceedings of the American Academy of Orthotists and Prosthetists State of the Science Conference 6: Outcome Measures in Lower Limb Prosthetics, Chicago, IL, September 7-9, 2005. Journal of Prosthetics and Orthotics, 18(1S):46-50.

Heinemann, AW, Gershon, R, Fisher, W (2006b). Development and Application of the Orthotics and Prosthetics User Survey: Applications and Opportunities for Healthcare Quality Improvement. Proceedings of the American Academy of Orthotists and Prosthetists State of the Science Conference 6: Outcome Measures in Lower Limb Prosthetics, Chicago, IL, September 7-9, 2005. Journal of Prosthetics and Orthotics, 18(1S):80-5.

Heinemann, AW, Bode, R, O'Reilly, C (2003). Development and Measurement Properties of the Orthotics and Prosthetics Users' Survey (OPUS): A Comprehensive Set of Clinical Outcome Instruments. Prosthetics Orthotics Int, 27(3):191-206.