Northwestern University Feinberg School of Medicine

Northwestern University Prosthetics-Orthotics Center

Enhancing Quality of Prosthetic and Orthotic Services with Process and Outcome Information

Co-Project Leaders: A. Heinemann, PhD, and L. Ehrlich-Jones, PhD

Project Manager: L. Connelly, MS

Consultants: M. Brncick, Northwestern University Prosthetics-Orthotics Center (NUPOC); D. Hart, Focus on Therapeutic Outcomes (FOTO); C. Carter, American Board for Certification in Prosthetics, Orthotics and Pedorthics (ABC)

Funded by: National Institute on Disability and Rehabilitation Research (NIDRR)

Status: Complete

Introduction

Despite the availability of standard measures to assess functional status, quality of life and satisfaction with services and devices, provider enthusiasm for routine outcomes monitoring and improvement is diminished by the time and expense. We proposed to work with the American Board for Certification in Prosthetics, Orthotics and Pedorthics (ABC) and Focus on Therapeutic Outcomes (FOTO) to develop an outcomes monitoring, data collection and reporting service and education program that gives providers the information they need to improve patient care quality. We worked with FOTO to develop a scannable paper and Web-based data entry system that provides secure and confidential outcomes information to ABC-accredited programs. We evaluated the utility of this system and developed a quality improvement education curriculum in collaboration with NUPOC in terms of the actions providers take to enhance the quality of their patient outcomes.

The ABC accreditation standards are designed to enhance quality healthcare in P&O practices and to help increase efficiency and support initiatives that improve patient outcomes. Facility accreditation helps ABC achieve specific goals including promoting the welfare of persons with disabilities by establishing standards for those engaged in the fitting of prostheses and orthoses. ABC defines six categories of standards including quality assessment and improvement. We have learned from providers that they perceive outcomes data collection and monitoring as time consuming and expensive. While they acknowledge the value of data collection, they do not have access to data management systems that allows them to compare their patient outcomes with other providers. We hypothesized that compliance with ABC's Performance Management and Improvement Standards related to use of quality indicators will improve from baseline through a three-year implementation process.

Purpose/Specific Objectives

(1) Develop a database of process and outcome indicators that are useful in guiding clinical practice improvement activities;(2) Develop an educational curriculum that enhances clinicians' ability to integrate process and outcome information in improving P&O care delivery quality;(3) Analyze facility compliance with ABC's Performance Management and Improvement Standards;(4) Evaluate and refine the curriculum on use of quality indicators to improve clinical practice and outcomes.

Clinical Implications

This project was designed to improve clinical practice favorably. The Centers for Medicare and Medicaid Services (CMS) requires facilities to achieve accreditation in order to be eligible for Medicare reimbursement. Still, wide variations in performance management exist, in part because facilities have few examples of how to monitor and improve their services. This project was developed to promote "best practices" to a wide audience.

Related Presentations and Publications

Heinemann A, Ehrlich-Jones L, Williams D. Enhancing Quality of Prosthetic Services with Process and Outcome Information. Paper presented at: 13th ISPO World Congress; May 10-15, 2010; Leipzig, Germany.

Connelly L, Heinemann A, Ehrlich-Jones L. Enhancing Quality of Prosthetic and Orthotic Services with Process and Outcome Information. Midwest Chapter of the American Academy of Orthotists and Prosthetists; June 3-4, 2011; Grand Geneva Resort, WI.

Heinemann A. Ehrlich-Jones L, Connelly L, Fatone S. Enhancing Quality of Prosthetic and Orthotic Services with Process and Outcome Information. in 38th American Academy of Orthotists and Prosthetists Annual Meeting and Scientific Symposium. March 21-24, 2012. Atlanta GA.

Heinemann A, Ehrlich-Jones L, Connelly L, Fatone S (2013) Improving the quality of prosthetic and orthotic services with process and outcome information. 14th World Congress of the International Society of Prosthetics and Orthotics, February 4-7, Hyderabad, India.

Heinemann A, Connelly L, Ehrlich-Jones L, Fatone S (2014) Outcome Instruments for Prosthetics: Clinical Applications. Invited Paper, Physical Medicine and Rehabilitation Clinics of North America, 25(1):179-198. PMID: 24287247.

Heinemann A, Connelly L, Ehrlich-Jones L, Fatone S (in press) Enhancing Quality of Prosthetic Services with Process and Outcome Information. Prosthetics Orthotics International.

Ehrlich-Jones, Linda. Quality Improvement: What Is It and How Do We Use It? Online Educational Module for Orthotists and Prosthetists, 2014.

Wong AWK, Heinemann AW, Ehrlich-Jones L, Connelly L, Semik P, Fatone S (2014) Comparison of the Orthotics and Prosthetics Users’ Survey (OPUS) and Orthotics and Focus on Therapeutic Outcomes (FOTO) Functional Status Measures for Persons with Lower Limb Amputation. American Congress of Rehabilitation Medicine, October 7-11, Toronto, ON, Canada. 

Heinemann A, Ehrlich-Jones L, Connelly L, Semik P and Fatone S (2016) Enhancing Quality of Prosthetic Services with Process and Outcome Information. Prosthetics and Orthotics International 1-7. DOI: 10.1177/0309364616637957. 

NUPOC and RIC Offer Free Online Educational Module for Orthotists and Prosthetists

Linda Ehrlich-Jones, PhD, RN, presents Quality Improvement: What Is It and How Do We Use It?

Northwestern University Prosthetics-Orthotics Center (NUPOC) and the Rehabilitation Institute of Chicago (RIC) offer a free, online educational module for orthotists and prosthetists.

Content includes a description of the benefits of continuous quality improvement efforts and step-by-step instruction on implementing such a project. Quality improvement initiatives have the potential to improve patient service, increase clinician and support staff effectiveness, and minimize cost by continuously identifying areas for targeted improvement. The outcome of such efforts can lead to improved patient satisfaction with clinical services and products, improved function, and, ultimately, improved quality of life.

Dr. Ehrlich-Jones introduces the Orthotics and Prosthetics Users’ Survey (OPUS), which is used to monitor patient functional status, health-related quality of life, and satisfaction with lower-extremity devices and clinical services. OPUS is an instrument that can be used to track patients’ feedback over the course of their treatment by collecting patient data at admission, at device delivery, and again at a later follow-up.

If you have questions or comments regarding the presentation, please contact Linda Ehrlich-Jones, Clinical Research Scientist: ljones1@ric.org or call (312) 238-0743.