Enhancing Quality of Orthotic Services with Process and Outcome Information
Abstract
Use of braces is growing, yet developing measures to assess quality of brace services lags behind other health specialties. Like other providers, clinicians who make braces (i.e., orthotists) are expected to base their clinical practice on research evidence and are under pressure to document outcomes of their brace treatments. While orthotists acknowledge the value of outcomes data, there is no consensus on the type of data that can best capture quality of brace services. Consequently, collection of outcomes data is not routine, and meeting facility accreditation requirements for quality improvement relies on approaches that are not standardized. Adoption of outcome measures in clinical practice is influenced by many policy and practice-based factors, including fee-for-device payment models, a lack of measures tailored for use with braces, and absence of efficient systems for gathering and reporting outcome or quality measure data. Commonly used indicators of brace quality include fabrication time, number of follow-up visits, number of times a device needs to be remade, timeliness of response to patient complaints, ease of patient access to facility, billing and coding procedures, and patient satisfaction with device and service. When accrediting facilities, surveyors seek evidence that outcomes and quality data are being collected and used to track trends and take follow-up action where needed. Facilities frequently ask the facility accreditation organization how they should comply with performance management standards, as they are the hardest standards to meet, but there are no industry-wide quality measures available. The objective of this project is to develop outcomes data modules that can be used to improve the quality of services for brace users, specifically people who use Ankle-Foot Orthoses (AFOs). The target population is people who use AFOs to address problems caused by polytrauma and neurologic disorders. This project will advance clinical practice regarding braces by developing consensus on quality measures and assessing to what extent patient questionnaires can substitute for more costly efforts to collect measures of patient performance. This project will identify quality measures suitable for assessing the outcomes of AFO use that meet the criteria set by the National Quality Forum (NQF), the leading organization responsible for endorsing quality measures. This project engages various stakeholders, including Veteran and civilian patients, organizations representing patients, accreditors, orthotists, and professional associations, in the selection and development of measures that could be used to document quality of care for patients receiving AFOs. Service members and Veterans experience complex medical problems sustained during combat and continuing after reintegration into civilian life. Problems include traumatic brain injury, extremity injuries and amputation, post-traumatic stress disorder, spinal cord injury, stroke, and polytrauma. The survival rate of Service members injured during combat in Operations Iraqi Freedom and Enduring Freedom (90%) has improved dramatically compared to previous conflicts. Unfortunately, despite increased survival rates, many Service members and Veterans experience disability, often necessitating rehabilitation. The Joint Theater Trauma Registry contains records of Service members who sustained injuries that required medical treatment and prevented their return to duty within 72 hours; 48% sustained serious lower extremity injuries and 9% had amputations. Individuals with polytrauma that includes ankle-foot injuries, have significantly worse outcomes than those without ankle-foot injuries. Advances in vascular repair and management of infection have reduced the number of lower extremity amputations and increased the number of limb-salvage patients. Advanced prosthetic design enables high-level functioning, but development of better AFOs has lagged.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 31, 2017
- Source ID
- W81XWH1610788
Entities
People
- Allen W Heinemann
Organizations
- Shirley Ryan AbilityLab
- United States Army