Industry group calls for better outcomes measures

Goal: Standardization of reporting

Open any corporation’s annual report and you’ll notice one thing: The key message isn’t about financial results. It’s about the atmosphere in which those results were achieved, as well as how the results compare with previous years’ performance.

Sales figures and revenue figures are more meaningful, for example, when they are compared with similar data from competitors, against previous years, and even in the context of the economy and other marketplace factors.

The same could be said for outcomes reporting in the rehab industry. Measuring outcomes is a good start, but actually presenting the data in a meaningful way for managed care organizations and consumers to make health care purchasing decisions can be a major challenge.

One national industry group, the American Congress of Rehabilitation Medicine (ACRM) in Glenview, IL, is reaching out to other industry leaders in an effort to promote what it calls an "evidence-based rehabilitation culture." The goals are greater disclosure of outcomes information and a standardized outcomes measurement tool that will allow better benchmarking within the rehab industry and a meaningful exchange of data.

Health care purchasers can use those data to make purchasing decisions based on quality as well as cost, says Gerben DeJong, director of the NRH Research Center at National Rehab Hospital in Washington, DC, and chair of ACRM’s research policy and legislation committee.

"We need in the rehab industry to develop a consolidated performance score . . . a weighted average of several measures," DeJong says. "At some point in the future, it will be important for individual consumers with rehab needs to be able to access [the information] via the Internet."

He says the Function Independence Measure, an 18-item assessment tool used by more than 1,300 hospitals nationwide, offers a good starting point. "But it’s focused on a fairly limited repertoire of skills. There are a lot of people who think we need to look beyond that. Just because a person acquires these skills, how does it translate to social performance and social role? Nor does the FIM speak adequately to the many other venues where rehab is currently practiced. . . . It’s really an inpatient hospital type of instrument."

DeJong’s committee is just beginning its work on this effort, he stresses. The group is creating a vision of where it wants to go, and it wants to reach out to other national groups such as CARF...The Rehabilitation Accreditation Com mi s sion, the American Medical Rehab Providers Association, and the American Academy of Physical Medicine and Rehab, among others.

The group hopes to collaborate with other organizations, develop a broad multi-year plan, and perhaps sponsor a national conference. DeJong says these criteria are important to better use outcomes data:

    • a commitment to the value of transparency and the principles of public accountability and disclosure;
    • a theory of rehabilitation practice/science;
    • a conceptual framework of disability that captures its etiology and consequences;
    • a nomenclature and commonly accepted definitions of terms;
    • valid, reliable, useful, and agreed-upon measures of function and outcome;
    • institution and facility capacities for functional and outcomes data collection;
    • large and accessible cross-institutional databases on patient/consumer outcomes;
    • full disclosure of standardized risk-adjusted outcomes;
    • payment systems that reward quality as well as resource utilization.