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Center to evaluate monitoring methods
Using a five-year, $3.5 million grant from the U.S. Department of Education, Boston University’s Sargent College of Health and Rehabilitation has launched a center that will devise better ways to evaluate the quality and effectiveness of treatment methods for ailments such as strokes, hip fractures, joint replacements, and traumatic spinal cord injuries.
The new Rehabilitation Research Training Center (RRTC) on Measuring Rehabilitation Outcomes will employ a core disciplinary team of health services providers from Boston Uni-versity; the National Rehabilitation Hospital in Washington, DC; the Institute for Clinical Outcomes Research in Salt Lake City; and the Health Assessment Laboratory at New England Medical Center in Boston.
"Practitioners have typically evaluated medical interventions and their success, including rehabilitation, on the basis of short-term results in each setting where the services are provided," explains Alan M. Jette, PhD, dean and professor of physical therapy at Sargent College.
However, he says, "In a climate of managed care and cost control, rehabilitation providers are now being challenged to monitor the quality of rehabilitation programs nationwide, understand how specific rehabilitation treatments affect patients’ quality of life, and explain how short-term changes affect long-term functioning at home and in the community. [The goal of the RRTC] is to develop and disseminate measurement tools that will help practitioners better use clinical outcomes data and make better decisions on how to treat and rehabilitate patients."
The core task for the RRTC team will be coming up with more efficient ways to monitor the quality of care provided to patients undergoing rehab, notes Jette. "The challenge here is that in the past, every person, every facility, every group involved in providing rehab care has done this in their own fashion."
There has been no generally accepted model for following individual patients throughout the course of their rehabilitation, he says. "What we will be doing is developing new methodologies that can be used in nursing homes, inpatient hospitals, home care, and outpatient facilities, so that we can ultimately improve the quality of the care being provided."
The methodology for evaluating the progress, and ultimately the quality, of rehabilitation activities has historically been time-consuming and labor-intensive, notes Jette. The RRTC team will be examining ways to get around this problem by utilizing methods that have proven successful in the field of educational testing, he says.
"For example, when you take the GRE [Grad-uate Record Exam] these days, you sit at a computer terminal, where you are presented with a set of sample questions," he says.
Your responses dictate what questions the computer presents next, he explains, a process that is repeated until the test is concluded. This testing methodology "generates a very accurate estimate of your level of competence within the GRE framework," says Jette.
"With a fractional number of the questions asked previously, the test can now provide a very accurate prediction of what you would have scored if you had taken the full battery of tests," he adds.
The RRTC will be bringing this sampling methodology to bear in measuring outcomes for rehab activities. "This will help us get around a lot of the problems we have encountered in the past," says Jette.
While successful in other fields, "it will be a challenge to use these methods in the clinical world; that’s why we’re doing this research," he adds.
(For more information contact Alan M. Jette, PhD, Dean and Professor of Physical Therapy, Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave., Boston, MA 02215. E-mail: firstname.lastname@example.org.)