Software allows quick access to outcomes data
Producing custom reports with off-shelf software
If a physician at St. David's Medical Center wants to know how hip replacement patients over age 70 progress compared with those younger than 70, the rehab staff at the Austin, TX, facility can have the answer in minutes.
When the hospital's business staff negotiate a contract with a third-party payer, they go to the table armed with statistics showing how rehab patients previously referred by the payer have progressed and how they fared compared to regional and national norms.
And supervisors at St. David's can quickly compare the outcomes of each treatment team to see which methods of treatment may be most effective.
"In the past, we would have thought these were interesting questions, but with the manual process, it would have been too cumbersome to figure it out," says Ann Hillis, MS, SLP, director of rehabilitation services.
Software helps dig data mine
Now the hospital staff have easy access to outcomes data through a computer program that automatically picks up data entered into the FIMware outcomes measuring software provided by the Uniform Data System for Medical Rehabilitation UDS, with headquarters in Buffalo, NY.
When the staff evaluate patients using the Functional Independence Measure (FIM), the rehabilitation unit's full-time data entry person enters information into the computer along with additional information being tracked specifically by the hospital. She also makes sure the data are complete and places follow-up phone calls after the patient is discharged.
St. David's rehab staff worked with a consultant to develop the overlay program that allows the staff to manipulate the material they collect for the UDS database and use it to make their own evaluations. The medical center's outcomes database uses Microsoft Excel, an off-the-shelf spreadsheet program. It takes the raw data right off the FIMware software and imports them into the Excel spreadsheet.
Once the data are in the spreadsheet, users can manipulate them in any way they wish. The data information person exports them to the hospital's server so all administrators and supervisors have access to the data at all times and can develop their own reports.
The hospital has added additional fields to the Excel program that give the staff a chance to look at outcomes and statistics that are not being tracked by UDS. "We can look at data by physician, by floor, by team, by diagnosis, and even by individual therapist," Hillis says.
For instance, one of the rehabilitation unit's 10 program evaluation goals is that patients will improve one or more FIM points in two or more areas of self-care. The Excel program gives the staff the ability to create reports specific to this goal. The new program allows Hillis to look at specific FIM items for a specific treatment team and to compare them to the overall rehab statistics.
The hospital already has started compiling data on patients in its Progressive Orthopedic Program, an accelerated program for joint replacement patients, and will be able to compare how those patients progress with how the rest of the joint replacement patients progress.
"We know that the POP program works, but this new computer programs gives us the ability to show people hard data," Hillis says.
Because the information is on the hospital's information server, the supervisory staff has access to it from any area of the rehab unit.
"Any different combination of the data we track can be obtained, and obtained in a matter of minutes," Hillis says.
For instance, if a physician comments that it seems like his stroke patients over 80 didn't progress very well, an administrator could find out exactly how that group of patients was progressing in less than five minutes.
"I can compare how Dr. Jones' hip replacement patients progress as compared to Dr. Smith's patients, or I can compare stroke patients over 70 with stroke patients under 70 who speak Spanish," Hillis adds.
In the past, St. David's staff spent hours going through paper documents and tracking program evaluation data manually. "It's so time-consuming to do it manually that some data comparisons we wanted to look at often just didn't get done," says Laura Halliday, LMSW, ACP, supervisor of the orthopedic program in the rehab hospital.
Until January 1995, when it became a subscriber to the UDS, the hospital had done some internal outcomes measurement but had not participated in a national database.
Next step: Going cross-continuum
The next project at St. David's is to move into measuring outcomes throughout the continuum of care - inpatient, acute care rehab, and outpatient, Hillis says.
Right now, it's a difficult problem because there are no comparable scoring systems for acute care inpatient, rehab outpatient, and home health to allow the staff to make numerical comparisons, she says.
For instance, the FIM works well in the rehab setting, but it's not sensitive enough for some of the lower-level patients in the acute care hospital or for the higher functioning patients in the outpatient setting, she adds.
"The problem is how to have a single system so you can measure people's functional status as they move through the continuum without ending up with a 15- or 20-point scale," Hillis says.
Testing new ideas
The hospital is participating in a pilot study using the FIM in an acute care setting, says Donna Young, PT clinical supervisor of the physical medicine department. St. David's sent its first quarter's worth of data on stroke and total knee replacement patients to the UDS in March, she says.
The FIM that has been developed for the acute care setting is a four-point scale, while rehab patients are rated on a seven-point scale. The St. David's staff have proposed to UDS that patients in the acute care hospital be rated on the seven-point scale.
"They are very open to the idea and have told us they will set up another pilot program that allows acute care and rehab to utilize the same measuring scale," Young says.
[For more information, call Ann Hillis at (512) 867- 5117.]
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