Home-grown system tracks outpatient quality
Length of stay, cost, return to work measured
Faced with the challenge of proving its effectiveness in treating workers’ compensation patients, Florida Hospital Rehabilitation Center in Orlando developed its own outpatient evaluation program to track length of stay, cost, and quality.
"We knew that with managed care, we couldn’t just tell providers that we do a good job. We had to show them, and to do that, we had to find a way to track length of stay, cost, and quality," says Brett Oakley, MS, coordinator of program outcomes.
There were no programs on the market that fit the hospital’s needs, so Oakley came up with a home-grown program that operates on the hospital’s computer network, using off-the-shelf Microsoft Excel spreadsheet software.
The hospital started collecting data from its eight outpatient centers in mid-1995. At the end of 1996, they were able to show payers that the outpatient program could get workers’ comp patients back to work in an average of 10 visits, regardless of injury.
To set up the program, the clinical staff at the hospital’s eight outpatient centers separated the disabilities treated into six components: back and neck; ankles and feet; elbows, wrists, and hands; shoulders; knees; and other.
Using their own experience, payers’ expectations, and information in medical literature, the staff came up with a target number of days to treat each disability successfully.
Categorized data more useful
Patients are placed in three categories: acute (0 days to six weeks after injury); chronic (more than six weeks to up to a year after injury) and superchronic (more than a year after injury).
Originally, all patients were lumped together, regardless of the length of time after injury, but the centers found the data were more meaningful, especially to physicians, if they were categorized, Oakley says.
The outpatient centers track patients’ duty levels before their injuries and after rehab. They also track work schedules before injury and after discharge, the number of lost work days, length of stay, and treatment costs. Data are obtained at admission, at discharge, and 90 days after discharge.
When the initial data were analyzed, staff had met their goal for lengths of stay for all six types of patients. Now they are focusing on reducing lengths of stay even further.
Although some of Florida Hospital’s managed care contacts call for fewer days of treatment than do the program evaluation goals, the hospital is usually able to arrange extended treatment.
"We have developed a good rapport with the managed care case managers, and they know the quality of our work. They know that even though they approve a 10-day stay, we can get some patients out in three or four visits, so they’ll work with us on a case-by-case basis and approve additional treatment when it’s needed," he adds.
When he set up the process, Oakley kept staff paperwork to a minimum, relying heavily on chart reviews and the hospitalwide computer system. Therapists are responsible for recording only the type of job the patient has and job status before the injury and after discharge. Each center’s support staff enter data collected by therapists into the hospital’s computer network.
"Therapists are swamped with paperwork and treating patients already. We knew we wouldn’t get good staff buy-in or compliance if we gave them a lot of paperwork," Oakley says.
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