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transparency by requiring post-acute care providers to report standardized patient assessment data on quality of care and resource use. CMS [Centers for Medicare & Medicaid Services] then is publicly reporting on these quality measures, two of which can be related to seating and wheeled mobility: Percent
of residents or patients with pressure ulcers that are new or worsened; all-cause unplanned readmission measure for 30 days post-discharge from long-term care hospitals.
This type of legislation highlights the emphasis being placed on evidence-based practice and quality of care. By providing evidence-based outcomes that show how proper equipment reduces the incidence of wounds and re-hospitalizations by improving function and productivity, we are justifying the need for selecting the best equipment for the individual, not cheapest. We then have data to demonstrate how providing the right equipment ultimately saves money. — Stacey Mullis OTR/L, ATP, director of clinical education, Comfort Company
Evidence As Advocacy
Patient outcome measurements and evidence-based practice are gaining steam in the industry — for good reason. Historically, the assumption of most funding agencies has been that CRT clients don’t need things the rest of us take for granted (being able to reach into a cupboard, or even standing, for example). That attitude, along with a general ignorance of the CRT industry,
has led to inadequate funding — or no funding — for equipment that can keep people independent, healthier and living at home. Evidence-based practice and outcome measurements are the key to educating funding sources and others of the benefits of CRT.
Each client is unique. So our approach should be unique and client centered. Measuring outcomes by evidence of benefit starts at the initial evaluation by performing a Functional Mobility Assessment. Interview and document the client’s needs, desires and goals. This approach creates a team spirit between clinician, ATP/SMS and the end user. More importantly, it empowers the client to make decisions regarding his/her own care. With this baseline the client can be tracked after delivery to verify goals have been met. Poor marks on the FMA clearly show the need for a different approach. Documenting improved functional status can do much to establish the benefits of traditionally non-funded items, such as power seat elevators and standing devices.
Outcome measurements and evidence-based practice are one of the best ways we can protect access to CRT, and advocate for appropriate funding. — Philip Wegman, ATP, CRTS, Aspirus Home Medical Equipment
Collaboration Needed
Evidence-based practice is in healthcare what continuous product improvement is to a CRT manufacturer. The future of many of these products will depend on our collective willing- ness to adopt both approaches. Successful clinical outcomes
require clinically effective products.
Standardized outcome instruments like the FMA can give
us some idea about how well we are doing. Recently, we began administering the FMA and are contributing to the database. As one of the first [Spinal Cord Injury] Centers in the VA to start providing data, I am certainly interested to see what the “evidence” tells us over time.
I also know the usefulness of the data of a standardized outcome measure will always have limits in complex rehab. Limited sample sizes, complex needs and high heterogeneity among users guarantee it. The irony is that the harder we try to control variables and get “the numbers” needed to do a large- scale, well-controlled scientific study, the less likely it will provide useful information. This applies to both clinicians adopting evidence-based practice or a manufacturer who uses continuous product improvement. Neither can get all the information they need unless they get the input and expertise of the other.
Lastly, we will never see meaningful peer-reviewed evidence published about the effectiveness of these products unless we share practice-based evidence. Oftentimes a less formal analysis of the practice-based evidence we can all collect in our individual settings can have a much greater effect on our clinical outcomes. When we identify common problems or potential solutions, we need to share those things in a responsible, qualified manner — not just to help someone else, but to allow others to examine, validate, propose alternatives or build upon what we’ve found.
— Steve Mitchell, OTR/L, ATP, Cleveland VA SCI/D Service, Multidisciplinary ALS Clinic
The Importance to Manufacturers
Measurable, evidence-based decision-making is of utmost importance whenever manufacturing or choosing any CRT.
The more we know as a manufacturer (testing, consumer and clinical surveys, research, etc.), the more appropriate and defined products we can produce for the best outcome for the consumer. When clinicians use evidence-based outcomes and consum- er-centered clinical reasoning, they add support to their choice of CRT and weight to their documentation that payors should understand, respect and pay for. — Nancy Perlich, COTA, ATP, funding specialist, EasyStand/Altimate Medical
Any clinician who has worked with children (or adults) with neuromotor impairments knows the importance of appropriate CRT. The therapy community has long recognized the impor- tance of research-based evidence to validate and promote what we have known through our own experience, and when evidence- based research is available, it certainly impacts our clinical decision making.
However, particularly in pediatrics, there is a dearth of research. Many clinicians, myself included, rely on what is considered the lowest level of evidence, basing our decisions on
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