Page 31 - Mobility Management, July 2018
P. 31

                                What Clients Say About CRT
Continued from page 19
outcomes in those same 10 categories when no Assistive Technology Professional (ATP) was involved in the seating and mobility provision process. The numbers in green show patient outcomes when ATPs were involved in the provision process.
Future Ramifications of CRT Outcomes
Currently, scores show that patients were more functional with wheelchairs than without them, and that involving an ATP in the provision process also resulted in higher scores than when ATPs were not involved.
Participating patients are asked for their perceptions multiple times. “We contact the patient, on average, five times in the first year,” Packer said of participating U.S. Rehab members. “If [a patient’s] score drops by a certain percentage, we’re contacting the clinician as well as the provider to reassess the issue. We make sure there has been patient contact by the provider to make an equipment adjustment or to change out a cushion or whatever needs to be taken care of. Once that’s done, we put [the client] back into the system for the next call.”
As time goes on and the amount of survey data grows, Schmeler said the FMA team will look for further indications of CRT’s impact.
“We’re looking at other factors in our uniform data
set regarding whether we start to see changes in employment, living situations, transportation,” he said. “These are all variables that could be monetized, so when we get to a mass of 10,000 cases and we start doing discrete analyses, we can say within a certain level of confidence that if a person has C4-C5 quadriplegia, based on large data, this is the best chair for them. Not only will it change their self-reported mobility-related activities of daily living, but we’ve cut pressure sores by x percent. We’ve cut falls by x percent.
“Patients are no longer using ambulances to
go to doctors’ appointments; they’re using public transportation, they’re using wheelchair-accessible Uber. These are all things that cost society less money. And when you look at the funding sources for this population, to me it’s alarming that almost 70 percent is on Medicare or Medicaid. That is the most expensive health insurance that tends to be less focused on preventive care. We
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want to see people go onto responsible managed care plans, but likewise need to educate these plans with outcomes.”
Having outcomes measures could also impact future funding policy.
“We’ve just started to scratch the surface on seat elevators,” Schmeler said. “We noticed an increase in satisfaction with reach and transfers, and we’re seeing a decrease in falls. One fall plus one visit to the emergency department is the cost of a wheelchair.”
So beyond affirming that CRT improves clients’ lives, and that ATP involvement in the equipment provision process improves functional outcomes, data gleaned from the FMA could impact clients’ overall health, and even affect coverage and funding policies.
“It’s a big public health project,” Schmeler acknowledged, “and we have two public health professionals on this team. They look at large populations and what’s happening to them.”
In Mobility Management August: A look at what
FMA scores say about CRT wheelchair provision and Secondary Health Conditions. For more info on the FMA, go to www.FMA.USRehab.com, or contact Mark Schmeler at schmeler@pitt.edu or Greg Packer at greg. packer@usrehab.com. m
       MobilityMgmt.com
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