Outcomes Measurement and Interpretation

1. Outcomes Measurement and Interpretation Jeff Redekopp MS CSCS RCEP Cardiopulmonary Rehab Coordinator Trinity Health Minot, North Dakota

2. What Are Outcomes? • Definition: • “The potential results one would anticipate after performing physical activity” ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (Fifth Edition). • “Optimal outcome evaluation reflects the ability to assess: (1) The individual patient’s progress toward health, clinical, and behavioral goals for each relevant component of care (2) The program’s effectiveness in providing all the components of care” AACVPR’s Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs (Fourth Edition).

3. Why Are Outcomes Important? • Outcome assessment demonstrates the effectiveness of the patient care we provide. • Outcomes data gathered during the evaluation process can be used for: • Quality Improvement • Accreditation/Program Certification • Reimbursement • Demonstrating acuity level of the patients we serve – helping to establish appropriate staff to patient ratios

4. Outcomes Expectations • 3 forms of Outcomes expectations have been identified by ACSM: • Positive and negative physical effects • Positive and negative social effects • Positive and and negative self-evaluative reactions to change in behavior

5. What Outcomes Should Cardiac and Pulmonary Rehab Programs Measure? • Programs should measure one or more outcomes in in each of the following areas: • Health • Clinical • Behavioral • Service

6. Behavioral Outcomes • Examples: • Patient’s Compliance with their Medical Regimen • Exercise sessions • Progression towards goals • Participation in Smoking Cessation Programs • Following Home Exercise Program • Taking Medications as prescribed • Patient’s Recognition and Reporting • Condition changes • Doctor’s Office visits • Medication updates • Any further medical procedures done • Understanding CAD/ Pulmonary Disease, signs/symptoms of disease

7. Clinical Outcomes • Examples: • Physical • Weight Food records • Functional Capacity Lipids • Heart rate and blood pressure Blood sugar levels • Blood nicotine levels • Psychological • Anxiety Depression • Stress Perception of Health Status • Medical Utilization • Hospitalizations • ER visits • Non-routine physician visits

8. Health Outcomes • Examples: • Morbidity • Rehab Session-related events; non-rehab session related events • Mortality • Session-related deaths; non-program related deaths • Quality of Life • Functional • Social • Vocational Status • Avocational Status • Independent living status

9. Service Outcomes • Examples: • Patient Satisfaction • Satisfaction of Care • Financial and Economic • Reimbursement • Deductibles

10. How Often Should Outcomes Be Measured? • Measurement should ideally be done at regular intervals. The following timeframes could be used: • Program entry • After 3 months of participation/ or discharge • At 6 months • At 12 months • At 2 years

11. How Do We Collect Outcomes Data ? • Step 1. Don’t Freak Out! • Step 2. When In Doubt, follow the KISS principle (Keep it simple, stupid.) • If at all possible, refrain from re-creating the wheel!! • Use a commercially available software program. • Contact another state or regional society to find out if you can use their tool, or their tool can be adopted and used for your state/region • Contact another facility that has designed their own tool/collection method and ask if you can get a copy (and use it if possible, or tailor it to your program’s specific needs) • If you are an AACVPR member you can log Log on to AACVPR’s website and go into the Outcomes Resource Guide page

12. What Are We Looking For?How To Interpret Our Results • Simply put, we are looking for the amount of change, or lack thereof, from reporting period to reporting period. • Change can be measured thusly: • Body weight gain or loss • Home exercise program compliance • Patient satisfaction score at program discharge • Quality of life survey score (Program entry vs. discharge)

13. Limitations to Collecting and Analyzing Data • Complexity of collection tool • Software Spreadsheet • Cost • Software Collection tools (surveys) • Staffing • Time Budgeted staff available • Data inaccuracies • Data Entry mistakes Entering an incomplete data set

14. Good Tools, Bad Tools, Mediocre Tools: Our Program’s Experience • Good Tools: • Beck • SF 36 • Orion Patient Satisfaction Survey • 6 minute walk test

15. Good Tools, Poor Tools, Mediocre Tools: Our Program’s Experience • Poor Tools: • Orion Diet Habits Survey • Mediocre Tools: • SF 12 • Dartmouth Quality of Life Index • DASI • Orion Outcomes Survey

16. Using Your Results to Improve Your Program • Share results with all departmental staff • Share results with your department director and/or quality management department • Brainstorm on specific indicators that you and your departmental co-workers can influence • Develop a reasonable action plan to improve these. • When possible, benchmark against other programs in your state, region, or nationally to see how you “measure up”.

17. What We Use – What Works For Us (Orion Software) • Behavioral • Medication, diet compliance • Home exercise program compliance • Smoking Cessation, or lack thereof • Beck Depression Inventory • Clinical • Weight change during course of rehab; BMI • Minutes of exercise per session • Fasting Blood Glucose changes • DASI changes • 6 min. walk changes (Pulmonary) • Health • Quality of Life – Dartmouth Survey • Service • Post-Rehab Patient Satisfaction Survey

18. What Other Programs Use • What works for your program? • (discussion)

19. Summary • Outcome assessment demonstrates the effectiveness of the patient care we provide. • Measure one or more outcomes in each of the following areas: Health, Clinical, Behavioral, and Service. • Measure outcomes at regular intervals, such as at Program entry, After 3 months of participation/ or discharge, at 6, 12 months or 2 years • Keep you data collection methods simple if possible. Look for change when interpreting your data. • Use good tools for each indicator when possible (easy to use, good reliability/validity, and have standardized national scoring protocols). Use tools that have already been developed. • Use your results to improve your program. Thanks for your time and participation !!

20. References 1. ACSM’s Resource Manual for Guidelines for Exercise Testing and Prescription (Fifth Edition). 2. AACVPR’s Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs (Fourth Edition).