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The ATOMS Project: Measuring Assistive Technology Outcomes. Dave L. Edyburn, Roger O. Smith, Todd D. Schwanke & Kelly S. Fonner Center for Rehabilitation Sciences & Technology Closing the Gap Conference, Minneapolis, MN October 17, 2002 View: Universal Access Features. Copyright.

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the atoms project measuring assistive technology outcomes

The ATOMS Project:Measuring Assistive Technology Outcomes

Dave L. Edyburn, Roger O. Smith,

Todd D. Schwanke & Kelly S. Fonner

Center for Rehabilitation Sciences & Technology

Closing the Gap Conference, Minneapolis, MN October 17, 2002

View: Universal Access Features

copyright
Copyright
  • This Microsoft PowerPoint file has been made available as an accessible, electronic handout for the participants of the presentation.
  • You must obtain permission from the ATOMS Project before copying or further distributing this presentation.

Update: The ATOMS Project

atoms projects vitals
ATOMS Projects Vitals
  • Based at the University of Wisconsin – Milwaukee
  • National consortium
  • 5 year AT outcomes project
  • NIDRR funded (US Dept of Education)
    • DRRP - Disability and Rehabilitation Research Projects

Update: The ATOMS Project

atoms project consortium
ATOMS Project Consortium

Helen Hayes

Hospital

Steve Mendelsohn

Update: The ATOMS Project

at outcomes vision and needs
AT Outcomes Vision and Needs?
  • What do you think an outcomes system should look like in 10 years?
  • How would you want to use it?

Audience Vision

Audience Need

Update: The ATOMS Project

the atoms project response
The Atoms Project Response
  • Difficult questions for response, aren’t they?
  • The ATOMS Project hopes to help clarify the field’s 10 year vision.

Update: The ATOMS Project

overall atoms project goal
Overall ATOMS Project goal
  • Explore, Pilot, and Test AT Outcome Measurement Ideas to Recommend an AT outcomes system

(Go Where No One Has Gone Before)

Update: The ATOMS Project

challenges to an at outcomes system
Challenges to an AT outcomes system
  • Diversity of perspectives of need for outcomes data
  • Diversity of populations
  • Diversity of domains for which we'd like outcomes data
  • Requirements for a data system to use reliable and valid measures
  • AT is only one of many interventions and it is an rarely used in isolation
  • Outcomes methodology has advanced, but so have new outcomes measurement ideas

Update: The ATOMS Project

at outcome model 1 context and baseline

Context

Baseline

Environment

  • Person

Function

Task

AT Outcome Model (1)- Context and Baseline

Update: The ATOMS Project

at outcome model 2 interventions

Intervention Approaches

Context

Baseline

Environment

Interventions:

Including

the Use of

Assistive

Technology

  • Person

Function

Task

AT Outcome Model (2)- Interventions

Update: The ATOMS Project

at outcome model 3 outcome

Intervention Approaches

Context

Baseline

Outcome

Environment

Interventions:

Including

the Use of

Assistive

Technology

  • Person

Function

Enhanced

Function

Task

AT Outcome Model (3) - Outcome

Update: The ATOMS Project

at outcome model 4 interventions detailed

Intervention Approaches

Context

Baseline

Outcome

Environment

Reduce the Impairment

Compensate for the

Impairment

  • Person

Functional

Performance

Enhanced

Functional

Performance

Task

Use Assistive Technology Devices and Services

Redesign the

Activity

Redesign the

Environment

Use Personal

Assistance

AT Outcome Model (4) - Interventions Detailed

Update: The ATOMS Project

at outcome model 5 with pre interventions

Intervention Approaches

Context

Baseline

Outcome

Environment

Reduce the Impairment

Compensate for the

Impairment

  • Person

Functional

Performance

Enhanced

Functional

Performance

Task

Use Assistive Technology Devices and Services

Redesign the

Activity

Redesign the

Environment

Health Promotion

Universal Design

Use Personal

Assistance

Pre-intervention

AT Outcome Model (5) - with Pre-interventions

Update: The ATOMS Project

at outcome model 6 with costs

Intervention Approaches

Context

Baseline

$$

Outcome

Environment

Reduce the Impairment

Compensate for the

Impairment

  • Person

Functional

Performance

Enhanced

Functional

Performance

Task

Use Assistive Technology Devices and Services

Redesign the

Activity

$$

$$

Redesign the

Environment

Health Promotion

$$

Universal Design

Use Personal

Assistance

Pre-intervention

AT Outcome Model (6) - with Costs

Update: The ATOMS Project

face the challenge or run
Face the Challenge or Run?
  • Does that mean that a coordinated outcome system is too difficult and that we are stuck with a fragmented, haphazard, homemade, anarchistic system?
  • Is a more cohesive and comprehensive AT outcomes approach possible?

Update: The ATOMS Project

strategies
Strategies
  • Computerized data collection
  • Centralized database
  • Customized or multiple interfaces for various user perspectives
  • Decision analysis data elicitation strategies

Update: The ATOMS Project

general atoms project timeline
General ATOMS Project Timeline

Year 1-2: Needs assessment & field feedback

Year 2-3: Instrument/methodology exploration & development

Year 3-5: Pilot ideas

Year 5: Propose AT outcomes methods & system

Update: The ATOMS Project

atoms specific activities
ATOMS Specific Activities

1. Needs Assessment

  • Field Scans
  • Stakeholder Focus Groups
  • Existing Database Analyses

2. Exploratory R&D Projects

(Instrument Development)

3. Abandonment Analysis

Update: The ATOMS Project

field scans types
Field Scans Types
  • Current Instruments (1,2)
  • Newer methodologies & instrumentation (4,5,6)
  • Feedback from field (focus groups)
  • Literature reviews (3,7,8,10,12)
  • Legal/Policy (9)
  • Conference scientific reviews (11)

Update: The ATOMS Project

field scan 1 instrument update and review
Field Scan 1 – Instrument Update and Review

Formal and informal tools

Commercial and program specific tools

Specific and general tool

  • Instrument nomination form
  • Identification of gaps and overlaps
  • Searchable directory
  • Identification of type of measurement domains addressed

Update: The ATOMS Project

field scan 2 coverage of at in current emerging health rehabilitation outcome measures
Field Scan 2 – Coverage of AT in Current/Emerging Health & Rehabilitation Outcome Measures

~100 instruments selected for review (2 scored two-ways)

Preliminary review reveals:

  • N = 41 fail to acknowledge the use of assistive technology in their outcome scoring
  • N = 47 lower the outcome score if AT is used (nude independence) (most examine limited types of AT)
  • N = 24 allow for AT to elevate the outcome score, but many do not differentiate among type of aids and assistance
  • Of the 102, 4 acknowledge that AT contributes to outcomes and isolates the outcome.

Update: The ATOMS Project

field scan 3 inventory of measures used in at research and design activity
Field Scan 3 – Inventory of Measures Used in AT Research and Design Activity

Do AT developers use appropriate outcomes instruments and methodologies for their projects?

How severe is the problem? Or how is this perceived by product developers?

  • Request methodology of grant proposals from PI’s – 2001 funding (NIH n=34, NIDRR n=27)
  • Survey of product developers
    • Technology Exhibitors, RESNA&AOTA National Conference 2002 n=78
    • Random sample (n=500/1100) from ABLEDATA Directory of Manufacturers

Update: The ATOMS Project

field scan 4 ascertain next generation data collection technology
Field Scan 4 – Ascertain Next Generation Data Collection Technology
  • Factors considered for review of Technology & Methodology
    • Content/outcomes information
    • Scaling potentials
    • Data collection processes/protocol
    • Equipment (hardware/software) characteristics e.g. interface, portability, cost, durability
    • Data handling protocols
    • Data Reporting

~ 50 hardware & software technologies being reviewed

Update: The ATOMS Project

field scan 5 evaluate cost comparison methods
Field Scan 5 – Evaluate Cost Comparison Methods
  • Helen Hayes Hospital: Frances Harris, Ph.D.
  • Initiating methodology review of cost comparison methods and how various approaches match the needs for AT Outcomes measurement procedures that include cost variables.
    • Methods of measuring costs
    • Methods of comparing costs
  • Cost-comparison literature review relevant to assistive technology

Update: The ATOMS Project

field scan 6 assess application of decision analytical approaches
Field Scan 6 – Assess Application of Decision Analytical Approaches
  • Multi-attribute Utility (MAU) Theory Application analysis (selected articles)
    • 47 Engineering articles using MAU methods
    • 60 Health-related articles using MAU methods
    • 32 General articles on MAU methodology
  • Bayesian Approach analysis (initial search)
    • 3797 articles, MEDLINE (1966-present)
    • 140 ERIC (1967-present)
    • 1573 Engineering Village (1970-present)

Update: The ATOMS Project

field scan 7 review taxonomies of outcome
Field Scan 7 – Review Taxonomies of Outcome

What intersection of domains across taxonomies provide common language for a more universal AT outcomes discussions?

  • e.g.
    • Nagi Model (1965)
    • ICIDH (1980, 1993)
    • Rehabilitation Indicators (1983)
    • NCMRR Research plan (1993)
    • Quality of Life Taxonomy (Spilker & Revicki, 1996)
    • Characterization of Rehabilitation Services (Duncan, Hoenig , Samsa , & Hamilton 1997)
    • Institutes of Medicine Model (1997)
    • ICIDH-2 draft (1997)
    • ICF (2002)

Update: The ATOMS Project

field scan 8 identify strategies for isolating at outcomes
Field Scan 8 – Identify Strategies for Isolating ATOutcomes

Compare methodologies that can isolate & quantify the outcomes of assistive technology. ~410 articles

e.g.

  • Multi-variate regression analyses
  • Structural equation modeling
  • Direct consumer qualitative input (perceived benefit / satisfaction of a device)
  • Randomized controlled trials
  • Sequential Clinical Trials
  • Time-series concurrent differential (TSCD)
  • Qualitative

Update: The ATOMS Project

field scan 9 describe legal implications of at outcomes instrumentation
Field Scan 9 – Describe Legal Implications of AT Outcomes Instrumentation
  • What are legal & ethical issues related to AT outcomes systems? -- Steven Mendelsohn
    • Legal, responsible, & ethical data collection procedures
    • Potential legal ramifications of AT outcomes data (positive and negative)
    • Implications of AT outcomes for policy-making

Update: The ATOMS Project

field scan 10 review of special education technology literature
Field Scan 10– Review of Special Education Technology Literature
  • Review of 31 special education technology journals
  • Reviews published in Journal of Special Education Technology (1999, 2000, 2001)
  • >2700 articles
  • Iteration with outcome filter to identify relevant articles.
  • Summarize and report findings.

Update: The ATOMS Project

field scan 11 technology conference program review
Field Scan 11– Technology Conference Program Review
  • Last two years of CTG, CSUN, RESNA, and TAM conferences reviewed as fugitive literature.
  • Identify relevant papers on AT Outcomes.
  • Summarize and report findings.

Update: The ATOMS Project

field scan 12 chronology of assistive technology outcomes measurement
Field Scan 12– Chronology of Assistive Technology Outcomes Measurement
  • Literature review reveals that At outcomes have been measured differently over the decades
  • This is consistent with what types of outcomes studies have been performed and the mandate for accountability
  • This field scan will develop a chronology map and accompanying discussion

Update: The ATOMS Project

quiz on the field scans
Quiz on the field scans:
  • Just Kidding….
  • Lots of data from field scans. What do we hope to learn?
  • Technical reports
  • Compendium document
  • Consensus meeting

Update: The ATOMS Project

stakeholder focus groups
Stakeholder Focus Groups
  • Direct Feedback from field
  • Consumer/User groups (4)
  • Service Directors (for records & documentation assessment),
  • Payors of AT devices & services,
  • Researchers, Developers, & Manufacturers, and
  • Parents & Caregivers.

Update: The ATOMS Project

service director focus group april 2002
Service Director Focus Group – April 2002
  • Modified NGT developed current list of identified AT Outcomes data domains (“If we had a magic wand”)

1. Change in performance/function (body, structure, activity)

2. Change in participation

3. Usage and why or why not

4. Consumer satisfaction (process, devices)

5. Goal Achievement

6. QOL

7. Cost

8. Demographics

9. AT interventions (services + devices)

10. Environment context

  • List is similar to DeRuyter (1998)

Update: The ATOMS Project

databases national
Databases – National
  • National Health Information Survey-Disability (NHIS-D)
  • Assistive and information technology survey (NIDRR/RESNA/University of Michigan)

Update: The ATOMS Project

databases clinical
Databases – Clinical
  • UW-Stout
  • University at Buffalo (SUNY)
  • HHH
  • PROVAIL
  • What data are being collected?
  • Are available data sufficient for analysis?
  • Is there an intersection of outcome data fields among existing service file systems?
  • Can clinical programs adapt to collecting more data?

Update: The ATOMS Project

clinical database update
Clinical Database Update
  • Data fields
    • Commonalities (few) and differences (numerous)
    • Setting & funding specific (education, vocation, hospital, university)
    • Stakeholders (variable)
    • Electronic records (variable & minimal)
  • Potentials
    • VR data
    • Willingness of clinical programs to modify data collection

Update: The ATOMS Project

exploratory r d projects instrument development
Exploratory R&D Projects (Instrument Development)

a) AT DeviceInventory

b) ATServices Inventory

c) Cost Identification Feasibility Study

d) Assistive Technology Approach Isolation Measure (Subjective)

e) Web-based visualization

f) Environmental access assessment (WebAUDIT, MED-AUDIT)

g) Computer branching questioning (TTSS)

h) AT supplements to existing instruments (SFA-AT)

Update: The ATOMS Project

public school at outcome pilots collaborative activity
Public School AT Outcome Pilots & Collaborative Activity

a) Ohio

b) Colorado

Ohio

Colorado

Colorado

Update: The ATOMS Project

nidrr drrp coordination
NIDRR DRRP Coordination
  • CATOR (Consortium of Assistive Technology Outcomes Research) http://www.atoutcomes.org
  • ATOMS Project

http://www.atoms.uwm.edu

Update: The ATOMS Project

dissemination what to expect
Dissemination: What to Expect
  • ATOMS Project Website Products
  • Special Issues of Journals
  • Conference Presentations
  • 2003-2004 Symposium

Update: The ATOMS Project

dissemination atoms project products in the works
Dissemination: ATOMS Project Products in the Works
  • AT Outcomes Primer
  • Study Group Outline
  • Test Your Knowledge of AT Outcomes
  • FAQ’s
  • Course Guide (syllabi and more)
  • Drafts of Instruments
  • Technical Reports
  • Compilation of Needs & Current Outcome Directions
  • Implications for Next Generation AT Outcomes System

Update: The ATOMS Project

needs assessment participation opportunities
Needs Assessment Participation Opportunities
  • Conversation
  • Product developer survey
  • Instrument collection

Update: The ATOMS Project

contacting the atoms project
Contacting the ATOMS Project

Completing interest survey

Web:www.atoms.uwm.edu

Email:atoms@uwm.edu

Voice: (414) 229-6568

TTY: (414) 229-5628

Update: The ATOMS Project

questions answers and discussion

?

?

?

?

?

?

?

?

Questions, Answers and Discussion

Update: The ATOMS Project

thank you for your attention
Thank-you…. . . . for your attention!

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Update: The ATOMS Project

universal access features
Universal Access Features
  • The “speaker notes” associated with each slide in PowerPoint are used as a Universal Access feature.
  • They contain long text descriptions of the graphics because it was not feasible to do this with PowerPoint’s “alternative text” function. The descriptions can be used by new presenters and presentation attendees, in addition to being used for accessibility by people with vision or cognitive impairments.

Update: The ATOMS Project

viewing the speaker notes does not work within powerpoint viewer 97 or 98
Viewing the Speaker Notes(does not work within PowerPoint Viewer 97 or 98)
  • In the “Slide Show” view within PowerPoint:
    • Windows: right click on the slide or use the context key to bring up the context menu and then select “speaker notes”
    • Mac: [Ctrl] + click on the slide to bring up the context menu and then select “speakers notes”
  • The notes can also be seen as a frame or pane in the “Normal” view or directly by using the “Notes Page” view.
  • When in “Normal” view, F6 is used to switch between the slide, notes and outline panes respectively.

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Update: The ATOMS Project