Core Outcome Measures for Adults with Neurologic Conditions: Pilot Implementation within Hospital-Based Outpatient Clinic
Purpose: To describe a pilot implementation project of 3 of the core neuro outcome measures (OMs) within a small outpatient clinic. Description: OMs provide standardized methods to track patient progress and functional status across levels of care. As the PT profession continues implementing standardized and evidence-based clinical practice guidelines (CPGs) to reflect expertise in the movement system, consistent use of OMs is crucial.1-3 A core set of OMs (COMs) CPG was developed for adults with neurologic conditions; tools to facilitate its use are being produced through the Academy of Neurologic PT (ANPT).4-6 PTs from new grads to clinical specialists should have adequate exposure to COMs and be able to administer them competently.7 Components of DPT education should be upheld once in the clinic. This capstone residency project is helping bridge that gap, bringing didactic and skills training into the clinic to refresh PTs’ OM exposure and facilitate standard and consistent use. Summary of Use: Needs assessment identified that the clinic (10-15 therapists) was not equipped to use COMs according to ANPT recommendations, and OMs were being used inconsistently. However, staff expressed willingness to begin adopting the CPG recommendations. Clinicians were provided ANPT administration guides and electronic medical record (EMR) documentation phrases. To introduce the CPG and COMs, an education session was given emphasizing recommended COM use, standardization of methods and interpretations, and group work for clinical decision-making with certain patient presentations. The session concluded with a departmental discussion on barriers to using OMs and a plan to address them, with the goal for intentional and consistent use beginning with 3 of the COMs. The department was equipped with a binder with laminated copies of ANPT guides, and the clinic was set up to standardize COM administration. For lab training, clinicians were provided copies of the 3 ANPT guides and a competency checklist, and each OM was demonstrated by the resident. During the lab, clinicians role-played alternating as therapist, patient, and observer for each OM to complete the checklist. Next steps of roll-out are currently in progress, beginning with a 5-week period to collect data, followed by data analysis. Implementation of the measures will occur during the 5 weeks, tracking frequency of OM use, documentation in the EMR, and incorporation into the plan of care as collected through a chart audit tool and weekly check-ins. It will also include a subjective pre/post survey to assess clinician learning outcomes and perceptions. Importance to Members: Barriers to OM administration are clinic-wide, and changing practice patterns may often be met with resistance.5,6,8-11 This pilot project may reflect a feasible way to standardize implementation of the COMs into hospital-based outpatient clinics in a way that is not overwhelming to clinicians nor overtly costly to management. This type of standardized OM implementation may also be able to aid in nation-wide outcomes tracking.