Our practice standards expect evidence-based approaches to the care we deliver. More and more, health plans including Medicare, Medicare Advantage and various commercial insurances are requesting outcomes to measure the value of the services we provide. Just recently, the IMPACT Act was signed into law, which will require standardized reporting of outcome measures for patients receiving therapy services in Post-Acute Care Settings.
Standardized outcome measures provide a common language with which to evaluate the success of therapy interventions. This provides a basis for comparing outcomes related to different intervention approaches. Measuring outcomes of care within the relevant components of function, including body functions and structures, activity and participation among patients with the same diagnosis is the foundation for determining which interventions comprise the best clinical practice.
As professionals we need to capture evidence-based documentation. Incorporating standardized tests is an easy way to show evidence-based data to support our intervention.
There are a number of tests that are available for free and many are referenced in the POSTette located on the Therapy Portal entitled, “Therapy Tests and Measures.” Some tests do require purchase and can be expensive – we recommend focusing on the diagnoses you treat most and purchase accordingly.
Standardized measures also help to:
- Identify dysfunction and deficits
- Remove subjective factors from assessment
- Provide results that can be generalized and repeated, which provides for external validity and reliability
- Compare deficits to normative data by age group
- Provide a “starting” point especially with the increased emphasis on evidence based practice
- Provide measurable/objective outcomes for patient success from start of care to discharge to improve quality of care
- Provide evidence based information to support intervention and reimbursement
- Allow for tracking and trending of outcomes over time.
To Enter the Contest: Complete a blog entry below on how you successfully implemented the use of standardize testing into your clinical programming and documentation. A committee will review all entries to determine winners. The names of winners will be posted and prizes will be sent to you at your facility. HAVE FUN!!
The Deadline: Friday December 19th
The National Outcome Measurement System (NOMS) is a standardized outcomes measurement developed by the American Speech-Language and Hearing Association. This allows Certified NOMS users to measure the outcomes related to SLP services provided and compares performance using various demographics. The CARE Item Set (Continuous Assessment Record of Evaluation) is a set of measures being used to measure the efficacy of PT and OT service delivery in the Post Acute setting within two domains of Mobility and Self Care. Tools such as NOMS and CARE provide us with another standardized tool for measuring our outcomes and analyzing how we can improve with efficient and effective care delivery.
Here at Glenwood Care Center in Oxnard, CA we have implemented the use of standardized testing on all evaluations for PT and OT. We encourage staff to make customized goals in order to track progress and note improvements with standardized measures. We find that doing this gives us a concrete comparison of a patients function throughout their stay. It also allows us to make researched base comparisons regarding fall prediction, safety, and overall independence when determining when someone is able to discharge home and what assistance they may require upon discharge from family or caregivers. We hope that Rehab Optima will soon allow us to link our standardized tests to our progress notes as well for good continuity of reporting. We look forward to further incorporating standardized measures into our evaluations and progress notes to further validate our skilled interventions.
Hi Aimee… How can I help to make sure SLP is also integrating standardized tests? Nice work for PT and OT 🙂
There are multiple outcomes measures that are quick and easy to use in the clinic and give not only reliable, but predictive information. At Northern Oaks, we use these tools daily and have incorporated them into our goals. In the geriatric population, the 6 min. timed walk test and the timed 30 sec. sit to stand test have been found to be valid and reliable predictors of function in the elderly and specifically with pt’s who have hip and knee OA. Also, the Berg Balance Scale and the Timed Up and Go are valid and reliable measures that are predictive of fall risk. Recent research indicates that grip strength may give us important information about our patients, including predictors for mortality, disability and even time spent in the hospital. These tests are simple, g-code friendly, time effective, based in research, and most of all, support the need for our skills: Because what we do has value and we can prove it!!
Hi Billye –
It looks like you and your team are doing a nice job integrating standardized tests. Your comment was more PT / OT focused – so please let me know if I can support your SLPs on integrating standardized testing into their practice if needed.
At Pacific Care and Rehabilitation Center we make standardized testing a pivotal part of our discussion, intervention, and goals for each of our patients. Doing this allows us to develop individualized treatment protocols that provide an excellent focus on areas that will get our patients home at an earlier date. On a weekly basis we meet together as an interdisciplinary rehab team and discuss individual patients with their standardized test results to review their performance and movement toward successful attainment of their rehabilitation goals. We use a myriad of standardized tests including: Berg Balance Scale, Dynamic Gait Index, Allen Cognitive Level, MOCA, SLUMS, BORG RPE, verbal analog pain scale, Timed Up and Go, Arm Curl Test, Sit to stand tests, 4 square test, gait speed tests, Barthel Index, CARE item set and RIPA-G, and others. We use a broad spectrum approach in our testing to ensure we develop the safest possible discharge plan for our patients in their journey back home at a safe and functional level. Our pursuit is focused providing the very best care for our patients and standardized testing keeps us accountable for their success.
Nice Job Scott!! Looks like your team is using a variety of great assessments to capture baseline data. I also love how you tie it back to safe discharge planning.
I am an occupational therapist at Willow Bend in Dallas, TX and I have used the Allen Cognitive Level Screen Assessment and the Allen Cognitive Level Module (placemat) to better work with and understand patients which enhances my ability to create interventions that are specific for each patient. Understanding a patients cognitive level is very important with pain management as well, often times patients are on PRN pain medications instead of scheduled pain medications. Patients with a certain Allen Cognitive level are unable to plan ahead for therapy or simply do not have the insight or memory to request pain medications.
When understanding the patient’s cognitive level it allows me to adapt interventions and work with other disciplines such as nursing to maximize patient independence with engagement in morning ADL routine.
Understanding a patients cognitive level allows us to create proper goals that are attainable. Also when documenting patient progress or current functional references it is always important to reference the cognitive level to help reviewers understand why this patient may or may not be able to go home safely or does require continued skilled services.
As the therapy world around us changes, standardized testing is becoming an integral part of what we do. Although we as therapists recognize the importance and necessity of our interventions, standardized assessments help us to prove that need to outside payor sources and reviewers. At Willowbend, we use a multitude of standardized tests, including the Barthel ADL Index, Tinetti and Berg Balance tests, and the RIPA-G, among others, in order to determine the baseline functional level of our therapy patients. In addition to providing objective data, it also helps us to become better therapists and assist with safe discharge planning. When we see our patient beginning to meet their goals, the standardized tests help remind us of different areas of functioning we may have not yet addressed. It assists us in validating that no further deficits remain to ensure that we leave no therapy stone unturned while providing our patients with the most skilled, individualized and complete therapy experience possible.
LGCR Standardized Assessments Check out Lemon Grove Care and Rehab’s blog.
Ann-Marie, great article! Thank you for the work you are doing at Lemon Grove as a great leader in the community. Me
Thanks, Deb! Another fabulous article written by my OTR, Huy Dinh! I am so blessed to have such a GREAT team.
I love using the Dynamic Gait Index test because it looks at gait, balance, and helps quantify fall risk. This particular test looks at not only steady gait, but gait with challenges such as turning ones head, stepping over/around obstacles, gait speed, and taking some steps. I can’t think of any better test that truly looks at so many different aspects of gait that our patients use in the real world each day. When documenting the test results, I describe how there score relates to potential fall risk, less than 19 is indicative of potential falls. When creating one’s treatment plan the PT can determine what areas were impaired and create goals/treatment that is correlated with improving, turning head while ambulating, or changing gait speed, etc.
At Willow Bend we promote evidienced based practice. Having a team that supports and believes in the benefits of standardized testing is a stepping stone to a sucessful evidienced based program. The standardarized test program we have implimented at WB has helped us become better by delivering increased quality of treatment services. It facilitates sucessful outcomes for our patients who return home and helps to track and measure progress in the LTC population. I am the DOR at Willow Bend and am very proud of my therapist and the outcomes they contribute to daily
Standardized Test are very important to provide objective data versus subjective. They are very important for us to make a more accurate assessment, therefore providing a much better service to our patients/residents. Here at Northbrook Healthcare Center, we are using Standardized Testing and Objective Measures to measure the progress of our patients. We have a day dedicated to do our Standardized test on a weekly basis (Balance Test Friday, Cognitive Test Tuesdays, etc). This year, we are also going to have a monthly staff in-service where we present to our team one Standardized Test that we use to better understand the implications of the Standardized Test. This way, the team will have a more holistic view of the patient and will be able to set their realistic goals based on each and every therapist’s assessment.