Quality Improvement: Outcome Measures
What are outcome measures?
Outcome measures are not new to the field of audiology. Outcome measures can be the assessment of the benefits of an intervention such as amplification or the goals and objectives that are established after the initial diagnostic work-up of a client. Measuring client outcomes as a QI activity obligates audiologists to address the efficacy and efficiency of client interventions.
Third party payers have historically based reimbursement decisions on the progress clients make during treatment. With the pressure to contain costs, payers and administrators will no longer tolerate "carte blanche" delivery of services without monitoring the cost, benefit, and outcomes of those services.
What is an example of outcome measures?
Objective:75% of clients will achieve stated discharge goals/objectives for hearing aid orientation.
Method of collection:100% of discharged client files are reviewed at the time of discharge to determine if initial goals/objectives were achieved, not achieved, or exceeded.
Information is tracked by client type, clinician, and severity. Information is collected and reviewed monthly. Those clients who did not achieve or exceeded discharge goals/objectives are routed back to the primary audiologist for analysis.
Reason for non-attainment of goal/objective:
- Client-related: Motivation, attendance record, illness, severity, complications, psychosocial/economic/cultural/ethnic factors
- Treatment-related: Method, approach, client appropriateness, frequency, comprehensiveness
- Financially-related: Coverage of services by payer, limits on frequency or duration of treatment, limits on follow-up/after-care
What needs to be done after the initial outcome data is collected?
After the analysis and feedback from the practitioner, the reason for non-attainment of outcome goals/objectives may be determined to be the result of insufficient treatment or teaching sessions, with clients returning too often for instruction and education which should have been delivered during the initial or follow-up sessions. An action taken then to improve the quality of care may include:
- additional teaching sessions
- additional teaching or instructional techniques (handouts, videotapes, self-tests)
- development of a protocol or outline which all audiologists at that facility will follow when providing hearing aid orientation
To complete the QI cycle, this same indicator and method of collection will be monitored for the next few months, to determine if there is a greater incidence of clients meeting discharge goals/objectives. If so, then indeed the quality of care has been improved.