Quality Improvement: Outcomes Measures
What are outcome measures?
Outcome measures are not new to the field of speech-language pathology. Outcome measures can be the short- and long-term goals and objectives that are established after the initial diagnostic work-up of a client. Measuring client outcomes as a QI activity obligates SLPs 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 ASHA's role in outcome measures?
ASHA established the Task Force on Treatment Outcomes and Cost Effectiveness in 1993 to create a national outcomes database for SLPs. In 1997, the National Center for Treatment Effectiveness in Communication Disorders took over this role. The key to ASHA's approach is the use of the seven-point Functional Communication Measures (FCMs), scored by a certified professional at client admit and discharge.
Speech-language pathologists with access to outcomes data possess a powerful tool for advocacy and negotiation. Participation in the National Outcomes Measurement System (NOMS) has the potential to enhance opportunities for reimbursement by increasing third-party coverage of services; improve the overall quality of care available to clients; help benchmark client progress; and guide the planning of staffing. For more information, go to ASHA's NOMS .
Speech-Language Pathology services:
Objective : 75% of clients will achieve stated discharge goals/objectives in language comprehension.
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 SLP 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 SLPs at that facility will follow when providing language treatment.
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.
Return to Quality Improvement Home Page