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Author Kaplan, Sandra L.
Title Outcome measurement and management : first steps for the practicing clinician / Sandra L. Kaplan.
Imprint Philadelphia : F.A. Davis Co., [2007]

Author Kaplan, Sandra L.
Subject Medical rehabilitation.
Outcome assessment (Medical care)
Treatment Outcome.
Data Collection -- methods.
Data Interpretation, Statistical.
Patient Care Planning -- organization & administration.
Practice Patterns, Physicians'.
Description xx, 250 pages : illustrations ; 26 cm
Bibliography Note Includes bibliographical references and index.
ISBN 9780803603103 (alk. paper)
OCLC # 67817113
Table of Contents
 PART 1 Defining Outcomes in Clinical Practice1
 Chapter 1 An Introduction to Outcome Measurement and Management 
 Chapter Outcomes and Key Terms3
 A Brief History of Outcome Research in Physical Therapy5
 This Book Will Help the Individual Clinician6
 The Clinician as Data Collector7
 Patient Care Management Parallels the Research Process7
 You Are What You Write9
 The Strength Is In the Numbers9
 Some Challenges of Retrospective Chart Reviews10
 The Benefits of Conducting Retrospective Outcome Studies10
 Health Insurance Portability and Accountability Act Privacy Rule11
 Chapter 2 An Outcome Approach to Patient Care Management 
 Chapter Outcomes and Key Terms15
 Defining Outcomes16
 Examples of the Definition Applied to Studies17
 An Outcome Approach to Patient Care18
 A Travel Analogy18
 Determining Patient Care Goals With an Outcome Approach19
 Patient Outcomes Are Different From Therapeutic Indicators19
 Selecting Interventions21
 All Outcomes Are Relative23
 Strategies for Ensuring Satisfaction With the Goals24
 Begin at the End24
 Include the Patient in Goal Setting25
 Ask Direct Questions26
 Identify the Value Placed by the Patient on Functional Losses26
 Educate the Patient27
 Identify Meaningful Measures of Functional Change28
 An Outcome Approach to Examination Is Different29
 The Fix-It Approach29
 The Evaluate-and-Treat Approach29
 Documentation Formats and the Outcome Approach31
 Location of the Goals31
 Patient Exposure to the Goals31
 Reflective Practice and Self-Evaluation32
 2A Sample Portion of a Traditional Initial Evaluation Format35
 2B Sample of an Outcome-Oriented Documentation Format37
 Chapter 3 Common Outcomes in Rehabilitation 
 Chapter Outcomes and Key Terms41
 Common Outcome Measures in Rehabilitation42
 Patient Outcomes43
 Functional Outcomes43
 Option 1: Normative Standards44
 Option 2: Relative Standards44
 Option 3: The Criterion Reference45
 Considerations in Choosing a Measurement Approach46
 Examples From the Literature47
 Social/Role Outcomes47
 Quality of Life Outcomes48
 Health-Related Quality of Life Outcomes48
 Examples From the Literature49
 Provider Outcomes in Rehabilitation50
 Impairment Outcomes50
 Examples From the Literature51
 Clinician Role Development52
 Clinician/Physical Therapist Satisfaction52
 Examples From the Literature53
 Service Outcomes53
 Patient Satisfaction53
 Service Satisfaction54
 Technical or Competence Satisfaction54
 Humaneness Satisfaction55
 Goods Satisfaction55
 Access Satisfaction55
 Examples From the Literature55
 Cost Outcomes56
 Unit Cost56
 Examples From the Literature58
 Medical Outcomes58
 Morbidity and Mortality Rates58
 Medical Treatment Effectiveness59
 Quality-Adjusted Life-Years59
 Quality-Adjusted Time Without Symptoms and Toxicities60
 Chapter 4 Consumers of Outcome Data 
 Chapter Outcomes and Key Terms65
 The Consumers66
 Patients and Clients66
 Family and Friends67
 Special Interest Groups68
 Work and Community Groups68
 The Providers69
 Individual Service Providers69
 Clinical Settings70
 Health-Care and Reimbursement Agencies71
 Professional Associations73
 Other Medical Professions74
 Business and Industry75
 Integrating Different Perspectives in Outcome Data76
 Different Perspectives Influence the Question Studied76
 Different Perspectives May Influence How Results Are Explained77
 Chapter 5 Models of Disablement 
 Chapter Outcomes and Key Terms81
 Theories and Models82
 Models of Disablement82
 The System Level83
 The Body Level84
 The Task Level84
 The Context Level84
 The Social/Role Level84
 The Confusion in Terminology85
 Application of Disablement Models to Clinical Practice85
 Models Describe Relationships Between Impairments and Function85
 Models Can Help Clinicians to Organize Examinations87
 Models Help to Organize Plans of Care87
 Chapter 6 A Model of Rehabilitation Service Delivery 
 Outcomes and Key Terms91
 A Model of Health Services Delivery92
 The Inputs92
 The Processes92
 The Outcomes93
 A Model of Rehabilitation Services Delivery93
 The Interaction of Inputs and Processes Resulting in Outcomes95
 Simple Designs95
 Complex Designs96
 PART 2 Implementing an Outcome Study101
 Preface to Part2 
 Chapter 7 Developing a Question 
 Chapter Outcomes and Key Terms103
 Identify an Outcome of Interest104
 Creating an Answerable Question105
 Model of Rehabilitation Service Delivery105
 Converting the Question into a PICO or PIO Format108
 Using Available Data to Develop a Question110
 Going to the Literature111
 Why Go to the Literature?111
 Where to Search111
 What If No Literature Is Found?112
 Recommended Resources113
 Chapter 8 Identifying a Rationale for the Study 
 Chapter Outcomes and Key Terms117
 The Rationale: An Operational Definition118
 Why a Rationale Is Needed119
 The Rationale Should Be Specific119
 Reasons for Conducting Outcome Studies120
 Measuring the Clinician's Own Clinical Effectiveness120
 Providing Data to Support Patient Management Decisions121
 Providing Data to Support Service Delivery Decisions122
 Adding to the Larger Body of Knowledge122
 Chapter 9 Coding Data From Clinical Documentation 
 Chapter Outcomes and Key Terms125
 The Benefits of Using a Coding System126
 Standardization of Terminology126
 Reduction of Variability in Documentation126
 Enhanced Completion of Documentation127
 Comparison Within Individuals127
 Comparison Across Individuals Within a Setting128
 Comparison and Collaboration Among Clinical Sites128
 The Qualities of Useful Coding Systems129
 Operational Definitions129
 Mutually Exclusive Categories130
 Breadth and Depth130
 Ease of Use130
 Sources of Coding Confusion131
 Examples of Coding Systems133
 Disease Coding133
 Impairment Coding134
 Disability Coding135
 ICF (Formerly ICIDH)135
 Minimum Data Set137
 Unified Parkinson Disease Rating Scale137
 Intervention Coding137
 CPT Codes138
 The National Classification of Physiotherapy Practice 2000138
 Coding Data From Narrative Notes139
 Chapter 10 Constructing the Data Set 
 Chapter Outcomes and Key Terms143
 The Basic Components of a Data Set144
 Relational Databases145
 The Coding Handbook147
 The Data Recording Form150
 Practical Tips for Entering Data Into a Spreadsheet151
 One Data Bit Per Cell152
 Record the Smallest Unit of Measurement Possible152
 Avoid Entering Transformed Data152
 Missing Data152
 Cleaning the Data152
 Example of a Simple Spreadsheet153
 Recommended Readings154
 Chapter 11 Data Analysis 
 Chapter Outcomes and Key Terms155
 A Strategy for Reading the Data156
 The Three Levels of Data Analysis157
 Statistics for Data Analysis159
 Descriptive Statistics159
 Correlative Statistics for Parametric Data159
 Correlative Statistics for Nonparametric Data160
 Comparative Statistics for Parametric Data160
 Comparative Statistics for Nonparametric Data160
 Choosing a Statistic160
 Interpreting the Data161
 Is the Question Answered?161
 Statistical Versus Clinically Meaningful Results161
 Potential Limitations to a Study163
 Sampling Bias163
 Procedure Variability164
 Measurement Bias164
 Historical Bias164
 Experimental Bias165
 Recommended Resources165
 Chapter 12 Using and Sharing the Data 
 Chapter Outcomes and Key Terms167
 Changing Patient Care Management168
 Potential Practice Changes Resulting From Outcome Studies168
 Changes in Documentation Processes168
 Changes in Service Delivery Processes169
 Staff Development Initiatives170
 Potential Misuses of Outcome Data170
 Constructing a Final Report171
 A Format for Reporting172
 Tailoring the Report for Different Audiences174
 A Study for Internal Use Only175
 A Report That Others May Read175
 Dissemination of the Results176
 Methods of Dissemination176
 Internal Reports177
 Poster Presentations177
 Platform Presentations177
 Non Peer-Reviewed Publications178
 Peer-Reviewed Publications178
 Consider Collaborating179
 PART 3 Integrating Outcome Measurement and Clinical Practice181
 Preface to Part 3 
 Chapter 13 Considerations for Conducting Outcome Studies 
 Chapter Outcomes and Key Terms183
 Outcome Addiction184
 Pilot Data May Not Fairly Represent Practice184
 One Clinician May Not Reflect Other Clinicians in a Practice185
 Learning About Outcome Studies Takes Time185
 Project Manager Responsibilities186
 Commitment and Communication186
 Identifying a Question186
 Time and Task Management186
 Institutional Review Board Preparation187
 Education and Morale Management187
 Preparation of the Final Report187
 Staff Preparation188
 Consensus on the Need for Studying Outcomes188
 Consensus on the Use of Data189
 The Value of Identifying Best Practice Patterns189
 The Impact on Documentation Time189
 Documentation Changes190
 Staff Reliability for Coding Data191
 Staff Reliability for Patient Documentation191
 Appreciation of Everyone's Contributions191
 The Costs of Studying Outcomes191
 Training and Supplies192
 Number of Charts to Review192
 Membership Fees193
 Technical Assistance193
 Extending a Study194
 Implementing Changes194
 Change Is Challenging194
 Outcome Measurement Is an Ongoing Process195
 Secrets to Success195
 Keep It Simple195
 Balance "Necessary" With "Interesting"196
 Choose an Outcome Study With Confidence196
 Chapter 14 Mixing Outcome Measurement With Practice Management 
 Chapter Outcomes and Key Terms199
 Quality Assurance200
 Small qa Versus Large QA200
 Continuous Quality Improvement201
 Total Quality Management202
 Five Areas to Measure202
 Steps of CQI/TQM203
 Step 1: Identify Problems204
 Step 2: Select a Priority for Improvement and Define Variables204
 Step 3: Collect Data204
 Step 4: Analyze Causes of Key Problems205
 Step 5: Develop Solutions and Set Goals205
 Step 6: Implement and Monitor205
 Clinical Pathways, Care Paths, and Protocols206
 Examples of the Effectiveness of Clinical Pathways208
 Developing a Clinical Pathway209
 Practice Guidelines209
 Benchmarking Definitions211
 Levels of Benchmarking211
 Benchmarking Steps212
 Examples From the Literature214
 Applications to Practice214
 Appendix 1 Conduct a Pilot Study of Documentation Patterns217
 Appendix 2 Model of Rehabilitation Services Delivery for Sample Question223
 Appendix 3 Sample Data Set225
 Appendix 4 Sample Codes and Operational Definitions227
 Appendix 5 Sample Data Calculations229
 Appendix 6 A Sample Pilot Study231
 Appendix 7 Answer Key to Exercises (Chapters 5, 6, and 7)239

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