Functional Outcome Measures : KUH Acute Care Functional Outcomes Tool & Barthel Index

1. Functional Outcome Measures: KUH Acute Care Functional Outcomes Tool & Barthel Index Mijo T. Cotic, SPT The University of North Carolina at Chapel Hill

3. Objectives • Understand how functional outcome measures can be used for clinical decision making regarding individual patients and program evaluation. • Understand the importance of the use of functional outcome measures and of impairment level characteristics in distinguishing the cause/causes of functional limitation and disability (or limitation in activity and participation) and in determining appropriate intervention strategies. • Interpret the characteristics of standardized measures critically through the study of statistical strategies for clinical decision-making.

4. Objectives • Be familiar with the properties and clinical use of KUH Acute Care Functional Outcomes Tool and Barthel Index along with their use in the Paragon documentation system • Understand Validity and Reliability and what makes an effective functional outcome tool

5. Why Use Functional Outcome Measures in the Clinic/Hospital? • A measurable baseline status of the patient/client • Evaluation • A means to quantify change in the patient’s/client’s functioning • Research • Provide information about whether predicted outcomes are being realized • Formulate appropriate interventions • Demand to use evidence based tools is growing

6. Functional Outcome Measures by Condition See Handout

7. What to look for in a functional outcome tool? Validity and Reliability

9. What to look for in a functional outcome tool? Validity and Reliability

10. Validity • The degree to which a measurement instrument measures the construct that it is supposed to measure

11. Measurement Validity • Construct • Content • Criterion

12. Construct • The validity of the abstract constructs that underlie the measures • ?

13. Content • The extent to which a measure is a complete representation of the concept of interest • ?

14. Criterion • How does a “new” measure compare to the “Gold or Reference” Standard

15. Reliability • AKA Precision! • A tendency to yield the same result when the same item is measured under the same conditions multiple times • Intra and Inter

16. Intra-Rater Reliability • Consistency in which an observer assigns a response on two occasions Some time later Observer 1 – 130 deg Observer 1 – 130 deg

17. Inter-Rater Reliability • Consistency in which two different observers assigns a response on the same measurement Observer 2 – 130 deg Observer 1 – 130 deg

18. Relationship between Reliability and Validity • Validation studies are used to assess accuracy between two measures when a “Gold Standard” exists. • Reliability can be present without validity • Validity must be accompanied by reliability • Unreliable measures are invalid • A reliable measure is valid only if it provides accurate information

19. KUH Acute Care Functional Outcomes Tool and Barthel Index A Closer Look

20. Barthel Index • Purpose: Assesses the ability of an individual with a NM or MSK disorder to care for him/herself • Description: • 10 ADL/mobility activities including: • Feeding, Bathing, Grooming, Dressing, Bowel Control, Bladder Control, Toileting, Chair Transfer, Ambulation, Stair Climbing * Items rated based on the amount of assistance required to complete each activity

22. Alternative Functional Outcome Measures:Barthel Index • FIM • FIM + FAM

23. Why was the KUH developed? • The need to demonstrate positive outcomes of patients receiving acute hospital care services (especially ICU) • Incentives to improve quality of care • Currently, most tools are disease-specific • Focus on overall activity level and functional abilities • Many tools are not appropriate for outcomes in hospital patients • Provide data on improved function and mobility of intensive care patients • More sensitive to change

24. KUH Acute Care Functional Outcome Tool • FIM is Gold Standard for IPR units • KUH developed to provide outcomes to physicians at interdisciplinary quality improvement team meetings • Retrospective study designed to determine validity of the KUH • Change of scores from admission to discharge of both KUH and FIM were compared • Mean score improvement for KUH tool was 4.5 points and 2.6 points with the FIM • Demonstrates effectiveness of PT interventions, even for a few visits while in the acute hospital setting • Why?

25. Results • Strong correlation between KUH and FIM with regard to the change of the total KUH score and the transfer and gait FIM score • 0.86 • Strong correlation comparing change between the two tools with patients discharged home and to other inpatient care • 0.84 and 0.86 The KUH is valid!

26. Alternative Functional Outcome Measures:Barthel Index • Johns Hopkins Acute Care Tool

27. Take Home Message • Reasons for payer denials of PT and OT services include lack of documentation of skilled care • Medicare and other third party reimbursement entities require evidence of MEASURABLE improvements in impairments and function

28. PARAGON Documentation Demo See TV screen

29. Questions?