Looking in the clinical mirror: outcomes as a tool for refining intervention.

Alla Onitskansky, Aegis Therapies district manager for Ohio and West Virginia, sits at her desk printing the outcomes reports for the therapy departments at the 17 facilities in her district. Before her are individual patient's scores on the Rehabilitation Outcomes Measure (ROM) scale and facility reports aggregated by length of stay, therapy minutes, overall patient gains, and discharge locations.

"I love these reports," she says. "I can look at the evaluation and discharge scores of patients in each of my facilities and see those areas in which functional gain scores have greatly improved and which areas need work. That helps me with training."

For example, on this day, Onitskansky notices that certain patients haven't made anticipated gains at two facilities. "I can see that in one of my buildings, the therapist needs further training in dementia," she says. "Another needs training in stroke therapy. With outcomes information, I can strategize and put appropriate training resources where they are needed most."

The polar, or "spider," graph (below) is one of Onitskansky's favorite report tools, customized for each therapy patient. It dramatically shows the patient's ROM scores at admission compared with the ROM scores at discharge. With it and the accompanying Patient Overview Report, therapists can quickly see the results of their interventions.

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"I feel that outcomes reporting has an impact on clinical care," says Onitskansky. "With this kind of quantifiable result, the therapist can see what has been done. Sometimes therapists go from patient to patient and we don't have time to look back and really see what we can do better. With the reports and ROM scores, the information is right there."

She cites an example of one physical therapist who noticed that outcomes scores fell when her assistant provided therapy. "That made us research the problem," says Onitskansky. "We brought in extra training to help the therapist."

By slicing and dicing data, outcomes reports can present a patient's ROM score from several different perspectives. "The idea is to isolate what might have driven the outcome," says Mark Besch, Aegis vice-president of clinical services. "Was it a staffing issue or a function of comorbidity or age? Or perhaps patients are coming to us further post-onset. Outcomes information tells us where to look for answers."

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Hard numbers on patient improvement give staff a window into the positive changes they are making in patients' lives. "Since we've begun measuring outcomes, our staff has become more enthusiastic about patient progress," notes Mary Spooner, director of operations for Beverly Healthcare for Ohio. "That's a big boost for morale and job satisfaction."

Outcomes data are a key component of evidence-based practice. "It's important for us as an industry and for our profession to prove that we are doing a valuable job," says Onitskansky. "Not just by storytelling, but also by having a measurable outcome."