1
|
Ballmer T, Frey S, Petrig A, Gantschnig BE. Quality indicators for occupational therapy: a scoping review. BMC Health Serv Res 2024; 24:1054. [PMID: 39267071 PMCID: PMC11395972 DOI: 10.1186/s12913-024-11548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/05/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Occupational therapists are increasingly asked to demonstrate the effectiveness, appropriateness, and efficiency of their interventions to funding bodies. However, the extent to which this is practiced and the health policy context within which such a practice is situated differs internationally. The aim of this scoping review was to establish which quality indicators are used internationally for this purpose. METHODS We conducted a scoping review, limiting our search to Europe and the English-speaking world. To search for suitable literature, we used specialized databases from medicine, health sciences, and related fields, including CINAHL Complete and MEDLINE, as well as free internet search via Google. Furthermore, we contacted national occupational therapy associations from several countries asking for access to documents found within this search that were only accessible to association members. RESULTS The screening process identified 32 studies and documents from six national contexts. We identified and described process-level indicators, functional outcome indicators, one outcome indicator based on individual goal attainment (the Goal Attainment Scale, or GAS), and PRO-Ergo, a patient-reported experience measure (PREM). There was little information on the use of quality indicators to demonstrate the effectiveness, appropriateness, and efficiency of occupational therapy services to funding bodies in Europe and the English-speaking world that was openly available. The identified process indicators were in most cases not specific to occupational therapy interventions. Functional outcome indicators were highly specific to certain client groups or health conditions and partially appropriate for use in occupational therapy. The GAS was found to be a highly customizable measure which allowed an evaluation on body structure and function levels as well as activity and participation levels. PRO-Ergo was focused on the clients' subjective view and their experience with occupational therapy interventions. CONCLUSIONS All identified quality indicators have advantages and disadvantages. Process-level indicators specific to occupational therapy could be a chance to foster the use of best practice methods. GAS and PRO-Ergo seem to be the most versatile assessment, allowing an evaluation on the level of activity and participation. Functional outcome indicators that cover a broad area of client problems may be useful additional quality indicators for some areas of practice.
Collapse
Affiliation(s)
- Thomas Ballmer
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland.
| | - Sara Frey
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andrea Petrig
- Swiss National Association of Occupational Therapy (EVS/ASE), Bern, Switzerland
| | - Brigitte E Gantschnig
- Institute of Occupational Therapy, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Rheumatology and Immunology, University Hospital (Inselspital) and University of Bern, Bern, Switzerland
| |
Collapse
|
2
|
Proffitt R, Rasmussen KAM, Ma M, Skubic M. An Algorithm for Activity Recognition and Assessment of Adults Poststroke. Am J Occup Ther 2024; 78:7802180090. [PMID: 38346280 PMCID: PMC11017741 DOI: 10.5014/ajot.2024.050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
IMPORTANCE Stroke is the leading cause of long-term disability in the United States. Providers have no robust tools to objectively and accurately measure the activity of people with stroke living at home. OBJECTIVE To explore the integration of validated upper extremity assessments poststroke within an activity recognition system. DESIGN Exploratory descriptive study using data previously collected over 3 mo to report on algorithm testing and assessment integration. SETTING Data were collected in the homes of community-dwelling participants. PARTICIPANTS Participants were at least 6 mo poststroke, were able to ambulate with or without an assistive device, and self-reported some difficulty using their arm in everyday activities. OUTCOMES AND MEASURES The activity detection algorithm's accuracy was determined by comparing its activity labels with manual labels. The algorithm integrated assessment by describing the quality of upper extremity movement, which was determined by reporting extent of reach, mean and maximum speed during movement, and smoothness of movement. RESULTS Sixteen participants (9 women, 7 men) took part in this study, with an average age of 63.38 yr (SD = 12.84). The algorithm was highly accurate in correctly identifying activities, with 87% to 95% accuracy depending on the movement. The algorithm was also able to detect the quality of movement for upper extremity movements. CONCLUSIONS AND RELEVANCE The algorithm was able to accurately identify in-kitchen activities performed by adults poststroke. Information about the quality of these movements was also successfully calculated. This algorithm has the potential to supplement clinical assessments in treatment planning and outcomes reporting. Plain-Language Summary: This study shows that clinical algorithms have the potential to inform occupational therapy practice by providing clinically relevant data about the in-home activities of adults poststroke. The algorithm accurately identified activities that were performed in the kitchen by adults poststroke. The algorithm also identified the quality of upper extremity movements of people poststroke who were living at home.
Collapse
Affiliation(s)
- Rachel Proffitt
- Rachel Proffitt, OTD, OTR/L, is Associate Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Kial-Ann M Rasmussen
- Kial-Ann M. Rasmussen, MOT, OTR/L, is Graduate Research Assistant, Department of Occupational Therapy, University of Missouri, Columbia
| | - Mengxuan Ma
- Mengxuan Ma, PhD, is Software Engineer, MathWorks, Boston, MA
| | - Marjorie Skubic
- Marjorie Skubic, PhD, is Curators Distinguished Professor, Department of Computer Science and Electrical Engineering, College of Engineering, University of Missouri, Columbia
| |
Collapse
|
3
|
Dorich JM, Howell DM, Skubik-Peplaski C. Pediatric hand therapists' experiences with outcomes measurement: An interpretive descriptive study. J Hand Ther 2022; 35:233-244. [PMID: 35414421 DOI: 10.1016/j.jht.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/09/2021] [Accepted: 01/24/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Demonstrating that pediatric hand therapy patients are achieving improved functional and health status outcomes is critical as reimbursement for therapy services shifts to value-based reimbursement. Yet, practice patterns of outcomes assessment in pediatric hand therapy are unknown. PURPOSE Explore how pediatric hand therapists describe their experience measuring treatment outcomes and using patient reported outcome measures (PROMs). Secondarily, to elucidate what therapists perceive children and adolescents receiving hand therapy desire as treatment outcomes. STUDY DESIGN Interpretive descriptive qualitative study METHODS: Pediatric hand therapists were recruited through an email invitation sent to members of the Pediatric Hand Study Group to participate in one-on-one interviews over a teleconference link. Interviews were transcribed verbatim and coded to derive themes. Data collection and analysis were iterative. RESULTS Ten therapists with a median 13 years (range, 2-25 years) of experience practicing in pediatric hand therapy completed interviews. Overall, participants reported using 52 unique outcomes measures, including 20 PROMs. The following themes were elucidated: (1) Complexity and variability in pediatric hand therapy practice and outcomes assessment; (2) Barriers to PROM use; (3) Value of PROM utilization; (4) Desired characteristics of an optimal PROM for pediatric hand therapy. CONCLUSION Practice with outcomes assessment is variable. PROM utilization in pediatric hand therapy practice may be improved with the development of a PROM that is aligned with the pediatric population's outcomes priorities.
Collapse
Affiliation(s)
- Jenny M Dorich
- Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Dana M Howell
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, KY, USA
| | - Camille Skubik-Peplaski
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond, KY, USA
| |
Collapse
|
4
|
Rhodus EK, Lancaster EA, Hunter EG, Nudell T, Humphrey C, Duke M, Harris AM. Occupational Therapy Utilization in Veterans With Dementia: A Retrospective Review of Root Cause Analyses of Falls Leading to Adverse Events. J Patient Saf 2022; 18:e503-e507. [PMID: 34009869 DOI: 10.1097/pts.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Falls in persons with dementia are associated with increased mortality. Occupational therapy (OT) is a rehabilitation discipline, which has, among its goals, the promotion of safety and fall prevention in older adults and those with dementia. The purpose of this study was to evaluate root cause analysis (RCA) data to identify causes of falls with adverse events in patients with dementia who were referred to or receiving OT services within the Veterans Health Administration (VHA). METHODS This study used retrospective review of RCAs within the National Center for Patient Safety database for the VHA. The RCA database was searched using these terms: falls with adverse events, dementia, and OT. Descriptive statistical analysis of demographic information, location, occurrence of orthopedic fracture, and mortality was used. All root causes were qualitatively categorized using thematic analysis of determined causes. RESULTS Eighty RCAs were included in analysis. Mean age of veterans included was 80 years; 96% were male; 76% resulted in hip fracture; and 20% died as a result of the fall. Occupational therapy evaluations occurred within 7 days of admission to VHA and falls most frequently occurred within 4 days of OT evaluation. Most common causes included inappropriate or lack of equipment (21%), need for falls/rehabilitation assessment (20%), compliance/training to fall protocol of all staff (19%), and behavior/medical status (17%). CONCLUSIONS Earlier identification for OT evaluation need may improve access to services, and use of proper equipment to decrease frequency of falls may improve patient safety for older adults with dementia.
Collapse
Affiliation(s)
| | | | - Elizabeth G Hunter
- Graduate Center for Gerontology, University of Kentucky, Lexington, Kentucky
| | - Tina Nudell
- National Center on Patient Safety, U.S. Department of Veterans Affairs, Ann Arbor, Michigan
| | - Casey Humphrey
- Department of Occupational Science and Occupational Therapy, Eastern Kentucky University, Richmond
| | | | | |
Collapse
|
5
|
Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
Collapse
Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
6
|
Kinney AR, Fields B, Juckett L, Read H, Martino MN, Weaver JA. Learning Health Systems Can Promote and Sustain High-Value Occupational Therapy. Am J Occup Ther 2022; 76:23117. [PMID: 34962517 DOI: 10.5014/ajot.2022.049071] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In the current policy context, the occupational therapy profession must act to promote and sustain high-value care. Stakeholders have delineated efforts, such as defining and measuring high-quality care processes or promoting the adoption of evidence into practice, that can enhance the value of occupational therapy services. There is a growing recognition, however, that low-value care is the product of deficiencies within health care systems and is therefore most amenable to system-level solutions. To date, the specific nature of system-level changes capable of identifying and rectifying low-value occupational therapy has yet to be elucidated. In this "The Issue Is. . ." column, we introduce occupational therapy to the Learning Health System concept and its essential functions. Moreover, we discuss action steps for occupational therapy stakeholders to lay the foundation for Learning Health Systems in their own professional contexts. What This Article Adds: This article is the first to outline concrete action steps needed to transform occupational therapy practice contexts into Learning Health Systems. Such a transformation would represent a system-level change capable of fostering the delivery of high-value occupational therapy services to clients in a variety of practice settings.
Collapse
Affiliation(s)
- Adam R Kinney
- Adam R. Kinney, PhD, OTR/L, is Assistant Professor, Rocky Mountain Mental Illness Research, Education, and Clinical Center, Department of Veterans Affairs, Aurora, CO, and Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora;
| | - Beth Fields
- Beth Fields, PhD, OTR/L, BCG, is Assistant Professor, Department of Kinesiology, School of Education, University of Wisconsin-Madison
| | - Lisa Juckett
- Lisa Juckett, PhD, OTR/L, CHT, is Assistant Professor, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Halley Read
- Halley Read, MOT, OTR/L, is Clinical Assistant Professor, School of Occupational Therapy, College of Health Professions, Pacific University, Hillsboro, OR
| | - M Nicole Martino
- M. Nicole Martino, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy Education, Department of Health and Rehabilitation Sciences, University of Nebraska Medical Center, Omaha
| | - Jennifer A Weaver
- Jennifer A. Weaver, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, College of Health and Human Sciences, Colorado State University, Fort Collins
| |
Collapse
|
7
|
Wong SR, Ngooi BX, Kwa FY, Koh XT, Chua RJJ, Dancza KM. Exploring the meaning of value-based occupational therapy services from the perspectives of managers, therapists and clients. Br J Occup Ther 2021. [DOI: 10.1177/03080226211030095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction There is a worldwide trend towards value-based health care, which strives to control healthcare costs while maximising value for clients. The main concept of value has been defined as health outcomes achieved per US dollar spent. This research explored how clients of occupational therapy services, managers and occupational therapists perceived value in occupational therapy services. Method A qualitative design was used to explore the perspectives of clients ( n = 11), occupational therapists ( n = 7) and occupational therapy managers ( n = 7). Appreciative inquiry guided the two phases of semi-structured interviews ( n = 5) and focus groups ( n = 6). Inductive and deductive coding were used to establish themes. Findings Three themes encompassed the participants’ perceived value of occupational therapy services: (1) outcomes which are meaningful to daily life, (2) a constructive client–therapist relationship and (3) affordable, coordinated and understandable therapy. Conclusion Participants attributed value to occupational therapy services when they encountered personalised goal setting, focused on meaningful outcomes, managed personal costs and experienced positive therapeutic relationships. Enhancing services could focus on (1) developing skills in collaborative goal setting, (2) determining suitable outcome measures which are meaningful at personal- and service-level reporting, (3) encouraging self-management strategies, and (4) emphasising therapeutic relationships and supporting therapeutic communication skill development.
Collapse
Affiliation(s)
- Su Ren Wong
- National University Hospital, Singapore
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | | | - Fang Yin Kwa
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Xiang Ting Koh
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Changi General Hospital, Singapore
| | - Rachel J J Chua
- Health and Social Sciences, Singapore Institute of Technology, Singapore
- Ng Teng Fong General Hospital, Singapore
| | - Karina M Dancza
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| |
Collapse
|
8
|
Abstract
Despite technological advancements in health care documentation and the proliferation of electronic health records, health information and health data remain disparate. Patients and health care teams benefit from access to comprehensive patient records to make informed health care decisions. Significant governmental policy and investments have been made to promote interoperability of systems that connect health information with the ultimate intent of developing a longitudinal patient record. In this article, we discuss how health data, interoperability, and related systems are influenced by federal policy. The intent is to expand occupational therapy practitioners' understanding of the promise of interoperability and the role the occupational therapy profession can play in advancing the infrastructure needed to optimize health care delivery.
Collapse
Affiliation(s)
- Joy Doll
- Joy Doll, OTD, OTR/L, FNAP, is Vice President, Community and Academic Programs, CyncHealth, Omaha, NE
| | - Julie Malloy
- Julie Malloy, MOT, OTR/L, PMP, CPHQ, is Director of Quality, Practice Improvement, American Occupational Therapy Association, North Bethesda, MD;
| | - Jaime Bland
- Jaime Bland, DNP, MBA, RN, is President and Chief Executive Officer, CyncHealth, Nebraska Health Information Initiative, Omaha
| |
Collapse
|
9
|
Burgess G, Jensen LE. Occupational therapy for adults with brain tumors in the acute care setting. NeuroRehabilitation 2019; 45:151-161. [PMID: 31498143 DOI: 10.3233/nre-192799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The number of adults diagnosed with brain tumors is increasing, as are the survival rates. Neurological impairments from brain tumors can impact activity and participation. Adults with brain tumors benefit from post-acute rehabilitation. However, there is limited evidence from the acute care setting. The purpose of this study was to examine how acute care occupational therapy services were utilized and whether patients made functional gains after receiving occupational therapy services. A retrospective chart review of 153 electronic medical records was completed for patients who received occupational therapy services at a large teaching hospital. Data collected included number of occupational therapy visits, the types of interventions, and patient performance using the Boston University Activity Measure for Post-Acute Care "6 Clicks for Daily Activity" short form (AM-PAC). More than half the patients received one occupational therapy visit (54.2%) with a median length of stay of three days. Most interventions focused on activities of daily living (ADLs). Of those patients who received more than one visit, 67% showed improvements in their AM-PAC scores. Occupational therapy practitioners provided interventions that addressed ADLs, and patients demonstrated gains in functional performance. These findings suggest that patients benefit from occupational therapy services provided in the acute care setting.
Collapse
Affiliation(s)
- Gillian Burgess
- University of California, San Francisco, Medical Center, San Francisco, CA, USA.,School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA
| | - Lou E Jensen
- School of Pharmacy and Health Professions, Creighton University, Omaha, NE, USA.,Department of Occupational Therapy, Creighton University, Omaha, NE, USA
| |
Collapse
|
10
|
Wong C, Fagan B, Leland NE. Occupational Therapy Practitioners' Perspectives on Occupation-Based Interventions for Clients With Hip Fracture. Am J Occup Ther 2019; 72:7204205050p1-7204205050p7. [PMID: 29953839 PMCID: PMC6023641 DOI: 10.5014/ajot.2018.026492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Occupational engagement is the foundation of occupational therapy. We identified perspectives of 18 occupational therapy practitioners on integrating occupation-based interventions during postacute care (PAC) rehabilitation for persons with hip fracture to identify occupational therapy's distinct contribution. METHOD We conducted six focus groups derived from a purposive national sample of occupational therapy practitioners (N = 18). A secondary analysis was conducted to analyze the transcripts for major subthemes around occupation-based interventions. RESULTS Three major themes arose from practitioners' perspectives regarding the role of occupation in rehabilitation: (1) conducting an occupational profile, (2) integrating occupation-based intervention in the facility, and (3) identifying goals for occupational engagement after discharge. Challenges and strategies for integrating occupation-based interventions were also identified. CONCLUSION Identifying practitioners' perspectives on integrating occupation into rehabilitation may inform strategies to facilitate occupation-based interventions in PAC and define occupational therapy's role in this setting.
Collapse
Affiliation(s)
- Carin Wong
- Carin Wong, MS, is PhD Candidate, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles;
| | - Brenda Fagan
- Brenda Fagan, OTR/L, is Project Manager, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, is Associate Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, and Davis School of Gerontology, University of Southern California, Los Angeles
| |
Collapse
|
11
|
von Zweck C, Alchouron C, Brandis S, Bressler S, Buchanan H, Clouston T, Cox C, Moreno L, Reistetter T, Zur A. Development of a Quality Indicator Framework for occupational therapy. WORLD FEDERATION OF OCCUPATIONAL THERAPISTS BULLETIN 2019. [DOI: 10.1080/14473828.2018.1556962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Claudia von Zweck
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Carolina Alchouron
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Susan Brandis
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Sandra Bressler
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Helen Buchanan
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Teena Clouston
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Camilla Cox
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Lucila Moreno
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Tim Reistetter
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| | - Ariela Zur
- WFOT Quality Indicators Project Expert Working Group, Geneva, Switzerland
| |
Collapse
|
12
|
Takata SC, Wade ET, Roll SC. Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. J Hand Ther 2019; 32:1-9. [PMID: 28647322 PMCID: PMC5740027 DOI: 10.1016/j.jht.2017.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/08/2017] [Accepted: 05/25/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Mapping review. INTRODUCTION Although published literature and evidence to support medical practice is becoming more abundant, it is not known how well available evidence supports the full spectrum of hand therapy practice. PURPOSE OF THE STUDY The aim of this mapping review was to identify strengths and/or gaps in the available literature as compared with the hand therapy scope of practice to guide future research. METHODS A systematic search and screening was conducted to identify evidence published from 2006 to 2015. Descriptive data from 191 studies were extracted, and the diagnoses, interventions, and outcomes used in the literature were compared with the hand therapy scope of practice. RESULTS Osteoarthritis, tendon surgeries, and carpal tunnel syndrome were most frequently studied. Exercise, education, and orthotic interventions were most common, each used in more than 100 studies; only 12 studies used activity-based interventions. Primary outcome measures included range of motion, pain/symptoms, strength, and functional status. DISCUSSION Abundant high-quality research exists for a portion of the hand therapy scope of practice; however, there is a paucity of evidence for numerous diagnoses and interventions. CONCLUSIONS More evidence is needed for complex diagnoses and activity-based interventions as well as behavioral and quality-of-care outcomes. LEVEL OF EVIDENCE Not applicable.
Collapse
Affiliation(s)
- Sandy C Takata
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Emily T Wade
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA.
| |
Collapse
|
13
|
Unsworth CA, Timmer A, Wales K. Reliability of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT). Aust Occup Ther J 2018; 65:376-386. [DOI: 10.1111/1440-1630.12476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Carolyn A. Unsworth
- School of Health, Medical and Applied Sciences; Central Queensland University; Melbourne Vic. Australia
| | - Amanda Timmer
- Donvale Rehabilitation Hospital-Ramsay Health Care; Donvale Vic. Australia
- School of Health, Medical and Applied Sciences; Central Queensland University; Rockhampton City Qld Australia
| | - Kylie Wales
- School of Health Sciences; University of Newcastle; Callaghan NSW Australia
| |
Collapse
|
14
|
Sandhu S, Furniss J, Metzler C. Using the New Postacute Care Quality Measures to Demonstrate the Value of Occupational Therapy. Am J Occup Ther 2018; 72:7202090010p1-7202090010p6. [PMID: 29426378 DOI: 10.5014/ajot.2018.722002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
As the health care system continues to evolve toward one based on quality not quantity, demonstrating the value of occupational therapy has never been more important. Providing high-quality services, achieving optimal outcomes, and identifying and promoting occupational therapy's distinct value are the responsibilities of all practitioners. In relation to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014, the Centers for Medicare and Medicaid Services (CMS) is implementing new functional items and related outcome performance measures across postacute care (PAC) settings. Practitioners can demonstrate the role and value of occupational therapy services through their participation in data collection and the interpretation of the resulting performance measures. In this column, we review the objectives of the IMPACT Act, introduce the new self-care and mobility items and outcome performance measures being implemented in PAC settings, and describe ways to use these new data to advocate for occupational therapy. We also discuss American Occupational Therapy Association initiatives to provide materials and guidance for occupational therapy practitioners to contribute to PAC data collection.
Collapse
Affiliation(s)
- Sharmila Sandhu
- Sharmila Sandhu, JD, is Counsel and Director of Regulatory Affairs, American Occupational Therapy Association, Bethesda, MD
| | - Jeremy Furniss
- Jeremy Furniss, OTD, MS, OTR/L, BCG, is Director of Quality, American Occupational Therapy Association, Bethesda, MD;
| | - Christina Metzler
- Christina Metzler is Chief Public Affairs Officer, American Occupational Therapy Association, Bethesda, MD
| |
Collapse
|
15
|
Kroll C, Fisher T. Justifying Rehabilitation Intensity Through Functional Performance Measures in Postacute Care. Am J Occup Ther 2017; 72:7201090010p1-7201090010p6. [PMID: 29280708 DOI: 10.5014/ajot.2018.721002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) has scrutinized the provision of rehabilitation services in skilled nursing facilities (SNFs) for some time. Little research guidance exists on appropriate dosage or rehabilitation intensity (RI) among SNF patients or patients in other postacute care (PAC) settings. CMS developed a PAC assessment, the Continuity Assessment Record and Evaluation (CARE) Tool, in response to questions about what issues drive placement in various PAC settings under Medicare. The ability to adequately assess functional outcomes and correlate them to the RI provided by using the CARE Tool is promising. However, further research, policy advocacy, and practice analysis must be undertaken to promote and protect adequate access to occupational therapy and physical therapy in SNFs and other PAC settings. Individual practitioners must participate in data gathering to ensure that the data for analysis are fully informed by the occupational therapy perspective.
Collapse
Affiliation(s)
- Christine Kroll
- Christine Kroll, OTD, MS, OTR, FAOTA, is Clinical Assistant Professor, School of Health and Rehabilitation Sciences, Department of Occupational Therapy, Indiana University at Indianapolis (IUPUI);
| | - Thomas Fisher
- Thomas Fisher, PhD, OT, CCM, FAOTA, is Dean, Vera Z. Dwyer College of Health Sciences, Indiana University South Bend;
| |
Collapse
|
16
|
Schwartz JK, Smith RO. Integration of Medication Management Into Occupational Therapy Practice. Am J Occup Ther 2017; 71:7104360010p1-7104360010p7. [DOI: 10.5014/ajot.2017.015032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Occupational therapy practitioners enable clients to improve performance in everyday occupations. As health care reform precipitates changes across health care service organizations, occupational therapy professionals must seize the opportunity to apply their unique skills and perspective to meet the changing needs of clients and other stakeholders. In this article, we explore the role and distinct value of occupational therapy practitioners in one area of changing need: medication management. We find that occupational therapy practitioners have unique skills that complement the factors affecting medication nonadherence and evidence-based interventions. With reforms to research, teaching, and practice, occupational therapy practitioners can better integrate medication management into regular evaluation and treatment, thereby contributing to broader patient outcomes defined by the Affordable Care Act.
Collapse
Affiliation(s)
- Jaclyn K. Schwartz
- Jaclyn K. Schwartz, PhD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami;
| | - Roger O. Smith
- Roger O. Smith, PhD, OT, FAOTA, RESNA Fellow, is Professor, Department of Occupational Science and Technology, College of Health Sciences, and Director, Rehabilitation Research Design and Disability Center, University of Wisconsin–Milwaukee
| |
Collapse
|
17
|
Yuen HK, Spicher HS, Semon MR, Winwood LM, Dudgeon BJ. Perceptions of Occupational Therapists on the Patient Protection and Affordable Care Act: Five Years After Its Enactment. Occup Ther Health Care 2017; 31:84-97. [PMID: 28094586 DOI: 10.1080/07380577.2016.1270480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study explored the perceptions of occupational therapists regarding the impact and implications of the Patient Protection and Affordable Care Act (PPACA or ACA) on occupational therapy practice. Fifteen occupational therapists participated in an interview to answer open-ended questions related to their thoughts and perceptions regarding the impact and implications of the ACA on their practice. The participants were practicing in eight different states and worked in five different settings with clinical experience ranging from 3 to 38 years; their positions ranged from staff therapist to owner of a free-standing outpatient clinic. Qualitative content analysis was used to synthesize the interview transcripts. Results showed that therapists did not have sufficient knowledge on the various mandates and provisions of the ACA, or were uncertain about what implications the ACA would have on practice, with the ACA affecting some settings more than others. Data revealed the perceived impacts of the ACA on occupational therapy practice include greater attention on documenting outcome-focused care, external accountability pressures on productivity, conscientiousness about clients' insurance coverage, uncertainty about collaborative care delivery, and survival of small businesses. Findings suggest training regarding knowledge about and implications of different elements of the ACA is needed as well as practices needing to promote the services that occupational therapists can provide to improve cost-effectiveness and outcomes in collaborative care environments.
Collapse
Affiliation(s)
- Hon K Yuen
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Hillary S Spicher
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Madelyn R Semon
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Leah M Winwood
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| | - Brian J Dudgeon
- a Department of Occupational Therapy , School of Health Professions, University of Alabama at Birmingham , Birmingham , AL , USA
| |
Collapse
|
18
|
Streater A, Spector A, Aguirre E, Orrell M. Cognitive stimulation therapy (CST) for people with dementia in practice: An observational study. Br J Occup Ther 2016. [DOI: 10.1177/0308022616668358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The delivery of cognitive stimulation as a cognitive based psychosocial intervention for people with mild to moderate dementia is supported in the National Institute for Health and Care Excellence guidelines. There is a strong evidence base for its effectiveness in providing improvements in cognition and quality of life for people with dementia. However, less is known about its delivery and its impact using outcome measures when used in practice. Methods A 1-year observational study was conducted, which measured the cognition and quality of life of 89 people with dementia living in care homes and the community and were in receipt of cognitive stimulation therapy and a maintenance programme as part of their usual care in practice. Results A paired sample T-test demonstrated a significant improvement in cognition. Quality of life remained unchanged for people with mild to moderate dementia. Conclusions This study reports promising findings with demonstrated benefits for people with dementia and strengthens the evidence base supporting its use in routine care. However, attention should be given to the level of cognitive impairment of attendees. This research is relevant to the field of occupational therapy as the profession has knowledge of using psychosocial interventions and a commitment to evidence-based practice.
Collapse
Affiliation(s)
- Amy Streater
- Senior Researcher, Research and Development, Goodmayes Hospital, Ilford, UK
| | - Aimee Spector
- Reader in Clinical Psychology, Research Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Elisa Aguirre
- Clinical Research Health Psychologist, Research and Development, Goodmayes Hospital, Ilford, UK
| | - Martin Orrell
- Director of the Institute of Mental Health, University of Nottingham, Nottingham, UK
| |
Collapse
|
19
|
Rogers AT, Bai G, Lavin RA, Anderson GF. Higher Hospital Spending on Occupational Therapy Is Associated With Lower Readmission Rates. Med Care Res Rev 2016; 74:668-686. [DOI: 10.1177/1077558716666981] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients’ functional and social needs, which can be important drivers of readmission if left unaddressed.
Collapse
Affiliation(s)
| | - Ge Bai
- Johns Hopkins University, Baltimore, MD, USA
| | - Robert A. Lavin
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
20
|
Abstract
Abstract
Occupational therapy practitioners play an important role in improving the health of populations through the development of occupational therapy interventions at the population level and through advocacy to address occupational participation and the multiple determinants of health. This article defines and explores population health as a concept and describes the appropriateness of occupational therapy practice in population health. Support of population health practice as evidenced in the official documents of the American Occupational Therapy Association and the relevance of population health for occupational therapy as a profession are reviewed. Recommendations and directions for the future are included related to celebration of the achievements of occupational therapy practitioners in the area of population health, changes to the Occupational Therapy Practice Framework and educational accreditation standards, and the importance of supporting, recognizing, rewarding, and valuing occupational therapy practitioners who assume roles in which direct care is not their primary function.
Collapse
Affiliation(s)
- Brent Braveman
- Brent Braveman, PhD, OTR/L, FAOTA, is Director, Department of Rehabilitation Services, University of Texas MD Anderson Cancer Center, Houston, and Secretary, American Occupational Therapy Association (2013–2016);
| |
Collapse
|
21
|
Mroz TM, Pitonyak JS, Fogelberg D, Leland NE. Client Centeredness and Health Reform: Key Issues for Occupational Therapy. Am J Occup Ther 2015; 69:6905090010p1-8. [PMID: 26356651 PMCID: PMC4564793 DOI: 10.5014/ajot.2015.695001] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Health reform promotes the delivery of patient-centered care. Occupational therapy's rich history of client-centered theory and practice provides an opportunity for the profession to participate in the evolving discussion about how best to provide care that is truly patient centered. However, the growing emphasis on patient-centered care also poses challenges to occupational therapy's perspectives on client-centered care. We compare the conceptualizations of client-centered and patient-centered care and describe the current state of measurement of client-centered and patient-centered care. We then discuss implications for occupational therapy's research agenda, practice, and education within the context of patient-centered care, and propose next steps for the profession.
Collapse
Affiliation(s)
- Tracy M Mroz
- Tracy M. Mroz, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle;
| | - Jennifer S Pitonyak
- Jennifer S. Pitonyak, PhD, OTR/L SCFES, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Donald Fogelberg
- Donald Fogelberg, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle
| | - Natalie E Leland
- Natalie E. Leland, PhD, OTR/L, BCG, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, Herman Ostrow School of Dentistry, and Davis School of Gerontology, University of Southern California, Los Angeles
| |
Collapse
|