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Outcome Measurement in Major Trauma

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Outcome Measurement in Major Trauma. Karen Hoffman. Clinical ... Neurosciences and Critical Care. Objectives. Why measure outcome. What do we need to measure ... – PowerPoint PPT presentation

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Title: Outcome Measurement in Major Trauma


1
Outcome Measurement in Major Trauma
  • Karen Hoffman
  • Clinical Specialist Occupational Therapist
  • Neurosciences and Critical Care

2
Objectives
  • Why measure outcome
  • What do we need to measure
  • When do we need to measure
  • Whats out there
  • Patient perspective
  • Provider perspictive
  • In the context of clinical outcome and
    rehabilitation

3
  • 1. Why measure outcome?

4
1. Why measure outcome?
  • Severe trauma remains the leading cause of death
    in people under the age of 30 due to incidental
    death (Mackenzie, et al., 1998)
  • Trauma patients occupy more hospital beds then
    all patients from heart diseases, and four times
    more than patients with cancer (Pickering et
    al., 1999)
  • World Health Organisation (WHO) predicts that
    trauma will rank third among he causes of
    disability in 2020 worldwide and has a
    significant global disease burden

5
1. Why measure outcome?
  • Measure the efficacy and effectiveness of acute
    care interventions, therefore, justifying
    healthcare expenditure (Halcomb et al., 2005)
  • Holistic view of patient recovery and experience
    after trauma (Richmond, 1997)
  • To prove the value and benefits of the services
    we provide
  • Establish preferred practice patterns and improve
    quality of services
  • Benchmarking - provide a standard of
    care/performance
  • Quality control measure for the government and
    the patient
  • Predict outcome
  • Marketing tool

6
(No Transcript)
7
  • 2. What do we need to measure?

8
World Health Organisation
Health Condition (disorder/disease)
9
Soberg et al, 2007. J Trauma,62471 481.
10
Using the ICF as a framework
11
2. What do we need to measure?
  • Baseline assessment
  • Treatment
  • which interventions are the most effective with
    resources available (rehabilitation programs)
  • The processes, pathways and systems
  • to ensure optimal outcome
  • The overall socio-economic cost
  • effectiveness and efficacy of rehabilitation,
    measured against the patient outcome and the
    impact on the society

12
  • 3. When do we need to measure?

13
3. When do we need to measure?
  • Throughout the patient pathway, e.g. on admission
    once stable, 2 weeks, 4 weeks, before discharge,
    3 months, 12 months, 2 years (Baldry Currens
    Coats 1999)
  • ICU, ward, discharge, in patient rehab,
    community, later
  • Consider pre-injury co-morbidities,
    socio-economic and demographic detail
  • Longitudinal lost to follow up

14
  • 4. Whats out there?

15
(Horwitz et al 2008)
16
4. Whats out there?
  • Trauma rehabilitation outcome scoring (Horwitz et
    al 2008)
  • Nottingham Health Profile and Rosser Disability
    Scale (Dimopoulou et al, 2004)
  • Kosar et al, (2009)
  • Hannover Score for Polytrauma Outcome (HASPOC)
  • Functional Capacity Index
  • AO/ASIF classification of fractures
  • Manual and the soft-tissue injury - Gustilo7
  • Closed fractures - Tscheme and Oestems.
  • Seekamp Injury 199627133-138

17
4. Whats out there?
  • Brief Symptoms Inventory to assess Post Traumatic
    Stress Disorder (PTSD)
  • Davidson Trauma Scale
  • Posttraumatic psychopathology
  • HADS
  • World Health Organisation Disability Assessment
    Schedule (WHODAS II )
  • SF-36
  • EQ-5D
  • PROductivity and DISbility questionnaire
    (PRODISQ )

18
4. Whats out there?
  • Multidimensional Health Locus of Control (MHLC)
  • peoples beliefs about their health as being
    determined by their own behaviours or not
  • The Brief Approach/Avoidance Coping Questionnaire
    (BACQ)
  • general coping strategies of approach/avoidance
  • Cognition
  • Head Injury Symptom Checklist (HISC)
  • FIM cognitive
  • COG self-assessed cognitive functioning
  • CAM

19
Cognition..
  • The majority of trauma survivors without
    intracranial haemorrhage display persistent
    cognitive impairment, which is nearly twice as
    likely in those with skull fractures or
    concussions. This cognitive impairment was
    associated with functional defects, poor quality
    of life, and an inability to return to work.
    Future research must delineate modifiable risk
    factors for these poor outcomes, especially in
    patients with skull fractures and concussions, to
    help improve long-term cognitive and functional
    status.
  • Jackson et al, 2007. Long-Term Cognitive,
    Emotional, and Functional Outcomes in Trauma
    Intensive Care Unit Survivors Without
    Intracranial haemorrhage. J Trauma, 628088.

20
5. Patient perspective
  • Zatzick et al, (2001)
  • Of all the things that have happened to you since
    you were injured, what concerns you the most?
  • What about this worries you?
  • How concerning is this to you?
  • Rated Physical health, psychological, work and
    finance, social, legal, medical
  • Anke Fugl-Meyer (2003) Life satisfaction
    several years after trauma
  • Satisfaction with leisure, family life and
    vocation

21
5. Patient perspective
  • Stineman et al (2007) and Kurtz et al (2008)
    Recovery Preference Exploration (RPE)
  • Focus on a persons qualities to promote positive
    adjustment rather than negative aspects of
    disability djustment

22
6. Provider perspective
  • Northwick Park Dependency Scale

23
Research Priority Recommendations - Clohan et al,
2007
  • Development of cognitive and psychosocial outcome
    measures, that are low in respondent burden and
    valid across patient populations
  • Development of measures of long-term outcomes
    that reflect participation, activity, and support
    system stability that can be obtained efficiently
  • Development of robust severity and selection
    criteria across different patient populations in
    PAC rehabilitation

24
Research Priority Recommendations - Clohan et al,
2007
  • 4. Evaluation of the reliability and validity
    of instruments across settings, diagnostic
    groups, and time points during the rehabilitation
    process
  • 5. Assessment of environmental factors to allow
    adjustment of outcomes related to supportive
    resources
  • 6. Development of evidence-based treatment
    guidelines and measurement systems to capture
    processes of care and outcomes to support quality
    improvement efforts and process- related payment
    systems
  • Clohan et al, 2007. Post acute Rehabilitation
    Research and Policy Recommendations. Arch Phys
    Med Rehabil, 88 1535-1541

25
In summary
  • Measure across the pathway
  • Consider the ICF as framework
  • Injury specific measurements and generic
    measurements
  • Patient perspective
  • Dependency
  • To Care for Him Who Shall Have Borne the Battle
    and for His Widow and His Orphan
  • (Abraham Lincoln)

26
References
  • Seekamp A, Regel G, Tscherne H Rehabilitation
    and reintegration of multiple injured patients
    an oucome study with special reference to
    multiple limb fractures. Injury 199627133-138
  • Zelle B, Stalp M, Weihs Ch, Müller F, Reiter FO,
    Krettek Ch, Pape HC Arbeitsgemeinschaft
    "Polytrauma" der Deutschen Gesellschaft für
    Unfallchirurgie. (Validation of the Hannover
    Score for Polytrauma Outcome (HASPOC) in a sample
    of 170 polytrauma patients and a comparison with
    the 12-Item Short-Form Health Survey) Chirurg.
    2003 Apr74(4)361-9.
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