AROC. Establishing and Maintaining a National Clinical Registry. Frances Simmonds, AROC Director

Transcription

1 AROC Establishing and Maintaining a National Clinical Registry Frances Simmonds, AROC Director

2 A R O C Australasian Rehabilitation Outcomes Centre A National Clinical Rehabilitation Registry

3 Rehabilitation population About 20% of Australians have a disability and 6% of the population has a profound or severe activity limitation. An increasing percentage of older people live alone - the ability to live in the community is often more dependent on functional independence than on medical factors

4 History of AROC - 1 No specific way of classifying rehabilitation outside of acute system Diagnostic Related Groups (DRG s) have 3 rehab codes; not specific Only one ICD-10 code for rehab, gives limited insight into rehabilitation

5 History of AROC - 2 The Australian government commissioned study... The Australian National Sub-Acute and Non-Acute Case-mix Classification (AN-SNAP) developed by CHSD, University of Wollongong in 1997 A bottom up costing study Identified the drivers in rehabilitation Recorded RUG-ADL, Barthel, FIM Recorded activity in 15 minute intervals

6 AN-SNAP classification study Involved 99 Australian and 5 NZ rehab units Collected detailed clinical, service utilisation and cost profile on over 30,000 sub-acute and non-acute episodes of care over a 3 month period Sub-acute care - enhancement of quality of life and/or functional status Non-acute care - maintenance of current health status if possible v4 AN-SNAP in development

7 History of AROC - 3 Rehabilitation doctors very involved in AN- SNAP project Wanted to use classification to begin to compare outcomes between different services Facilitated meeting of rehab sector stakeholders with objective of developing a national benchmarking system Outcome was business plan for development of AROC

8 AROC born in 2002 AROC began as a joint initiative of the whole Australian rehabilitation sector (providers, payers, regulators and consumers) with support from key New Zealand providers Established 1 July 2002 as a not-for-profit Centre The Australasian Faculty of Rehabilitation Medicine (AFRM) is the auspice body The Australian Health Services Research Institute (AHSRI) at the University of Wollongong is the data manager and responsible for AROC s day to day operations

9 AROC Purpose The purpose of AROC was established as, and continues to be: Develop a national benchmarking system to improve clinical rehabilitation outcomes for patients. Produce information on the efficacy of interventions through the systematic collection of outcomes information in both the inpatient and ambulatory settings. Provide annual reports that summarise the Australasian data.

10 AROC has 5 roles 1. Management of data - AROC is the national data bureau that receives and manages data on rehabilitation services in Australia and New Zealand 2. National benchmarking centre providing for rehabilitation services 3. National certification for the Functional Independence Measure (FIM) 4. Education and training and research for the FIM and other rehabilitation outcome measures 5. Research and development - AROC develops research and development proposals and seeks external funding for its research agenda

11 AROC as sector advocate AROC well positioned to promote the importance of rehabilitation in the continuum of care When Rehabilitation is effectively provided it: is the glue that sticks together acute care and community services results in people with greater functional ability and more independence lowers the incidence of readmission back to acute care minimises the requirement (and cost) of community services required

12 AROC coverage 232 rehabilitation services WA 17 NT 2 QLD 32 About 100,000 episodes per annum SA 8 NSW 86 ACT 4 VIC 42 TAS 5 New Zealand 39

13 AROC Funding Core funding Annual funding Subscription basis Data submitting members - $ per bed Non data submitting members lump sum based on historic calculation Ad-hoc funding for specific projects

14 AROC Governance Auspice body AFRM (Australasian Faculty Rehabilitation Medicine) MAG Management Advisory Committee SCAC Scientific and Clinical Advisory Committee

15 AROC Dataset De-identified dataset part of routine clinical data collection Bank of data items Six possible pathways, each requiring a subset of data items Core data items + impairment specific items Linkage key Integrates collection of rehab ACHS clinical indicators

16 Data Submission AROC Online Services (AOS) Web based data entry Access to reports Extract own data Upload data to AOS Data collected in own system Incorporated in PMS (eg Synaptix, NSW publics; Meditech, Ramsay) Uploaded online via specific formatted text file extract

17 AROC Outputs Routine periodic benchmarking reports Annual AROC Report: the state of the rehabilitation nation National LOS and FIM Change benchmarks Facilitate development of impairment specific outcome targets (workshops) Jurisdictional benchmarking workshops/quality forums Data/data analysis access available for bona fide research Process support/ help desk (resources, verbal advice) Training dataset, FIM, process

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19 Benchmarks by impairment

20 Benchmarks by AN-SNAP class

21 Recommended AROC Data Collection Process 1 Benchmarking Reports Allocate responsibility to distribute (widely) Use as part of quality plan Use in team planning days (process review and optimisation; patient and/or unit level outcome target setting) 7 Data Submission Submit AROC Online Services (AOS) user name/ password request Allocate responsibility to extract and submit AROC data (usually data entry person) 6 Preparation to Collect AROC Data AROC Membership Form FIM training/credentialing AROC dataset training 2 Data Collection Form Start with AROC proforma Modify to suit Unit s processes Submit to Forms Committee for Approval Include in Medical Record 3 Data Collection Process 1 Rehab team discussion Allocate responsibility for each data item (eg. demographic items admin staff impairment code rehab physician clinical items allied health team) 4 Data Entry Use AROC dataset compliant software (ie SNAPshot, Synaptix (NSW) HBCIS (Qld) Provide training for data entry person DO NOT require data entry person to make clinical decisions 5 Data Collection Process 2 Use case conference to facilitate data collection directly onto data collection form in medical record, (especially clinical data items like suspension days, co-morbidities, complications, leave days, relevant dates, FIM scores, etc) FIM Credentialing Allocate FIM champion Key FIM contact for AROC Responsible to ensure unit staff maintain training and credentialing status Establish AROC Resource Folder Keep in location easily accessible by rehab team members. Include in it: AROC Impairment Codes and the associated Coding Guidelines, Suspensions Explained, the AROC dataset and data dictionary copies of relevant dataset training slides Formal Multi-Disciplinary Rehab Plan Document Part of medical record Use to document rehab plan, goals, and progress against these during the episode

22 Benchmarking Reports AROC provides analysis of each individual member s data, and also compares that data to: themselves over time analysis of peer providers the national data industry developed impairment specific target outcomes

23 AROC Reports Core Reports Outcome Target Reports Impairment Specific Reports Analysis of all impairments, presenting the facilities data and comparing that to the either all public or all private data and the national data six monthly Graphical representation of each facility against each relevant outcome target, and how the facility compares to peers six monthly For stroke, brain injury, spinal cord injury, amputations, etc. provide greater analysis at an impairment level, and present facilities data and compare that to the national data - annually

24 Benchmarking reports AROC Benchmarking Reports are available to facility members electronically twice yearly

25 AROC Outcome Targets Report Inpatient Pathway 3 Anywhere Hospital July 2012 June 2013 Australasian Faculty of Rehabilitation Medicine

26 Impairment Specific Outcome Targets Benchmarking workshop & development of impairment specific outcome targets driven by desire to: evolve benchmarking beyond comparison of actual to aspiration for an (evidence based) target focus benchmarking at the impairment level identify and collect impairment specific data items which may include additional outcome measures especially relevant to a given impairment

27 How to interpret your graphs Page 27 AROC Target Outcomes Report (Inpatient - pathway 3) --- Anywhere Hospital from June 2013 to June d. 1. Impairment the graph is about 2. Target the graph is about 3. AN-SNAP class the graph is about 4.Target details for this AN-SNAP class for this impairment 5. Target value shown on graph 6. Line indicating target level 7. One bar per facility 8. Your facility will be highlighted if you had at least 5 episodes for this AN- SNAP class within this impairment: a) green indicates the target was achieved at your facility b) orange indicates your facility is within 5% of achieving the target c) red indicates your facility did not achieve the target d) if your facility achieved 0% for this

28 AROC Impairment Specific Report Inpatient Pathway 3 ORTHOPAEDIC FRACTURES Anywhere Hospital January 2012 December 2012 Australasian Faculty of Rehabilitation Medicine

29 Case mix adjustment

30 Casemix Adjustment AROC uses the AN-SNAP classification to statistically control for differences in the types of patients attending different hospitals Once we control for differences in the mix of patients, remaining differences in rehabilitation service performance start to reflect real differences between providers Facility LOS and FIM change adjusted for casemix to compare with sector data

31 CARMI Facility LOS (Expected, Actual, Difference) 31

32 CARMI Facility FIM Motor change (Expected, Actual, Difference) 32

33 Conclusion Casemix information is now routine in Australia Due to AROC, measuring rehabilitation patient outcomes is also now routine AROC data used in day to day clinical decision making as well as benchmarking/ review/ reflection Data collection integrated into standard rehabilitation processes Continue to learn how to use data to drive improvements in both efficiency and patient outcomes

34 EVIDENCE

35 AROC Contact Details Australasian Rehabilitation Outcomes Centre Australian Health Services Research Institute ic Enterprise 1, Innovation Campus University of Wollongong NSW 2522 Phone: Web: ahsri.uow.edu.au/aroc