CMLA Accreditation Workshopcmlainc.org/docs/CMLA_Accreditation_Workshop_2014.pdf · 2014-07-07 ·...

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James Carollo, PhD, PE

Gordy Alderink, PT, PhD

CMLA Board of Directors

June 25, 2014

CMLA Accreditation Workshop

GCMAS 2014 – CMLA Accreditation Workshop – June 25, 2014

Workshop Objectives

• Develop an understanding of the purpose, history & benefits of accreditation

• Inform the GCMAS membership about the CMLA accreditation process

• Describe the components of the application

• Answer general questions about the process of application completion

• Results of CMLA survey to the GCMAS membership

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CMLA Mission Statement

www.CMLAinc.org


Commission for Motion Laboratory Accreditation

Member Societies

AAOS – Tom Novacheck, MD

– Open

AAPMR – Katharine Alter, MD

– Dennis Matthews, MD

APTA – Juan Garbalosa, PhD, PT

(Treasurer)

– Wayne Stuberg, PT, PhD, PCS (Secretary)

GCMAS – Jim Carollo, PhD, PE

(President)

– Jim Richards, PhD

Directors-at-Large – Gordy Alderink, PT, PhD

(Vice-President)

– Freeman Miller, MD (Asst. Treasurer)

– Jean Stout, PT, MS (Past-President)

– Open

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Purpose of Accreditation

• Provide a “seal of approval” from an independent accrediting body

• Promote effective delivery of service with high quality standards

• Assure public confidence in clinical movement analysis

– Public: consumer and 3rd party payer

• Officially recognize laboratories delivering high quality service

• Encourage continuous quality improvement – Not just every 3 years; but a regular schedule of quality

improvement


Accreditation and Quality

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Does Accreditation Improve Quality?

• Not directly; However …

• It suggests a “Framework” for measuring and assuring quality

• Promotes an “Environment” where Quality can flourish

• To achieve accreditation, it requires the development of best practices/procedures that you always planned to implement, but perhaps never got around to.


Accreditation in UK and Ireland: CMAS

• Steve Attfield (Derby Gait Laboratory) • Rachael Boocock (Guy’s Hospital, London) • Tom Collins (Queen Mary’s, Roehampton) • Mark Corbett (MARCC, Worcester) • Colin Davenport (Sheffield Children’s Hospital) • Roisin Delaney (RNOH, Stanmore) • Wendy Dickens (Sheffield Children's NHS Trust) • Sally Durham (Queen Mary’s, Roehampton) • Helen Evans (Derby Gait and Movement Laboratory) • Sheila Gibbs (Institute of Motion Analysis & Research, Dundee) • Linda Eve (One Small Step Gait Laboratory, Guy’s Hospital) • Marian Harrington (Nuffield Orthopaedic Hospital, Oxford) • Penny Hewart (Central Remedial Clinic, Dublin / Newcastle Gait Lab) • Gill Holmes (Alder Hey Children’s Hospital, Liverpool) • Hazel Hughes (ORLAU, RJAH Orthopaedic Hospital, Oswestry) • Damien Kiernan (CRC Gait Lab, Dublin) • Jennifer McCahill (Oxford Gait Lab) • Ralph Palmer (West Midlands Rehab Centre, Selly Oak, Birmingham) • Emma Pratt (Sheffield Children’s Hospital) • Alison Richardson (Anderson Gait Laboratory, Edinburgh) • James Robb (Anderson Gait Laboratory, Edinburgh) • Jose Salazar (Musgrave Park Hospital, Belfast) • Tanya Sale (One Small Step Gait Laboratory, Guy’s Hospital) • Caroline Stewart (ORLAU, RJAH Orthopaedic Hospital, Oswestry) • Nicky Thompson (Nuffield Orthopaedic Hospital, Oxford) • Matt Thornton (RNOH, Stanmore) • Jill Vander Meulen (Sheffield Gait Labs)

28 members of the working group

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Steps

1 • Exchange of Protocols

2 • Formulation of Standards

3 • Training in audit

4 • Implementation of audit

5 • Management processes

6 • Registration and Fees

7 • Revision of Standards


Key Issues

• The training of staff

• Maintenance and calibration of equipment

• The use of standard, controlled protocols and recording forms

• Combination of clinical and technical expertise in conducting the data review session

• Controls placed on the production of the report

• Methods for reporting and managing problems

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CMAS: UK and Ireland

15 Accredited Laboratories

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Accreditation in USA: CMLA • 1990: Started as an ad-hoc committee of AACPDM

• 1997: CMLA incorporated in Delaware

• 1998: Accreditation committee within GCMAS formed

• 2001-2007: Assessment criteria development

• 2007: Initiated beta testing of criteria with 6 laboratories associated with CMLA Board members

• 2008: Website goes live; Began accepting applications

• 2009: First two laboratories received ‘Full Accreditation’

• 2010: CMLA granted tax-exempt, non-profit status

• 2011: First non-beta laboratories receive ‘Full Accreditation’

• 2013: First accredited labs achieve re-accreditation


Accreditation in UK/Ireland and US Key Issues

CMAS CMLA

Staff Training: Yes Yes

Equipment Maintenance & Calibration:

Yes Yes

Establish Controlled Testing Protocols:

Yes Yes

Data review w/clinical & technical expertise:

Yes No, but protocols must be defined

Defined Reporting Procedures:

Yes Yes

Procedures for reporting and managing problems:

Yes Yes, in form of a quality assurance program

Cost: $500 (annually) $750 (3 years)

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CMLA Application Review Criteria 1 of 10

Board Approved 10/26/2007

Application Review Criteria

Part 1: Administration and Personnel

Question 1: Summary Statement.

Statement of Laboratory’s scope, purpose and mission is provided. Stated purpose indicates that the

Laboratory is involved in clinical work.

Question 2: Lab Personnel/Titles/Credentials/Licensure.

Completed Table of Laboratory personnel included in application.

Appendix A is included – current CPR or BLS certificates of all staff with direct patient contact

provided.

Appendix B is included – current licensure verifications of all medical /clinical staff provided.

Laboratory demonstrates that clinical assessments and evaluation are being conducted by or under

the supervision of a clinician with credentials/licensure which includes assessment/evaluation within

the scope of practice for the population being served.

Laboratory demonstrates that any invasive procedures performed (including but not limited to fine

wire placement) are being conducted by or under supervision of a clinician whose

licensure/credentials include such procedures within the scope of their clinical practice.

The Laboratory demonstrates that data interpretation team includes at least one licensed clinician

with demonstrated knowledge and expertise for treatment of conditions present in the population

being served.

The Laboratory demonstrates that personnel involved in clinical recommendations have appropriate

licensure.

Question 3: Components of Clinical Evaluation

The application indicates that the Laboratory captures & reports 3-D kinematics

The application indicates that the Laboratory captures & reports 3 orthogonal components of force

(kinetics)

The application indicates that the Laboratory measures & reports electromyographic muscle activity

(EMG)

The application indicates that the Laboratory captures all components (kinematics, kinetics, & EMG)

simultaneously.


Accreditation in UK/Ireland and US Similar goals, different paths

CMAS CMLA

Origins: EU standards development Professional society committees

Year started: 1989 1990

Original Purpose: Develop EU standards Standards / Reimbursement

Refocus: 2001: Implementation of standards for UK/Ireland

1997: Independent corporation specifically for accreditation

Development of Requirements:

CMAS Working Group Shared protocols => Standards

Board Members from 4 professional societies => Criteria

Requirements Drafted By:

Members of CMAS CMLA Board of Directors: GCMAS, AAOS, APTA, AAPMR

Applicant Responsibility:

Maintain required procedures and records verified by

internal audit

Applicant Self Study: External review panel

Monitoring: Annually: External audit and site visit

3 years: Online submission, review panel

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CMLA Accreditation: Open to the World!

• Originally developed for USA laboratories only.

• Board of Directors included members of GCMAS, which is a North American society.

• Format of application is self study with online submission; therefore conducive to international applicants.

• In 2013, CMLA Board of Directors voted to allow international application.

• Currently, no accredited laboratories outside the US.


Why Should You Seek Accreditation?

• Receive recognition for delivering a high-level standard of care

• Allow peer review of your policies, procedures, and quality assurance programs

• Promote quality of care among all providers of clinical motion analysis services

• Beneficial for our profession for laboratories to achieve accreditation

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How to apply

• All applications are submitted electronically via the CMLA website (www.CMLAinc.org)

• Documents must be converted to pdf format and uploaded to the discussion forum assigned to your login

• Cost to submit a new application: $750US

• Application format and evaluation criteria can be found under the “Application Portal”


http://www.CMLAinc.org

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Evaluation Criteria

• 87 Accreditation Criteria

• Developed over several years by the CMLA Board of Directors to include the most important policies, procedures, and practices required in all clinical motion laboratories

• Reviewed regularly for updates/changes as part of continual quality improvement

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How is Accreditation Determined? • Each application is reviewed by a panel of at

least three individuals of different disciplines – Medical – Engineering/Technical – Clinical

• Review panel makes a recommendation to CMLA Board of Directors

• Board votes on the application • Accreditation level achieved is determined

by the number of major/minor deficiencies related to the established criteria


Levels of Accreditation

Full Accreditation – An application with no major and no more than four (4) minor deficiencies.

Provisional Accreditation – An application with no major and no more than eight (8) minor deficiencies.

– deficiency resolution allowed within 3-year period of accreditation

Accreditation Under Review – An application with either:

1. One or more major deficiencies or

2. No major, but more than eight (8) minor deficiencies

– deficiency resolution within 12 months of 1st review

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CMLA Review Activity 2013-14

• 9 Applications were reviewed by CMLA

• 2 of these were new, first time applications

• 7 were renewal or responses to deficiencies

• 4 Laboratories achieved Full Accreditation

– A. I. duPont Hospital for Children

– Gillette Childrens Specialty Healthcare

– MossRehab

– Shriners Hospital, Salt Lake City


Accredited Labs June 2014

• 8 Labs have achieved Full Accreditation • 6 Fully Accredited

• 2 labs in process

• 2 new labs are currently in the process of review

• 10 labs are registered awaiting application

• 2 previously accredited labs no longer accredited

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8 CMLA Accredited Labs in USA

A. I. duPont Hospital for Children, Wilmington, DE

Children’s Hospital Colorado , Aurora CO

Children’s Hospital Los Angeles, Los Angeles, CA

Gillette Children’s Specialty Healthcare, St. Paul, MN

Mayo Clinic, Rochester, MN

MossRehab, Elkins Park, PA

Shriners Hospital for Children – Salt Lake City, SLC, UT

Shriners Hospital for Children – Spokane, Spokane, WA


23 Accredited Labs Worldwide

15 8

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CMLA Accreditation Application Format

I. Administration & Personnel

II. Equipment and Data Collection

III. Data Processing/Data Management/Reporting


Part 1: Administration & Personnel

• Describe Laboratory Personnel (table)

– Licensure/credentials, expertise, roles

• Describe what comprises a “full diagnostic clinical motion study”

• Clinical evaluations (volume, diagnostic categories)

• Referral process

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Part 1: Administration & Personnel

• Training material

– Marker & electrode placement, data reduction, procedural consistency (QA), assessing competency (initial & annual)

• Policies & Procedures

– CPR training

– Safety

– Age specific competencies

• Accrediting agencies, eg, Joint Commission, CARF; institutional P & P


Part 2: Equipment & Data Collection

• Hardware Systems – Motion Capture System

– Force platforms

– Electromyography

– Foot plantar pressure

– Energy expenditure

• Data Collection Software

• Marker set and biomechanical model

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Part 2: Equipment & Data Collection

• Calibration – for all lab equipment

– Motion capture system, force platforms, EMG system, plantar pressure, etc.

• System accuracy (validity) & precision (reliability)

• Marker set and model definition

– Strengths, weaknesses

– Demonstrate you understand limitations


Part 3: Data Processing/Management/Reporting

• Software for data reduction

• Normal database

• Sample clinical report

• Data interpretation & clinical recommendations

• Patient confidentiality

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Tips on the Accreditation Process • Application is Comprehensive

• Application is Explicit: Between the application and criteria we tell you clearly what should be provided

• Not intended to be punitive

• Intent: Promote Continuous Quality Improvement

• Time Commitment – give yourself plenty of time for initial and any re-submissions

• Don’t expect to achieve accreditation on your first submission (similar to a journal article)


CMLA Survey 2014

• 2013 Strategic Planning Retreat

– CMLA BoD assessed the progress made since accepting applications in 2008

– A stable system was in place for performing our core function, i.e. accepting and reviewing laboratory applications

– Developed CMLA Vision Statement

– Motivation for the current survey

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2014 CMLA Survey

• Methods

– Developed survey questions over a 6 month period

– 23 questions

– Branching logic

– Combination of 5 point Likert scale, dichotomous branching, and open text responses

– Questions about accreditation process, intent to submit an application, website, and communication

– Two solicitations to the GCMAS mailing list


Survey Results

Is there a need for clinical motion laboratory accreditation?

Answer Options Response

Percent

Response

Count

Yes 84.6% 44

No 15.4% 8

answered question 52

• Response:

– 52/217

– 23.9% response rate

• Need for Accreditation

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Survey Results: Need

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Given your affirmation of a need for clinical motion laboratory accreditation, rate each of the following factors with respect to the value of accreditation:

Not ImportantAt All

SomewhatImportant

ModeratelyImportant

VeryImportant

ExtremelyImportant


Survey Results: Experience with Process

With respect to the accreditation process was your experience

beneficial or challenging?


Percent

Response

Count

Beneficial 5.9% 1

Challenging 17.6% 3

Both 76.5% 13


skipped question 1

Has your laboratory applied for accreditation?


Percent

Response

Count

Yes 42.9% 18

No 57.1% 24


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Survey Results: Challenges Are there other factors that you believe made the motion laboratory accreditation

process difficult?

Answer Options Response Count

10

• Process is too complex

• Too much overlap with Joint Commission

• Not always clear what response is expected

• Requirements are a burden

• Evaluation seems subjective; i.e. limited standards


Survey Results: Barriers

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Thinking about the effort required to submit an application, rate each of the following factors with respect to it being a barrier to achieving accreditation:

Not a Barrier

MinimalBarrier

ModerateBarrier

Large Barrier

ExtremelyLarge Barrier

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Survey Results: CMLA Responsiveness Did you have any personal communication/consultation with a CMLA

Board member or laboratory reviewer?


Percent

Response

Count

Yes 70.6% 12

No 29.4% 5


skipped question 1

The communication/consultation with the CMLA board member or lab reviewer was:

ExtremelyHelpful

Very Helpful

ModeratelyHelpful

SomewhatHelpful

Not Helpful AtAll


Survey Results: Website Have you visited the CMLA website?


Percent

Response

Count

Yes 63.4% 26

No 36.6% 15


Was the web site easy to navigate?


Percent

Response

Count

Yes 84.0% 21

No 16.0% 4


Was the web site useful?


Percent

Response

Count

Yes 83.3% 20

No 16.7% 4


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Survey Results: Suggested Improvements

• Improve the clarity of the application

• Provide example of responses and best practices

• Include North America not just US

• Website looks dated; consider modernizing


Limitations of the Survey

• Intent of the survey was to solicit information from the GCMAS members about Accreditation

– Not a scientific survey

– Survey questions haven’t been validated

– Not generalizable

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What we learned from this survey.

• For those who responded, a large majority feel accreditation is important

• Survey results as a whole affirmed CMLA’s current direction

• Acknowledge that the process is challenging, and there are barriers that need to be overcome

• Criticisms were constructive and will positively influence CMLA


Questions?

THANK YOU

www.CMLAinc.org

CMLA Accreditation Workshopcmlainc.org/docs/CMLA_Accreditation_Workshop_2014.pdf · 2014-07-07 ·...

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