Occupational Therapy Service Outcome Review using the Outcome Measure SPREE (Service Performance...

Occupational Therapy Occupational Therapy Service Outcome Review Service Outcome Review

using the Outcome Measure SPREEusing the Outcome Measure SPREE(Service Performance Record of Effectiveness and Efficiency)(Service Performance Record of Effectiveness and Efficiency)

By

Amil Magpantay

Clinical Specialist OT

Objectives

• To discuss the “Drivers”

• To introduce and discuss SPREE

• To show our method

• To present Outcome of Service

Why we did what we did

I.I. Quality, Innovation, Performance and Quality, Innovation, Performance and Prevention (QIPP)Prevention (QIPP)

II.II. Top Ten Priorities for Stroke Service Top Ten Priorities for Stroke Service Research – Research – DOH publication 2008DOH publication 2008

III.III. Current Political Climate and TrendCurrent Political Climate and Trend

Driver 1: QIPP

Quality & PerformanceQuality & Performance

This initiative sought to measure and report performance of the OT service in This initiative sought to measure and report performance of the OT service in Stroke Service using data obtained from SPREE as an alternative to existing Stroke Service using data obtained from SPREE as an alternative to existing method of service reportingmethod of service reporting

Government Standard Government Standard

‘‘You should expect your care provider to routinely check the quality of their You should expect your care provider to routinely check the quality of their services’services’

InnovationInnovation

Use of Use of Service Performance Record of Effectiveness and EfficiencyService Performance Record of Effectiveness and Efficiency (SPREE)(SPREE) as a tool to measure outcome of the service as a tool to measure outcome of the service

Driver 2: Top Ten Priorities for Stroke Top Ten Priorities for Stroke Service ResearchService ResearchDOH Publication 2008DOH Publication 2008

By Professor Charles Wolfe, Dr Anthony Rudd, By Professor Charles Wolfe, Dr Anthony Rudd, Dr. Christopher McKevitt, Dr Peter Heushmann, Dr. Christopher McKevitt, Dr Peter Heushmann, Professor Lalit KalraProfessor Lalit Kalra

• Relevant

Priority 10:Priority 10: Development of Comprehensive Outcome Development of Comprehensive Outcome Measures for Stroke that can be Universally Adopted Measures for Stroke that can be Universally Adopted by the Stroke Communityby the Stroke Community

• Gaps in the Evidence BaseGaps in the Evidence Base–SimpleSimple and widely applicable and widely applicable tools to tools to

measure the outcome of interventions measure the outcome of interventions should be developedshould be developed

• Summary of Research NeedsSummary of Research Needs–Research is required Research is required to develop to develop

common outcome measurement toolscommon outcome measurement tools acceptable to all professional groups acceptable to all professional groups and to patients and their carersand to patients and their carers

Driver 3: Current Political Climate and TrendCurrent Political Climate and Trend

• Generally themes around Outcomes, Generally themes around Outcomes, Commissioning, Payment by Results, Commissioning, Payment by Results, Promoting Services, QIPP, evidences re: Promoting Services, QIPP, evidences re: Achievements.Achievements.

OT News OT News

Naomi HankinsonNaomi HankinsonChairman of COT councilChairman of COT council

‘‘Now is the time to stop being hesitant andNow is the time to stop being hesitant and

be bold about what we achieve’ be bold about what we achieve’

‘ ‘ We need to back up with evidence and We need to back up with evidence and

share our achievements’share our achievements’

Lisa HughesLisa HughesAllied Health Professions Officer at DHAllied Health Professions Officer at DH

““If somebody loses their commissioningIf somebody loses their commissioning

because their service is not good enough, Ibecause their service is not good enough, I

don’t have a problem with that. If you lose the don’t have a problem with that. If you lose the

commission because you didn’t put out the commission because you didn’t put out the

information about how good it is, that’s a information about how good it is, that’s a

tragedy”tragedy”

The biggest problems encountered amongThe biggest problems encountered among

AHPs in promoting their own servicesAHPs in promoting their own services

were:were:

1.1. failure to tell the storyfailure to tell the story

2.2. a lack of key data and informationa lack of key data and information

3.3. a lack of confidence a lack of confidence

4.4. waiting to be told by others what to dowaiting to be told by others what to do

Service Performance Record Service Performance Record of Effectiveness and Efficiencyof Effectiveness and Efficiency

(S.P.R.E.E.)(S.P.R.E.E.)

• Day to day document with a re-designed system Day to day document with a re-designed system of measurement that can record, quantify, report of measurement that can record, quantify, report and measure the Outcome of the OT Service. and measure the Outcome of the OT Service.

• Measures “Effectiveness” and “Efficiency” Measures “Effectiveness” and “Efficiency” rendered by the Service (Occupational Therapy)rendered by the Service (Occupational Therapy)

• Records number of problems reported by the Records number of problems reported by the clientsclients

• Based on Goal Setting and Outcome ReportingBased on Goal Setting and Outcome Reporting

Problem and Goal Themes

• Focused on “Occupational Concerns”

• Related to OT parameters of Assessment and Intervention– Value– Independence– Safety– Adequacy of Performance

EFFECTIVENESSEFFECTIVENESS The percentage of problems addressed and The percentage of problems addressed and

resolved by the serviceresolved by the service

EFFICIENCYEFFICIENCY

The percentage of the problems The percentage of the problems FULLYFULLY resolved resolved by the serviceby the service

WHAT DOES IT LOOK LIKE?WHAT DOES IT LOOK LIKE?

Case Study

Mr A. with R CVA, Left Hemiparesis

ProblemProblem GoalGoal Action/sAction/s OutcomeOutcomeGoal Goal

Achievement Achievement

ValueValue



ValueValue

Unable to get out Unable to get out

of bedof bed



ValueValue


of bedof bed

Patient will be Patient will be

able to get out of able to get out of

bed independentlybed independently



ValueValue


of bedof bed




Functional Functional

Mobility re-Mobility re-

training, assess training, assess

need for adaptive need for adaptive

equipment, issue equipment, issue

identified adaptive identified adaptive

equipmentequipment



ValueValue


of bedof bed

Patient is not Patient is not

safe strip safe strip

washingwashing










equipmentequipment



ValueValue


of bedof bed



washingwashing





able to strip wash able to strip wash

safelysafely







equipmentequipment



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment

-Washing practiceWashing practice-Identify and issue Identify and issue

needed adaptive needed adaptive

device if requireddevice if required



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment




Patient can get Patient can get

out of bed with out of bed with

stand by stand by

assistanceassistance



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment






stand by stand by


Patient can strip Patient can strip

wash safely with wash safely with

the use of perch the use of perch

stoolstool

Goal Achievement ValueGoal Achievement Value

Fully achievedFully achieved == 22

Partially AchievedPartially Achieved == 11

Not AchievedNot Achieved == 00



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment






stand by stand by





stoolstool



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment






stand by stand by





stoolstool

11



ValueValue


of bedof bed



washingwashing






safelysafely







equipmentequipment






stand by stand by





stoolstool

11

22

2 4

1 2

1 1

0 0

375%

50% 2

FORMULAFORMULAHow do we measureHow do we measure

Effectiveness Effectiveness

Actual Outcome Score divided by Expected Actual Outcome Score divided by Expected Outcome Score multiply to 100Outcome Score multiply to 100

2 4

1 2

1 1

0 0

375%

50% 2

EfficiencyEfficiency

Goals that are Fully Achieved divided by Goals that are Fully Achieved divided by Total Goals multiplied to100Total Goals multiplied to100

2 4

1 2

1 1

0 0

375%

50% 2

HOW WE DID IT

• Obtained support from OT Professional LeadObtained support from OT Professional Lead

• Initially piloted for 3 months (End of July to end of October 2011)Initially piloted for 3 months (End of July to end of October 2011)

• Follow up implementation for 11 months: from January to November Follow up implementation for 11 months: from January to November 20122012

• Occupational Therapy Service was monitored using the data Occupational Therapy Service was monitored using the data obtained from the use of obtained from the use of SPREESPREE

RESULTS AND FINDINGSRESULTS AND FINDINGS

CONCLUSION

• OT address an average of 5 problems for Stroke patients• OT resolves 97.7 % of the 5 problems• OT fully resolves 95.7% of the 5 problems• Use of SPREE has been helpful in monitoring service

input and performance

On reflection re: SPREE

o SPREE quickly captures OT involvemento Quick and easy to do as it is incorporated in

Treatment Planning Processo SPREE documents Outcomes it claims to measure:

number of problems, Effectiveness and Efficiencyo Can be used to monitor service deliveryo Data can easily be presentedo Easy reference to past input on readmissiono Easy for hand over to other serviceso Easy math compared to what is available….so far

SPREE Formulae:

Effectiveness Effectiveness = =

Efficiency Efficiency = =

Goal Attainment Scale formula

On reflection re: SPREE

- In its youth- It relies on goal setting- Comparison between patients can be

challenging- Requires staff training and understanding of

principles- Is it another paperwork?- It relies on building of new clinical/work habit

FUTURE DIRECTIONFUTURE DIRECTION

• Encourage and promote peer review • To have qualitative analysis of content• To establish inter-rater reliability of SPREE• On-going with staff education and

implementation• Consider use of SPREE in other areas in OT =

orthopaedics, medical etc.• Consider use of SPREE in other services

Those who have inquired about SPREE

• Nottingham City Council• Peterborough and Stamford Hospitals NHS Foundation

Trusts (A&E, Stroke)• Freeman Hospital Newcastle Upon Tyne• Newport Social Services• Lister Hospital, Stevenage• East Lancs Hospice• Adult Local Social Services, Cumbria Council• Sheffield Health and Social Care• Coventry Community Services• Royal Borough of Kensington and Chelsea

ACKNOWLEDGEMENT

Lois Wrigley

Professional Lead OT WSHFT

Amy Haddock,OT

Karen Bambrough,OT

Amy Newman,OT

Hannah Davey,OT

Katherine Lawes,OT

Lucy Whent,OT

THANK YOU

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