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  • Measure Summary
  • NQMC:005036
  • Jan 2009

Physical functional health status: average change in patient functional status from initial to discharge visit among patients receiving outpatient rehabilitation services.

CareConnections Outcomes System (formerly TAOS). [database online]. Portland (OR): Therapeutic Associates, Inc.; 1996- [accessed 2009 May 11]. [various].

This is the current release of the measure.

This measure updates a previous version: Therapeutic Associates Outcomes System (TAOS). [database online]. Portland (OR): Therapeutics Associates, Inc.; 1996- [accessed 2005 Jan 20]. [various].

The measure developer reaffirmed the currency of this measure in March 2016.

Primary Measure Domain

Clinical Quality Measures: Outcome

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the average change in patient functional status among patients receiving outpatient rehabilitation services as measured by the CareConnections Outcomes System Functional Index.

CareConnections Outcomes System is a system that measures the efficacy of intervention of rehabilitation (physical therapy and occupational therapy) services in the outpatient setting. Patient data collected on the first visit is compared to data collected on the last visit.

Rationale

The CareConnections Outcomes System Functional Index is a quality improvement tool for therapists at both the micro (individual patient) and macro (overall quality management) level. At the individual patient level, the CareConnections Functional Index provides an objective measure of function for the therapist, assists the therapist in documenting progress toward goals, and helps justify the benefits of therapeutic interventions provided. The CareConnections Functional Index also helps therapists measure the quality of the services they are providing against other providers by providing a standard measure of function that can be used across large populations of patients. Aggregation of data from providers using the CareConnections Functional Index provides information that will allow therapists to implement quality management programs to improve the overall quality of treatments provided to patients.

Evidence for Rationale

Therapeutic Associates. (Therapeutic Associates Outcomes System (TAOS) Functional Index. Portland, OR). National Quality Measures Clearinghouse (NQMC) measure submission form: TAOS functional improvement: average percent change from initial to discharge visit as measured by TAOS functional index in patients receiving outpatient rehabilitation services. 1996.  6 p.

Primary Health Components

Physical functional health status; outpatient physical rehabilitation; musculoskeletal impairments

Denominator Description

All patients with musculoskeletal impairments who complete both an initial and discharge CareConnections Outcomes System assessment form at a participating clinic

Numerator Description

The average change in patient functional status from initial to discharge visit as measured by the CareConnections Outcomes System Functional Index

Type of Evidence Supporting the Criterion of Quality for the Measure

  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

Content validity was established by a panel of experienced physical therapists who reviewed the instrument and determined that the items for each anatomical area appropriately measured the content domain. Further, factor analysis was performed on 100 questionnaires to confirm that items under each category evaluated the same anatomical area. Discriminate analysis was used to determine how well the instrument could classify patients into categories of anatomical involvement. In the entire sample of 100 patients, 76.54% were placed in the correct group by the discriminate function. Test-retest reliability was evaluated for each item using an Intraclass Correlation Coefficient (ICC). Range of test-retest reliability was 0.69 to 0.96 with a mean ICC of 0.85.

Concurrent validity was established in a 2011-2012 study performed by Chris Hoekstra, PT, DPT, and David Deppeler, PT, DPT, "Content Validity, Clinical Responsiveness, and Reliability of the CareConnections Functional Index." Validity measures were established for each body region relative to correlating reference standards: Neck Disability Index (NDI), Oswestry Disability Index (ODI), Disabilities of the Arm Shoulder and Hand (DASH), and Lower Extremity Functional Scale (LEFS). All subscales were valid compared to reference standards. Reliability was generally good to excellent across all subscales.

The most notable outcome of this study was the establishment of the minimal clinically important difference (MCID). This measure is the number of points of improvement a patient needs to achieve to experience meaningful change in his or her condition. This MCID will allow clinicians to be more objective in rating the level of improvement obtained through PT. For instance, if a patient with neck pain begins therapy with a score of 70% and ends therapy with a score of 90%, he/she has noted meaningful change in his/her ability to perform daily activities. Future research will explore patient-specific factors that affect the MCID (such as other medical conditions, age, time since symptom onset, etc.).

Body Region MCID Reliability – ICC (95% CI) Validity – Pearson's Correlation
Neck 7 .919 (.869-.950) NDI -.820
Arm 16 .935 (.900-.975) DASH -.773
Low Back 11 .948 (.923-.966) ODI -.701
Leg 8 .926 (.894-.949) LEFS .701

Evidence for Extent of Measure Testing

Hoekstra CJ, Deppeler DA, Rutt RA. Criterion validity, reliability and clinical responsiveness of the CareConnections Functional Index. Physiother Theory Pract. 2014 Mar 25;:Epub ahead of print. PubMed External Web Site Policy

Schunk C, Rutt R. TAOS Functional Index: orthopaedic rehabilitation outcomes tool. J Rehabil Outcomes Measure. 1998;2(2):55-61.

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Occupational Therapists

Physical Therapists

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Encounter

Therapeutic Intervention

Denominator Time Window

Time window brackets index event

Denominator Inclusions/Exclusions

Inclusions
All patients with musculoskeletal impairments who complete both an initial and discharge CareConnections Outcomes System assessment form at a participating clinic

Exclusions
Non-English, Non-Spanish, or Non-Russian speaking patients who do not have an interpreter to communicate CareConnections questions

Exclusions/Exceptions

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
The average change in patient functional status from initial to discharge visit as measured by the CareConnections Outcomes System Functional Index

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Patient/Individual survey

Type of Health State

Functional Status

Instruments Used and/or Associated with the Measure

CareConnections Functional Index

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Composite/Scale

Mean/Median

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

Internal time comparison

Original Title

CareConnections (formerly TAOS) Functional Index.

Submitter

Therapeutic Associates, Inc. - For Profit Organization

Developer

Therapeutic Associates, Inc. - For Profit Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source, with the exception of one Lumbar question that was adapted from the Oswestry Low Back Questionnaire.

Date of Most Current Version in NQMC

2009 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: Therapeutic Associates Outcomes System (TAOS). [database online]. Portland (OR): Therapeutics Associates, Inc.; 1996- [accessed 2005 Jan 20]. [various].

The measure developer reaffirmed the currency of this measure in March 2016.

Source(s)

CareConnections Outcomes System (formerly TAOS). [database online]. Portland (OR): Therapeutic Associates, Inc.; 1996- [accessed 2009 May 11]. [various].

Measure Availability

Source available for purchase from the CareConnections Web site External Web Site Policy.

For more information, contact Therapeutic Associates, Inc. at (800) 219-8835, ext. 1118.

Companion Documents

The following is available:

  • CareConnections functional index: patient worksheet. Portland (OR): Therapeutic Associates, Inc.; 2012 Nov 16. 2 p. This document is available in Portable Document Format (PDF) from the CareConnections Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI on January 20, 2005. The information was verified by the measure developer on February 15, 2005.

This NQMC summary was updated by ECRI Institute on May 21, 2009. The information was verified by the measure developer on June 4, 2009.

This NQMC summary was retrofitted into the new template on May 11, 2011.

The information was reaffirmed by the measure developer on March 15, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

Refer all questions pertaining to CareConnections Outcomes System to Therapeutic Associates, Inc. at (800) 219-8835; Web site www.therapeuticassociates.com External Web Site Policy.

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