Measuring outcomes of care following a single assessment process
Nancarrow, S 2005, 'Measuring outcomes of care following a single assessment process', International Journal of Therapy and Rehabilitation, vol. 12, no. 11, pp. 479-485.
The Australian Capital Territory (ACT) community health service successfully introduced a single point of entry and single assessment process for its community health services at the same time as the ACT government moved to outcomes-based funding. This article discusses an attempt to measure the outcomes of the single assessment process, which was part of a larger study to explore the practicalities of routine outcomes measurement in clinical practice. The aim was to investigate whether it is possible to introduce routine outcome measures for an assessment and complex intervention.
A quasi-experimental design was developed, which involved the 3-month follow-up of all patients who underwent an assessment during a single month. Outcome measures included the Dartmouth Primary Care Cooperative Information Project (COOP) charts and achievement of patient goals. While the quantifiable outcomes improved slightly across some domains, one third of the participants developed new needs over the 3-month follow-up period.
While the Dartmouth COOP charts were easy to use in this setting, rates of adherence to the tool were low, and the tool provided less valuable information than simply asking the clients whether they had achieved their goals. As a result of the project the service introduced routine 3-month telephone follow-up to ascertain changes in health-care needs and the achievement of client goals. This study highlights the dynamic nature of older people's needs and the need for ongoing monitoring and care, rather than a snap-shot assessment of outcomes, and makes recommendations for services attempting to introduce a comprehensive assessment process.