Diversity of Outcomes: From Person-Centered to International Neurorehabilitation Perspectives #3221

INSTRUCTIONAL COURSE DETAIL

TUE, 27 OCT: 8:00 AM – 12:00 PM

SPEAKERS

Gordon J. Horn, PhD
Chair & Adjunct Clinical Professor, Florida State University College of Medicine (Neuropsychology); NeuroRestorative Deputy Director of National Outcomes

Frank D. Lewis, PhD
Co-Chair & Adjunct Assistant Professor, Medical College of Georgia at Georgia Regents University, Department of Surgery, Trauma & Critical Care; NeuroRestorative Director of National Outcomes

James Malec, PhD
Professor & Research Director, Emeritus Professor of Psychology – Mayo Clinic
Indiana University School of Medicine & Rehabilitation Hospital of Indiana

Christina Papadimitriou, PhD
Associate Professor, Northern Illinois University, College of Health and Human Sciences-Nursing & Health Studies

Paula Kersten, PhD
Professor of Rehabilitation, Head of Research, School of Clinical Sciences Director, Centre for Person Centred Research, New Zealand

Cynthia R. O'Donoghue, Ph.D., CCC-SP
Professor, James Madison University, Department Head

Cara Meixner, PhD
Associate Professor & Faculty Consultant
James Madison University, Graduate Psychology - Center for Faculty Innovation

Victoria Harding, Ph.D., CCC-SLP
James Madison University; NeuroRestorative, Vice President of Development

Robert Russell, BHA
Data Analyst, Benedictine University College of Education & Health Services, NeuroRestorative National Outcomes

DIAGNOSIS

Brain Injury, Other, International,

Rehabilitation Outcomes

FOCUS

Outcomes research/epidemiology

In-depth information communication/knowledge translation (course is intended primarily to impart information)

DESCRIPTION

Rehabilitation outcomes are complex to achieve best practices. Measures such as the Glasgow Coma Scale, Glasgow Outcome Scale, and the Functional Independence Measure have been used for acute care documentation, while the Mayo Portland Adaptability Inventory-4 has been used to measure post-hospital outcomes. This presentation will review outcomes analyses, measurement selection, timing of outcome measurement, and managing data systems. Statistical approaches will address research and clinical questions. Meeting CARF standards with outcomes analyses will be discussed. Delineation of differences between quantitative and qualitative outcomes, and person-centered and group trends. Panel discussion will be held at the conclusion.

ABSTRACT BODY

Rehabilitation outcomes are complex and diverse requiring a comprehensive approach to develop clinical and research best practices. One reason for the complexity is that different levels of care have different measurement of outcomes. Measures such as the Glasgow Coma Scale, Glasgow Outcome Scale, and the Functional Independence Measure have been used for acute care documentation. At the post-hospital level, the Mayo Portland Adaptability Inventory-4 has been used to measure outcomes for a longer period of recovery. Reasons for different measurement types will be discussed, including the role of chronicity of injury, instrumental activities of daily living, and neurobehavioral impact. Diversity of outcomes may include individual vs. group measurement, qualitative and quantitative analysis, and function vs. disability / impairment. The purpose of this program is to provide information from experts in the field of neurological rehabilitation outcomes within various levels of the continuum of care. The course will review outcomes analyses, measurement selection, timing of outcome measurement, and managing data systems. Statistical approaches, including the use and application of RASCH analysis, will address research and clinical questions. In addition, meeting CARF standards for outcomes analyses will be discussed at length with suggestions provided for data presentation. Research and clinical methods are reviewed at length so that participants can delineate differences between quantitative and qualitative person-centered outcomes, group change, national trends, and international trends. Panel discussion will be held at the conclusion to review the various methods discussed with current research data from each of the presenting faculty.

LEARNING OBJECTIVES

  1. Describe outcomes analyses for clinical and research best practices.
  2. Describe measurement selection and decision making depending upon the level of care being evaluated and statistical methods used.
  3. List components of database management when collecting large data sets such as storage and data transfer for statistics.
  4. Learn to apply outcomes to CARF standards of Effectiveness and Efficiency.
  5. Delineate differences between qualitative and quantitative results, person-centered, group, national and international outcomes and how this impacts the future of healthcare practices.

 

Intended Audience

This Lecture/Panel discussion is most appropriate for professionals providing clinical work and/or research in brain injury within a continuum of care. Individuals to attend may include: Rehabilitation Specialists, Nursing, Physicians, Psychologists, Neuropsychologists, Speech and Language pathologists, Physical Therapists, Occupational Therapists, Research Methods and Statistics professionals, Academics, Outcomes and Quality Assurance Specialists, Clinical Researchers, Program Developers, Program Evaluators, Health Care Administration, and Operations Specialists within the neurological rehabilitation industry.

COURSE OUTLINE

Part I: Introduction to Rehabilitation Outcomes

Gordon Horn, PhD & Frank Lewis, PhD

This section will cover outcome trends currently in the United States and abroad. Topics reviewed will include translating research findings to clinical practice for improved outcomes. Outcome use with payer sources will also be discussed.

Part II: Measurements and Statistics

James Malec, Ph.D. & Paula Kersten, PhD

Dr. Malec and Dr. Kersten will review various measures used in brain injury rehabilitation (e.g., Glasgow Scales, FIM, and MPAI-4) across continents. They will also discuss the use of statistical methods to evaluate the reliability and validity of outcome measures. Particular emphasis will be the use of Factor Analysis and RASCH analysis. Particular focus will be placed on the Mayo Portland Adaptability Inventory in post-hospital care.

Gordon Horn, Ph.D. & Frank Lewis, PhD

Dr. Horn and Dr. Lewis will provide discussion of additional statistical methods with post-hospital care outcomes understanding treatment efficacy. Multivariate analyses will be reviewed to answer specific funder questions for accountable care.

Part III: Database Management (30 minutes)

Robert Russell, BHA & Frank Lewis, PhD

This lecture and discussion will review the application of Excel techniques to manage large database file for purposes of completing outcomes analyses. Data merging techniques, pivot tables, and data conversion for use with SPSS will be discussed.

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Break: 10 minutes
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Part IV: Quantitative vs. Qualitative analysis (60-70 minutes)

Christina Papadimitriou, PhD, Cynthia R. O'Donoghue, PhD, Cara Meixner, PhD, & Victoria Harding, PhD

This section will provide a variety analysis and insights regarding qualitative vs. quantitative analysis. This group of researchers will review techniques to comprehensively understand person-centered approach to outcomes and developing individualized goals. This group will also discuss specific methods to analyze qualitative (e.g., beliefs, attitudes, perceptions of improvement) and quantitative (statistical evaluation of data) analyses (e.g., mixed design approach) to provide indication of optimal outcomes within a neurological rehabilitation continuum of care model.

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Break: 10 minutes
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Part V: Meeting CARF standards with outcome measurement (Effectiveness and Efficiency) (30 minutes)

Frank Lewis, Ph.D., Gordon Horn, PhD, Victoria Harding, PhD, & James Malec, PhD

This section will focus specifically on applying the techniques noted in the other sections to produce an outcomes presentation that demonstrates meeting the Commission on Accreditation of Rehabilitation Facilities (CARF) measure of Effectiveness. This presentation shows how to complete analyses that will show different levels of improvement, and will provide examples of presenting this simplistically during a CARF survey. This portion of the program will also show how complex data analysis can be used to help patients, families, and stakeholders understand outcomes for informed decision making and projection of outcomes.

Part VI: Panel Discussion regarding outcomes and the impact on healthcare (30 minutes)

All of the presenters will provide an interactive panel discussion regarding outcomes. Each of the presenters will use their research to help solidify concepts for the participants. Implications for complex outcomes analyses impact on healthcare will be discussed. Use of outcomes with payer sources in and outside of the United States will be discussed.

 

BIO SKETCHES

Gordon J. Horn, PhD completed his fellowship training in Neuropsychology and Rehabilitation from Duke University, School of Medicine in 1997. He is currently the Deputy Director of the National Outcomes Services for NeuroRestorative focusing on neurological outcomes, translational research and clinical applications, and healthcare economics in post-hospital rehabilitation. For NeuroRestorative, he has also served as the State Clinical Director for Florida (2011 – 2013). He is also an Adjunct Clinical Professor for Florida State University, College of Medicine. He has presented and published research in epilepsy, migraine headache, normal pressure hydrocephalus, and traumatic brain injury assessment and outcomes. Dr. Horn was a staff Clinical Neuropsychologist for 12 years with Florida Hospital Healthcare System in Orlando, FL, and served as the Medical Psychology Practicum Director and Executive Medical Staff Committee Member for Florida Hospital. He has also been a facility administrator for post-hospital care. He has worked the entire continuum of neurological care from ICU to post-hospital treatment with Duke University Medical Center and Florida Hospital Healthcare System.

Frank D. Lewis, PhD is the National Director of Clinical Outcome Services for NeuroRestorative and Clinical Director for NeuroRestorative Georgia. He received his Ph.D. in Psychology from the University of Arkansas. He is an Adjunct Assistant Professor in the Department of Surgery, Trauma, & Critical Care at the Medical College of Georgia at Georgia Regents University and part-time faculty member in the Department of Psychology at Georgia Regents University in Augusta Georgia. He has 30 years of experience in the field of brain injury rehabilitation as an educator, researcher, and administrator. He has won the Leydorf Medical Clinical Review citation for best literature in the field of developmental disability. Dr. Lewis is the author of numerous peer reviewed publications and is on the Editorial Board of Care Management: Journal of the Academy of Certified Case Managers.

James F. Malec, PhD is Professor and Research Director in the Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine and the Rehabilitation Hospital of Indiana. He is a Professor Emeritus of Psychology at the Mayo Clinic and is Board Certified in Clinical Neuropsychology and in Rehabilitation Psychology through the American Board of Professional Psychology. He has been active in research and the clinical practice of brain injury rehabilitation for over 35 years and has received a number of professional recognitions, including the Lowman Award for interdisciplinary contributions to rehabilitation, the Research Award of the North American Brain Injury Society, the Sheldon Berrol, MD, Clinical Service Award from the Brain Injury Association of America, and the prestigious Robert L. Moody Prize for Distinguished Initiatives in Brain Injury Research and Rehabilitation. He has over 145 peer-reviewed publications as well as other professional publications and continues to conduct research in brain rehabilitation and outcome measurement.

Christina Papadimitriou, PhD is an Associate Professor at Northern Illinois University, College of Health and Human Science, School of Nursing and Health Studies. Christina received her Ph.D. from Boston University, Department of Sociology (2000) and her post-doctoral training in health services research from Northwestern University, Institute of Healthcare Studies (2009) and the Rehabilitation Institute of Chicago, Center for Rehabilitation Outcomes Research (CROR). Christina is an active qualitative rehabilitation researcher who studies client-centeredness in SCI (NIDRR, H133F090053), peer-health navigation (NIDRR, HI33B140012), and peer mentoring among other topics. She is methodological consultant in several SCI QUERI studies at the Hines Veteran Hospital, IL. Research interests: Person-Centered Care; Sociology of Disability; Spinal Cord Injury and Rehabilitation Outcomes.

Paula Kersten, PhD, is Professor and Co-Director of the Centre for Person Centred Research. Dr. Kersten trained as a physiotherapist and is a rehabilitation expert. She has significant leadership and management experience in higher education, including being Head of School of Health Professions and Rehabilitation Sciences at the University of Southampton (UK) and presently Head of research in the newly established School of Clinical Sciences at AUT University. Dr. Kersten has 16 years of post-PhD research experience. Her research interests focus on new rehabilitation approaches and measuring meaningful rehabilitation outcomes. Recent examples of her work include a study of peer mentoring for people with traumatic brain injury funded by the HRC and a study of the validity of the Strengths and Difficulties Questionnaire funded by the Ministry of Health. She also carries out consultancy work, e.g. for ACC, the Ministry of Social Development Welfare Reform committee and local service providers. Paula actively contributes to postgraduate teaching and supervision drawing on her research.

Cynthia R. O'Donoghue, PhD, CCC-SLP, is a Professor of Communication Sciences and Disorders, serves as the Head of the Communication Sciences and Disorders Department at James Madison University, Harrisonburg, Virginia. Dr. O’Donoghue teaches graduate courses and conducts research in adult neurogenic communication disorders and dysphagia. She presents nationally and internationally in her areas of expertise. Notable service contributions include Legislative Representative from the Commonwealth of Virginia to American Speech-Language-Hearing Association, Board of Trustees President for Crossroads to Brain Injury Recover, Inc., and Vice-Chair of the Nominations and Elections Committee, Virginia Brain Injury Council. She is currently grant funded through Commonwealth Neurotrauma Initiative Trust Fund.

Cara Meixner, Ph.D., is an Assistant Professor of Psychology at James Madison University. Dr. Meixner received her BS from JMU, her MA from the University of Maryland, and her PhD from Antioch. Cara's expansive background in leadership and community development - intersected with her self-identify as a caregiver for a sister who survived a devastating TBI - provoked her involvement in a multifaceted research agenda for survivors of acquired brain injury. With Dr. Cynthia O’Donoghue, she was co-principal investigator of a three-year grant funded by the Commonwealth Neurotrauma Initiative (CNI) Trust Fund that investigated barriers to accessing crisis intervention services, with focus on the experience of survivors with mental health and substance abuse co-morbidities. To date, this work has been presented and published through multiple refereed venues such as the World Congress on Brain Injury, the Federal Interagency Conference on Brain Injury, the North American Brain Injury Society, Brain Injury, Journal of Head Trauma Rehabilitation, and Rehabilitation Psychology. Most critically, this body of inquiry has contributed to the development of noteworthy changes and advocacy initiatives, locally and regionally. Currently, Cara’s research team is working on a systematic study investigating access to neurobehavioral services for persons with brain injury who are citizens of the Commonwealth of Virginia. At James Madison University, Cara teaches graduate-level courses in research methods and serves as methodologist on multiple dissertation studies. Cara holds a joint appointment with the Center for Faculty Innovation, within which she works with faculty on pedagogical development and course design.

Victoria Harding, Ph.D., CCC-SLP, provides specialized program and location development for NeuroRestorative and oversees contracting, marketing and admissions functions. For over two decades, she has been a clinician and operations leader in brain injury rehabilitation for several national companies providing community-integrated and independent living programs. Her primary research and clinical interest areas include outcome measurements in post-acute settings, the self-efficacy mechanism in post-acute brain injury, neurogenic communication disorders and family training for long-term success and advocacy. As a Speech-Language Pathologist, she has worked as a clinician and an educator. As a Certified Brain Injury Trainer, she teaches through the Academy of Brain Injury Specialists and serves as a medical rehabilitation surveyor for the Commission on Accreditation of Rehabilitation Facilities (CARF). She has recently completed her Ph.D. from James Madison University. She also completed a Masters of Business Administration at Plymouth State University, and Master of Science in Speech-Language Pathology at Dalhousie University, Nova Scotia, Canada.

Robert Russell, BHA, is a Data Analyst for NeuroRestorative’s National Outcomes Services. He has been working in this role since 2012. He has been working extensively in database management and integration for NeuroRestorative. He is currently the liaison for the Outcomes Services with Information Technology, working extensively on electronic healthcare record management. He is currently completing a dual Master’s Degree program in Business Administration and Health Care Administration. Clinically, he was a Life Skills Trainer teaching instrumental activities of daily living skills for the adolescent intensive programs within NeuroRestorative.

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