- Why Ambulatory benchmarking?
- The Ambulatory Benchmarking Initiative
- The Dataset
- AROC Online Data Dictionary (V4)
- Data collection forms
- Ambulatory Outcome Measure – Australian Modified Lawton’s IADL Scale
- How to collect the ambulatory dataset
- Data compliance and audit
- Download the AROC clinical ambulatory data set & supporting documents
- Want further information?
Evolving models of care in rehabilitation, as a direct response to those in acute and sub acute care, have seen the focus shift to development of ambulatory rehabilitation services. Changes in patient acuity and demand have impacted on the rehabilitation sector, challenging providers to develop innovative models of service delivery that free up traditional inpatient care while continuing to offer quality patient outcomes.
Provision of out of hospital services presents a number of challenges to providers, including evaluation of the efficacy of program interventions, and with a diverse range of care models across all sectors there are an equally diverse range of accompanying outcome measures.
Benchmarking allows the opportunity for comparison of similar service models and patient groups, and is invaluable to clinicians and other stakeholders in evaluating and improving models of care and service delivery.
AROC was established with a main goal of improving clinical rehabilitation outcomes by benchmarking rehabilitation providers nationally. An original objective of AROC was expansion of data collection to the non-inpatient care setting having established inpatient data collection and benchmarking. The challenge to meeting this objective in an area with such a diverse range of care and service delivery lies in standardising the information collected, including the outcome measure.
Implementation of the National Ambulatory Rehabilitation Benchmarking Initiative commenced in mid 2008. For Phase 1 of the initiative AROC invited all current members to participate via an Expression of Interest. Participants in Phase 1 collaborated in refining the processes for data collection, analysis and reporting.
Phase 2 extended the initiative by continued recruitment of exclusive ambulatory rehabilitation services and those that are not current AROC members.
A draft data set was developed, piloted and refined during 2007/08 with the involvement of stakeholders through representation in the AROC Scientific and Clinical Advisory Committee (SCAC). The ambulatory data set (version 1) was based on the AROC inpatient dataset, modified to include items that relate specifically to evaluating the efficacy of ambulatory rehabilitation programs.
The ambulatory dataset was reviewed and updated in tandem with the inpatient dataset. The Version 4 AROC Dataset comprises a “bank” of data items and was implemented on 1 July 2012. The “bank” holds data items pertaining to in-patient and ambulatory episodes of rehabilitation care, which have been grouped into 6 pathways (models of care); 3 in-patient (admitted) and 3 ambulatory (non admitted). The pathway (model of care) your service provides will determine which set of data items you are required to collect and submit to AROC. Further information can be found here: Pathway Determination.
The AROC Online Data Dictionary (V4) is now available. The online data dictionaries provide information about each of the data items in the AROC data bank. There are separate dictionaries for Australia and New Zealand because the codesets for some of the data items are different. AROC has produced separate data dictionaries for clinicians and developers.
Data collection forms
Data collection forms for the version 4 dataset are available. These may assist in ensuring that all the relevant data items are collected and entered. The proformas are available in Microsoft Word format, and can be modified to suit the needs of participant services as desired.
The choice of outcome measure, Australian Modified Lawton’s IADL Scale, resulted from vigorous discussions with major stakeholders regarding the goal orientation of ambulatory rehabilitation as opposed to that of inpatient rehabilitation; namely the focus of inpatient rehab on a return to physical and cognitive functional ability in the self care spectrum, rather than the ability to interact and function in the community independently, the assumption being that in general most participants in ambulatory care already demonstrated a degree of functional independence. To this end the Australian Modified Lawton’s IADL Scale represents a more sensitive measure of the outcome of ambulatory rehabilitation than the FIM™ (the outcome measure used by AROC in an inpatient setting) as it relates to instrumental tasks, such as a patient’s ability to do their own shopping, cleaning, cooking, manage their finances, skills that demonstrate their independence in the wider context.
The Australian Modified Lawton’s is widely used by Home and Community Care Services (HACC) where it has been shown to be valid and reliable, and as a generic outcome measure it successfully demonstrates changes in the patient’s ability to participate in activities of daily living as effected by their rehabilitation. The Australian Modified Lawton's is an easy tool to administer and requires minimal training.
The Australian Modified Lawton’s IADL Scale measures rehabilitation outcomes in a broad context across the spectrum of care and service delivery models; as such, it is not designed, or intended, to replace existing patient, discipline, or service specific outcome measures, but to be an additional tool used to enable benchmarking across all participating services. There is future opportunity, once the ambulatory data collection is established, for AROC to add impairment specific outcome measures to the ambulatory dataset to provide more specific benchmarking at an impairment level.
Facilitie can choose to:
- Enter ambulatory data directly into the AROC database using the AROC Online Services (AOS) web-based data entry functionality, or
- nter data into their own IT systems, with the V4 ambulatory data items built in. Ambulatory data extracts are then uploaded regularly via the AOS, for inclusion in the AROC database.
All items in all AROC data sets are mandatory and should be collected and submitted to AROC via AROC Online Services (AOS). It is important that all uploaded data (as opposed to data entered directly into the AROC database via the data entry functionality of AOS conform to the specified format, therefore, if a facility is unable to collect some items in the AROC data set space for them should be included in their data extract.
All data submitted to AROC undergoes a comprehensive audit process. Data entered via AOS data entry is audited as the data is entered. After entering each patient the user will receive an audit report on screen highlighting any errors or missing data. Data uploaded to AROC via extract from another IT system will be audited on upload. Episodes with missing data and definite or potential errors are notified to the submitting facility by email for review and correction. Corrected data should be resubmitted to AROC via AROC Online Services (AOS).
- V4 Resources
- Pathway determination
- AROC Online Data Dictionary (V4)
- Data collection forms
- AROC impairment code guidelines
- Australian Modified Lawton’s IADL Scale – the instrument
- Australian Modified Lawton’s IADL Scale – the research paper
- AROC Ambulatory National Reports
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