- AOS Training: Data Entry — Pathway 4
- Why Ambulatory benchmarking?
- The Ambulatory Benchmarking Initiative
- The Dataset
- Online Data Dictionary
- Data Collection Proforma
- 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, facilitating a resultant standard of best practice.
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. During Phase 1 all members current at that time were invited 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 ambulatory rehabilitation services and those that are not current AROC members.
The initial AROC ambulatory 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, incorporating items for both inpatient and ambulatory settings, was implemented on 1 July 2012.
The AROC Online Data Dictionary (V4) is now available. Users can choose to browse online or download the document.
Proformas for data collection of 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.
Facilities can choose to:
- Enter ambulatory data directly into the AROC database using the AOS web-based data entry functionality, or
- Enter 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 the AROC data set are mandatory and should be collected and submitted to AROC. It is important that all uploaded data (as opposed to data entered directly into the AROC database via the data entry functionality of AROC Online Services - 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.
- V4 Resources
- Pathway determination
- Online Data Dictionary (V4)
- Data Collection Proformas
- AROC impairment code guidelines
- Australian Modified Lawton’s IADL Scale – the instrument
- Australian Modified Lawton’s IADL Scale – the research paper
- AROC Ambulatory National Report 2009
- AROC Ambulatory National Report 2010
- AROC Ambulatory National Report 2011
- AROC Ambulatory National Report 2012 NEW
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TERMINOLOGY CHANGES — RESIDENTIAL CARE (AUSTRALIA)
As at 1 July 2014 the Australian Government changed the definition of residential care resulting in “low level care” and “high level care” no longer being current terminology (more details). The AROC V4 Dataset for Australia and the Australian Data Collection Forms for pathways 2, 3, 4 & 5 still have this concept in the data items “Type of Accommodation prior to the impairment”, “Interim Accommodation post discharge” and “Final Accommodation post discharge”. The ramifications of this definitional change was discussed by the AROC Scientific Clinical Advisory Committee. It was agreed that whilst AROC can’t change the V4 code set for the three affected data items mid-stream, we can introduce a new business rule that takes account of this definitional change.
New business rule for Australian facilities: All episodes admitted from or discharged to residential care from July 2014 are to be coded to residential high level care (nursing home).
NOTE: all future analyses on Australian admissions from / discharges to residential care will combine residential low level care (hostel) and residential high level care (nursing home). When the AROC V4 dataset is revised the Accommodation data items affected by this definitional change will be adjusted to include codes identifying the 4 levels of care packages at home now available, as well as residential aged care and a code identifying referral to NDIS.
- Rehabilitation Care Plan - Anywhere Hospital
- AN-SNAP Classification Version 3 (Released January 2012, NB: Rehabilitation classes are unchanged)
- AN-SNAP Calculator (Excel 2007+)
- Inpatient Clinical Data Set
- Ambulatory Clinical Data Set
- Impairment Specific Data Items
- Australian Impairment Codes
- Guidelines for Coding Impairments
- Data submission dates
- Order of Australia Award for AROC Clinical Director