1. Occupational Therapy Service Outcome Review using the Outcome Measure SPREE (Service Performance Record of Effectiveness and Efficiency) By Amil Magpantay Clinical Specialist OT

2. Objectives To discuss the “Drivers” To introduce and discuss SPREE To show our method To present Outcome of Service

3. Why we did what we did I.Quality, Innovation, Performance and Prevention (QIPP) II.Top Ten Priorities for Stroke Service Research – DOH publication 2008 III.Current Political Climate and Trend

4. Driver 1: QIPP Quality & Performance This initiative sought to measure and report performance of the OT service in Stroke Service using data obtained from SPREE as an alternative to existing method of service reporting Government Standard ‘You should expect your care provider to routinely check the quality of their services’ Innovation Use of Service Performance Record of Effectiveness and Efficiency (SPREE) as a tool to measure outcome of the service

5. Top Ten Priorities for Stroke Service Research DOH Publication 2008 Driver 2: Top Ten Priorities for Stroke Service Research DOH Publication 2008 By Professor Charles Wolfe, Dr Anthony Rudd, Dr. Christopher McKevitt, Dr Peter Heushmann, Professor Lalit Kalra Relevant Priority 10: Development of Comprehensive Outcome Measures for Stroke that can be Universally Adopted by the Stroke Community

6. Gaps in the Evidence BaseGaps in the Evidence Base –Simple and widely applicable tools to measure the outcome of interventions should be developed Summary of Research NeedsSummary of Research Needs –Research is required to develop common outcome measurement tools acceptable to all professional groups and to patients and their carers

7. Current Political Climate and Trend Driver 3: Current Political Climate and Trend Generally themes around Outcomes, Commissioning, Payment by Results, Promoting Services, QIPP, evidences re: Achievements.Generally themes around Outcomes, Commissioning, Payment by Results, Promoting Services, QIPP, evidences re: Achievements.

8. OT News OT News August 2011 –“There has been efforts to attach outcomes to funding through payment by results in York and Humber and The Northwest” November 2011 –Articles mention of Commissioning Outcomes Framework (COF)Commissioning Outcomes Framework (COF) Patient Reported Outcome Measures (PROMs)Patient Reported Outcome Measures (PROMs) Payment by OutcomePayment by Outcome

9. Naomi Hankinson Chairman of COT council ‘Now is the time to stop being hesitant and be bold about what we achieve’ ‘ We need to back up with evidence and share our achievements’

10. Lisa Hughes Allied Health Professions Officer at DH “If somebody loses their commissioning because their service is not good enough, I don’t have a problem with that. If you lose the commission because you didn’t put out the information about how good it is, that’s a tragedy”

11. The biggest problems encountered among AHPs in promoting their own services were: 1.failure to tell the story 2.a lack of key data and information 3.a lack of confidence 4.waiting to be told by others what to do

12. Service Performance Record of Effectiveness and Efficiency (S.P.R.E.E.)

13. Day to day document with a re-designed system of measurement that can record, quantify, report and measure the Outcome of the OT Service.Day to day document with a re-designed system of measurement that can record, quantify, report and measure the Outcome of the OT Service. Measures “Effectiveness” and “Efficiency” rendered by the Service (Occupational Therapy)Measures “Effectiveness” and “Efficiency” rendered by the Service (Occupational Therapy) Records number of problems reported by the clientsRecords number of problems reported by the clients Based on Goal Setting and Outcome ReportingBased on Goal Setting and Outcome Reporting

14. Problem and Goal Themes Focused on “Occupational Concerns” Related to OT parameters of Assessment and Intervention –Value –Independence –Safety –Adequacy of Performance

15. EFFECTIVENESS The percentage of problems addressed and resolved by the service The percentage of problems addressed and resolved by the serviceEFFICIENCY The percentage of the problems FULLY resolved by the service

16. WHAT DOES IT LOOK LIKE?

17. Case Study Mr A. with R CVA, Left Hemiparesis

18. ProblemGoalAction/sOutcome Goal Achievement Value

19. ProblemGoalAction/sOutcome Unable to get out of bed

20. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient will be able to get out of bed independently

21. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient will be able to get out of bed independently Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment

22. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment

23. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment

24. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required

25. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required Patient can get out of bed with stand by assistance

26. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required Patient can get out of bed with stand by assistance Patient can strip wash safely with the use of perch stool

27. Goal Achievement Value Fully achieved=2 Partially Achieved=1 Not Achieved=0

28. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required Patient can get out of bed with stand by assistance Patient can strip wash safely with the use of perch stool

29. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required Patient can get out of bed with stand by assistance Patient can strip wash safely with the use of perch stool 1

30. ProblemGoalAction/sOutcome Goal Achievement Value Unable to get out of bed Patient is not safe strip washing Patient will be able to get out of bed independently Patient will be able to strip wash safely Functional Mobility re- training, assess need for adaptive equipment, issue identified adaptive equipment -Washing practice -Identify and issue needed adaptive device if required Patient can get out of bed with stand by assistance Patient can strip wash safely with the use of perch stool 1 2

31. 2 4 1 2 11 0 0 3 75% 50% 2

32. FORMULA How do we measure

33. Effectiveness Actual Outcome Score divided by Expected Outcome Score multiply to 100

34. 2 4 1 2 11 0 0 3 75% 50% 2

35. Efficiency Goals that are Fully Achieved divided by Total Goals multiplied to100

36. 2 4 1 2 11 0 0 3 75% 50% 2

37. HOW WE DID IT

38. Obtained support from OT Professional LeadObtained support from OT Professional Lead Initially piloted for 3 months (End of July to end of October 2011)Initially piloted for 3 months (End of July to end of October 2011) Follow up implementation for 11 months: from January to November 2012Follow up implementation for 11 months: from January to November 2012 Occupational Therapy Service was monitored using the data obtained from the use of SPREEOccupational Therapy Service was monitored using the data obtained from the use of SPREE

39. RESULTS AND FINDINGS

46. CONCLUSION OT address an average of 5 problems for Stroke patients OT resolves 97.7 % of the 5 problems OT fully resolves 95.7% of the 5 problems Use of SPREE has been helpful in monitoring service input and performance

47. On reflection re: SPREE o SPREE quickly captures OT involvement o Quick and easy to do as it is incorporated in Treatment Planning Process o SPREE documents Outcomes it claims to measure: number of problems, Effectiveness and Efficiency o Can be used to monitor service delivery o Data can easily be presented o Easy reference to past input on readmission o Easy for hand over to other services o Easy math compared to what is available….so far

48. SPREE Formulae: Effectiveness = Efficiency =

49. Goal Attainment Scale formula

50. On reflection re: SPREE -In its youth -It relies on goal setting -Comparison between patients can be challenging -Requires staff training and understanding of principles -Is it another paperwork? -It relies on building of new clinical/work habit

51. FUTURE DIRECTION

52. Encourage and promote peer review To have qualitative analysis of content To establish inter-rater reliability of SPREE On-going with staff education and implementation Consider use of SPREE in other areas in OT = orthopaedics, medical etc. Consider use of SPREE in other services

53. Those who have inquired about SPREE Nottingham City Council Peterborough and Stamford Hospitals NHS Foundation Trusts (A&E, Stroke) Freeman Hospital Newcastle Upon Tyne Newport Social Services Lister Hospital, Stevenage East Lancs Hospice Adult Local Social Services, Cumbria Council Sheffield Health and Social Care Coventry Community Services Royal Borough of Kensington and Chelsea

54. ACKNOWLEDGEMENT Lois Wrigley Professional Lead OT WSHFT Amy Haddock,OT Karen Bambrough,OT Amy Newman,OT Hannah Davey,OT Katherine Lawes,OT Lucy Whent,OT

55. THANK YOU