NORMA J. STUMBO, PH.D., CTRS, FALS

EDUCATION ASSOCIATES

The Importance of Evidence-Based Practice

on Our Future

Session Outcomes2

At the conclusion of this workshop, participants will have an increased knowledge about:

• Importance of specifying outcomes at the outset

• Exit minus entry = outcomes

• Types and qualities of outcomes

• Importance of evidence-based practice (EBP)

•What EBP can do for TR

•What you can do toward EBP

Why It Matters

•Client Outcomes: The Why

•Evidence-Based Practice: The How

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Why are Outcomes Important?

• External Accreditation• Third Party Payers• ATRA Standards of Practice• Health Care Consumer Groups

• It’s the Right Thing to Do!

4

What are Outcomes?

• Observable changes that result from intervention (Client status, functional status, well-being, care satisfaction, cost/resource utilization

• Changes over specified time

• Clinical results

• Results of performance

• Direct effects of service

• Difference between input (assessment baseline) and output (discharge)

• Straightest line between A and B

• Both planned and unplanned

• Both beneficial and harmful

5

Client Outcomes

Client characteristics at end of treatment

(re-assessment)

(e.g., health status, functional status,

quality of life, etc.)

Client characteristics at baseline

(assessment)

(e.g., health status, functional status,

quality of life, etc.)

InterventionEntry Exit

Difference between Point A/Entry and Point B/Discharge= Outcomes

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Typical Categories of Outcomes

•Change in clinical status • Effect of tx. on pt. symptoms

•Change in functionality• Effect of tx. on pt. lifestyle

•Change in utilization of services• Effect of tx. on using future services

•Recidivism • Patterns of relapse or re-entry

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Outcome Qualities

• Identifiable/Measurable

• Achievable

• Demonstrable/Documented

• Predictable/Causal—direct result of intervention

• Meaningful

• Predetermined—target behavior BEFORE intervention

• Accountable—deliverable every time

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Outcome Measure Selection

• Relevant/important to clients

• Result from intervention

• Incorporate into existing client & program documentation e.g. objectives

• Understandable by professionals and caregivers

• Data collection processes quantify results

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What Do We Know For Sure?

•Outcome measurement depends on:• Specification of important, meaningful

outcomes

• Systematic programming/intervention (standardized practice)

• Valid and reliable client assessment

• Accurate and meaningful documentation/records

• Systematic program evaluation and efficacy/effectiveness research

• YOU!!! (yes, YOU!!!)

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Therapeutic Recreation Outcomes

•What are important TR outcomes?

•What outcomes are important in your setting?

•What TR service model do you use in your practice?

•What are the needs of your clients?

•What are the goals of your programs?

•What outcomes do you program for?

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What are Important Outcomes of TR Intervention?

•Your Views…

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Typical Categories of Outcomes in TR

• Improve functional ability

• Improved leisure awareness

• Improved social skills

• Improved leisure skills

• Improved knowledge/utilization of Leisure resources

• Improved community independence

• Improved quality of life

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What is Evidence Based Practice? The How

• Targets outcomes based on standardized interventions

• Promotes selection of treatments which have some evidence

• Improves predictability and causality of service outcomes

• Involves applying results of outcomes research to improve day-to-day TR practices

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Why Evidence-Based Practice Needed?

Three concerns surfaced:

•many physicians relying on personal judgment rather than research for treatment of patients

•new knowledge exploding at almost direct, inverse relationship to time available to read and absorb it

•managed care eroding independence of physician decisions

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Why Do Healthcare Practices Need to Change?

The structures, incentives, and forces at work in the U.S. health system produce exactly what we should expect in the quality of care for chronic disease: highly variable patterns of care, widespread failure to implement recognized best practices and standards of care, and the persistent inability of provider systems to achieve substantive changes in patterns of practice. Moreover, after more than two decades of effort to improve clinical care management and to promote the adoption of evidence-based standards, these variations [still] persist. (Coye, 2001, p. 44)

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Produced need for…

Systematic collection of data, over time, through near-patient research studies as well as the clinician’s reflective approach in applying this information in daily work with clients

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Evidence-Based Practice: Research Informing Practice

Therapeutic Recreation Practice

Therapeutic Recreation Research

Evidence-Based Practice

Practice Based Research: Practice Informing Research

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Definitions of Evidence-Based Practice

• Process of systematically reviewing, appraising and using clinical research findings to aid in the delivery of optimum clinical care of patients.

• Ability to track down, critically appraise…and incorporate this rapidly growing body of evidence into one’s clinical practice

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Definitions of Evidence-Based Practice

• Evidence-based practice can be described as selection of treatments for which there is some evidence of efficacy

• That is, through evidence-based service delivery, each practitioner should feel confident that she or he is providing the best possible care that is known to produce the most desirable, intended, and meaningful outcomes

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What is Evidence-Based Practice?

Evidence-based healthcare usually involves systematic research – and better yet, the accumulation of systematic research – as applied by conscientious specialists who have the ability to synthesize the research and incorporate it into daily practice decisions with clients. Its aim is to reduce wide variations in practice based solely on clinicians’ preferences or personal experiences, eliminating the worst practices, and embracing the best practices

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What Does This Mean for You?

• Evidence-based clinical judgment:

• is neither solely evidence nor judgment

• requires understanding of requirements to make satisfactory clinical decision

• increases with opportunity and practice

• reduces but does not eliminate clinical uncertainties

• is currently grounded in Western, allopathic, and professionalized approach to medicine.

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What Does This Mean for You?

•Evidence-based healthcare is process of life-long, self-directed, problem-based learning in which caring for patients creates need for clinically important information about diagnosis, prognosis, therapy, and other clinical and healthcare decisions

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Supporting Evidence-Based Practice

• Evidence-based practice can be accomplished in three ways:

• learning the 5 steps of evidence-based practice,

• seeking evidence collected by others,

•adopting protocols written by other who have done evidence-based practice research.

•Ultimate expectation of evidence-based service delivery is improved, informed, and more consistent healthcare for all clients.

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Steps to Evidence-Based Practice

1. Formulate a clear clinical question from a patient’s problem.

Will a middle-aged person with a recent spinal cord injury gain greater stress awareness through yoga or Tai Chi?

2. Search databases for relevant clinical evidence

3. Appraise the evidence.4. Implement and use findings in practice.5. Evaluate the impact of change in

practice.

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The Challenge26

Changing How We Do Business

•What did you learn about OUTCOMES?

•What did you learn about EBP?

•What impact could EBP make on your services?

•What impact could EBP make on client outcomes?

•How will you apply this to your daily practice?

•What other resources are needed to

implement EBP?

•What is your next step?

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Your Turn28

•Questions?

•Comments?

•Thoughts?

Session Outcomes

At the conclusion of this workshop, participants will have an increased knowledge about:

• Importance of specifying outcomes at the outset

• Exit minus entry = outcomes

• Types and qualities of outcomes

• Importance of evidence-based practice (EBP)

•What EBP can do for TR

•What you can do toward EBP

29

Thank You!30

Norma J Stumbo, Ph.D., CTRS, FALSnjstumbo@gmail.com

Facilitation of TR Services: An Evidence-Based and Best Practice Approach to Techniques and Processes, 2011, Venture Publishinghttp://venturepublish.com/product.php?id=172