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Outcome Measurementand Management:
First Steps for the Practicing Clinician
Sandra L. Kaplan,
PT, PhD
 Associate Professor and Assistant Director,Doctoral Programs in Physical TherapyMember Stuart D. Cook MD Master Educators GuildUniversity of Medicine and Dentistry of New JerseyNewark, New Jersey
 
F. A. Davis Company1915 Arch StreetPhiladelphia, PA 19103www.fadavis.comCopyright © 2007 by F. A. Davis CompanyAll rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in aretrieval system, or transmitted in any form or by any means, electronic, mechanical photocopying,recording, or otherwise, without written permission from the publisher.Printed in the United States of AmericaLast digit indicates print number: 10 9 8 7 6 5 4 3 2 1
 Acquisitions Editor:
Margaret Biblis
Developmental Editor:
 Jennifer Pine
Manager of Art & Design:
Carolyn O’BrienAs new scientific information becomes available through basic and clinical research, recommended treat-ments and drug therapies undergo changes. The authors and publisher have done everything possible tomake this book accurate, up to date, and in accord with accepted standards at the time of publication. Theauthors, editors, and publisher are not responsible for errors or omissions or for consequences from appli-cation of the book, and make no warranty, expressed or implied, in regard to the contents of the book.Any practice described in this book should be applied by the reader in accordance with professional stan-dards of care used in regard to the unique circumstances that may apply in each situation. The reader isadvised always to check product information (package inserts) for changes and new information regard-ing dose and contraindications before administering any drug. Caution is especially urged when usingnew or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Kaplan, Sandra L.Outcome measurement and management: first steps for the praticing clinician/ Sandra L. Kaplan.p. ; cm.ISBN-13: 978-0-8036-0310-3 (alk. paper)ISBN-10: 0-8036-0310-X (alk. paper)1. Medical rehabilitation. 2. Outcome assessment (Medical care)I. Title.[DNLM: 1. Rehabilitation. 2. Treatment Outcome. 3. Data Collection—methods. 4. Data Interpretation, Statistical. 5. Patient Care Planning—organization & administration. 6.Physician Practice Patterns. WB 320 K17f 2007]RM930.K37 2007362
.
1dc222006013289Authorization to photocopy items for internal or personal use, or the internal or personal use of specificclients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center (CCC)Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy licenseby CCC, a separate system of payment has been arranged. The fee code for users of the TransactionalReporting Service is: 8036-0310/07 0
$.10.
 
Preface
vii
This book has two main goals:
GOAL 1: TO INTRODUCE READERS TO THE TERMINOLOGY AND PROCESSES OF OUTCOMEMEASUREMENT
This first goal may seem straightforward enough. At the time I began thisproject (mid-1990s), there were very few books that addressed outcomemeasurement in rehabilitation. In fact, most of the literature available was,and continues to be, in the domains of medicine, nursing, and quality assur-ance. Pulling definitions together, finding threads to tie processes together,and finding links to the educational and experiential backgrounds of phys-ical therapists have and continue to be an iterative process of new discov-ery, reorganization, and refinement.This book does not purport to be an exhaustive review of the literature.Rather, it uses literature to credit ideas, provide examples, and demonstratethe range of strategies available to address outcome measurement processes.I have tried to pick examples from the literature that illustrate ideas and thatalso represent the wide variety of practice venues of physical therapists.Many of the ideas and suggestions provided in this book are my own,having evolved from conducting outcome studies and teaching courses onoutcome measurement. I have had the privilege of teaching these courses toprofessional and post-professional physical therapy students. Many expla-nations that have been included are there because students needed “dots”to be explained or “dots” to be connected. I am grateful to the many stu-dents who have asked questions and shared their confusions, as they havehelped to ground the application of information in practical terms.I have also learned that while the academic community is immersed insuch frameworks and terminology as
disablement models
,
evidence-based practice
, and
measurable outcomes,
there are many practicing clinicians whohave not applied or observed these frameworks or terms in their daily clin-ical practice. Recognizing the categories of a disablement model appears tobe a different skill than categorizing examination measures according tothat model or using the model to create hypotheses about patient care.Consequently, I have included chapters about service delivery models, dis-ablement models, and statistics. Academic programs teach this content ingreater depth, so current students and recent graduates may not need thesechapters. They have been included to help those practicing clinicians whohave not had the same academic exposure and to enable clinicians fromother professions to use that information.
GOAL 2: TO PROVIDE CLINICIANS WITH STRATEGIESFOR USING THEIR OWN DOCUMENTATION TO EVALUATE THEIR PRACTICE PATTERNS OREFFECTIVENESS RETROSPECTIVEL
This second goal was the harder of the two to address, and I am hopeful thatPart 2 of this book successfully delivers on the goal. Outcome measure-
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