Special interest groups
A variety of people and institutions have expressed a need for outcome data. Each group has a different perspective as to which data are meaningful and how to apply those data to fit their needs. Despite having separate needs for and interests in outcome data, all of the parties involved in health-care delivery are interconnected. Therefore, meaningful outcomes for one party are influenced by the perspectives and needs of other parties. As the outcomes from a single encounter or episode of intervention can be meaningful to many parties, it is helpful to understand who the parties are and how their perspectives differ.
Figure 4.1 depicts the different parties that are interested in outcome data. In general, the bubbles toward the left side represent the consumers of health-care services, and the bubbles toward the right side represent those that deliver or support health-care services. Each party will be described; sample outcome questions are posed at the end of each section to indicate how that group might pose a question. “Intervention A” will be the imaginary focus of the questions—it represents any intervention or service that a physical therapist or clinic might offer.
Perspectives on outcomes.
Patients and clients who receive physical therapy services are consumers of rehabilitation outcome data. Their interest is at a personal level because they are interested in their own progress relative to their prognosis for improvement. In an outcome approach to care, patients participate in determining meaningful outcomes for intervention. Improved scores on meaningful functional outcomes are important patient indicators that an intervention plan is working. Whereas feedback about changes in impairments may be helpful when appreciable changes in functional limitations have not yet occurred, patients will more clearly see the benefits of physical therapy when functional losses are resolved. Grimmer, et al. (1999) demonstrate that naive patients (those receiving intervention for low back pain for the first time) expect different outcomes of their first intervention session than do experienced patients (those who have received intervention for the same diagnosis in the past). Both groups of patients expect symptom relief, but experienced patients expect more advice and explanation than the naive group. Grimmer, et al. also demonstrate that some expectations can be clearly described by the patient, and some are more covertly assumed. For instance, these researchers found that the decision to return for a second visit was partly influenced by whether patients received symptom relief as well as by the interpersonal skills and ability to provide information of the ...