AROC Ambulatory Clinical Data Set
Why ambulatory benchmarking
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, and facilitates a resultant standard of best practice.
The ambulatory benchmarking initiative
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. For Phase 1 of the initiative AROC invited all current members to participate via an Expression of Interest. Participants in Phase1 have the opportunity to collaborate in refining the processes for data collection, analysis and reporting.
Phase 2 will extend the initiative to cover providers of exclusive ambulatory rehabilitation services and those that are not currently members of AROC. The results of Phase 1 should see a streamlining of the data collection process allowing for a seamless transition to Phase 2.
The dataset
A draft 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) is based on the AROC inpatient dataset, modified to include items that relate specifically to evaluating the efficacy of ambulatory rehabilitation programs.
The AROC Data Dictionary and Guidelines is now available for use and comment.
Users can choose to browse through the AROC Data Dictionary and Guidelines Online, or download print friendly versions of the AROC Inpatient Data Dictionary and Guidelines or the AROC Ambulatory Data Dictionary and Guidelines.
Data collection proforma
A proforma for data collection of the version 1 data set has been designed that may assist in ensuring that all the relevant data items are collected and entered. The proforma is available in PDF and Microsoft Word format, and can be modified to suit the needs of participant services as desired.
The outcome measure – Australian Modified Lawton’s IADL Scale
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 represents a more sensitive measure of the outcome of ambulatory rehabilitation than the FIMTM 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, 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 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 as an additional tool used collectively to enable benchmarking. 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.
Data compliance and audit
All items in all AROC data sets are mandatory and should be collected and submitted to AROC. It is important that all submitted data 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. Facilities submit their data directly to the AROC database via AROC Online Services (AOS).
All data submitted to AROC undergoes a comprehensive audit process. 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 .
Download the AROC clinical ambulatory data set & supporting documents
Want further information ?
Contact AROC
E: aroc@uow.edu.au
P: 02 4221 4411
A: Building 29, University of Wollongong, Wollongong NSW 2522
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