Whatcom P2 is using 4 distinct individual patient surveys to assess the physical and emotional well being and capabilities of patients that have been admitted to a Clinical Care Specialist (CCS).
These 4 measures are: Depression, Simple Quality of Life, Physical Function, and Activated Patient. Each patient admitted to a CCS is asked to complete each survey at the time of initial evaluation. After the initial evaluation they are asked to complete the surveys once every 3 months. Currently we have both English and Spanish versions available for each except the Activated Patient measure, which we are working on the translation right now
Once the surveys are complete they are handed in to the P2 staff and the surveys are then key-entered into a Microsoft Access supported key-entry form specific to each survey. Once a week we (Data Analysts of P2) run a MS Access macro that extracts the results for each survey and saves it off to a text file. This text file is then loaded into Winsteps, which is the application that performs the Rasch analysis of the data. Once Winsteps crunches the data it automatically writes off a text file. Another MS Access macro is run that imports the patient scores back into the database. These scores are on a 0-100 scale. The macro also produces a report listing only those scores that have come into the database since the last time the analysis was run. (For a more complete description of what this MS Access based process looks like please read my other weblog titled: Automating Rasch Based Survey Analysis)
The results of the surveys are analyzed in a couple of different ways. First, the scores are loaded into an SPSS (Statistic/Data Management program) table that supports the graphical display of a patient’s progress. On a single chart, each survey is graphed over time. This allows the patient and caregiver to not only see the results of each survey but to also see how the dependent relationship between the surveys, ie as physical function increases depression levels decrease.
Second, within the Winsteps application an analysis tool is used for a detailed evaluation of a single patient’s set of responses. This tool, Person KeyForm, is able to compare how the patient actually answered each question with how Winsteps approximated they would answer it. The approximation is base on the patient’s 0-100 score. This table is particularly useful as it is able to quickly pinpoint areas of concern. For example, a patient takes the Depression Measure and analysis shows a low score. (Low score for depression is good!) If on the question: ‘I worry a lot about the past.’ the pt answered ‘Agree Strongly’. The Person KeyForm table could possibly show that their answer is significantly different than what would be expected from someone with that low of an overall score. The Clinical Care Specialist will immediately be able to identify that the patient’s answer to this question is an outlier and that it might warrant further discussion with the patient. The CCS may then be able to have a discussion with the patient about why they worry about the past and how that worrying is affecting their overall health. The Person KeyForm is able to instantaneously identify outliers, ie areas of possible concern or even areas of positiveness.
This individual analysis is able to produce the remarkable effect of creating a tool that works for the individual patient. This is a paradigm shift in many ways. The shift isn’t that we have produced a survey that seems to accurately collect data on the levels of patient depression, physical function, etc or that the data is then reported in an aggregate form that describes the overall status of the population we are working with. Instead, the shift is that this data gathering and measurement tool does all that AND is able to be applied, in a timely fashion, as a clinical tool to open dialogue with a patient about where they are at and why. It aids the clinician in evaluating a person in their entirety. It is the beginning of treating the patient as an entire individual as opposed to treating their chronic “medical” conditions without addressing their physical and emotional well being.
In summary, these tools that are being developed and utilized with our P2 patients are beginning to bridge the gap. The gap between the type of care the patients have been receiving and the type of care they need. The tools are new and their
Some specific learnings that we have had are:
With the activated pt measure ….acute episode eliminates their activation.
Other learning……all interrelated. It has been seen in some patients that as their physical function improves so does their activation and their depression.
