Therapy Outcome Measures Implementation of TOMs within ABUHB Introduce self and Cathy Our talk about TOMs Implementation journey Toms familiar to many if not all of you Talk about what we have done, how we have done this and the stage we are at now. We’ll share our progress and some of our challenges.

Introduction Health services, including SLT, are under increasing pressure to demonstrate that what we are delivering is effective. We need ways of measuring what we do and we need to know and show our impact. We need to demonstrate that we are making a difference to the populations that we provide services to. In Wales we are aiming to implement Prudent healthcare principles. “Best fit” criteria: as agreed by members at the 2013 Hub Summit, to support national outcomes data collection, 60+ outcome measures appraised against the agreed criteria SLT services need outcomes data to: demonstrate the impact of SLT, demonstrate contribution to national policy outcomes, inform commissioning of services, ensure services are of good quality for service users and sustainable for the future READ POINTS ON SLIDE

The Principles of Prudent Healthcare We need to spend the money we have wisely, on the services that make the biggest difference to the most amount of individuals. We need to be able to look at the bigger picture and have a measure that can help us to do this.

What is TOMs? A Therapy Outcome Measuring tool - Pam Enderby and Alexandra John Uses an 11 point rating scale to rate scores in 4 domains: Impairment Activity Participation Wellbeing Records where a patient starts their journey and ends their journey after accessing our service Enables us to record outcome measures which will guide care and give information about the needs of the population and the benefits of our service Brief info re: pam Enderby and Alexandra John.

ABUHB: First steps ABUHB had a commitment to adopt TOMs Training 8 Therapists attended training with Pam Enderby in May 2015. 4 of the eight therapists attended the Train the Trainer day Implementation group Lead group of TOMs trained therapists established. Monthly meetings to plan and make TOMs related decisions for the department including: Training of the workforce Data collection (including E form for ABUHB) RCSLT Links Data Analysis Progress: In a short space of time we had a ‘lead team’ for TOMs in the department (for Adults and Paediatrics). Challenges: TOMs still very new to us. Positive impact of having an implementation group. Refer to minutes and note here different aspects discussed in meetings.

Training of the workforce Three one-day training sessions which included rating practice Access for all TOMs rating scales at all sites. All SLT’s asked to complete ratings for all new patients who were assessed and to whom we had an open duty of care. Initially recorded in case note / EOC form, then moved to using excel spreadsheet. SLT’s to complete other ratings, intermediate and final as appropriate Targeted teams at a time Did this so would be able to discuss in supervision/formal/informal increasing motivation to use tool. Progress: 72/75 Therapists in ABUHB were TOMs trained by February 2016. Rating started! Lots of questions generated and answered so TOMs becoming much more familiar. Challenges: Time taken from clinical work to train staff. TOMs new to staff. A change to manage. TOMs doesn’t replace the need to have clinical outcomes/ research. Different kind of tool.

In response to questions… FAQ’s in third edition book referred to. TOMs at a glance devised and circulated to team. Responses to any questions circulated to the whole team. Telephone and email liaison with Pam Enderby. TOMs at a glace here for anyone to look at. Have copies at presentation. Keeping staff informed – responding to all. Concerns raised by staff: inc some scales – degenerative diseases. Say what concerns of staff have been .

Quality Control Ensuring consistency and reliability Inter-rater groups Team meetings or specifically organised session 3-4 sessions per year (quarterly) Typically 8-10 ratings per session System used by Admin for recording mandatory training adapted to note interrater reliability sessions for each therapist Supervision Inter-rater groups: Increased reliability / consistency.

Data Collection ABUHB SLT decision to develop a form that was compatible with ABUHBs IT system, so could hold this information locally. Started work developing the e-form in Autumn 2015, initially starting in SMT. Devised in ABUHB with two E-form implementation officers from Health Records. Data collected using an excel spreadsheet Data collected in compatible form for RCSLTs use when exported for the pilot via RCSLTs web based tool. Progress: Decisions about data collection made. Data collection for RCSLT underway. Development of e-form. Challenges: Development of e-form - many different processes and stages. (but worth it!) Explanation why ASBUHB preferred to develop e form. RCSLT web based tool. Our info uploaded within to this tool by us and details exported to the tool / record. e chose not to input directly to RCSLTs web based tool.

E-form development Patient data imported from Clinical Work Station (CWS) Drop down boxes Minimise errors Ease of use Core info collected at Admission, incl ICD10 aetiology code and disorder code. Points selected highlighted for ratings Hours/minutes recorded to calculate time spent. Summary pages generated automatically Talk though the form. Will add bullet points here before presentation.

Summary form Add bullet point notes.

Data Analysis Information to enable us to plan services: Most effective and most efficient. Impact across the domains per disease code/ SLT code Average input to gain an impact (time/contacts) Ability to analyse patient journey, via intermediate ratings, to look at best period of time for patient to benefit. Ability to compare results across a team Ability to compare across departments Explain why useful to have the above info for service planning / re-shaping and re-designing services. Benchmarking internal or external : we can learn from the team who are making the best progress with patients.

RCSLT Pilot ABUHB one of RCSLT TOMs pilot project. Lead clinicians from Implementation Group were main links between RCSLT and ABUHB. RCSLT link: Amy Ward (pre Dec 2015) and Kathryn Moyse (Jan 2015 to present) , Outcomes Project Officer, RCSLT. Regular liaison with data analysis team re: spreadsheets exporting information Submission of data to RCSLT, to link to web based tool. Initial information / outcomes reported by RCSLT. Evaluation of RCSLT pilot by Bristol Speech & Language Therapy Research Unit, North Bristol NHS Trust Note further info here about RCSLT pilot: Aims of project. How many health boards / trusts involved Info about the project. Where we are at _ What we are waiting for. Progress: Increase in confidence in using TOMs. Collaborative relationships established with RCSLT Challenges: Takes some time to gain information for analysis – due to needing a Final Score Rating.

Initial Data Analysis for Stroke Cathy

Data Analysis for Stroke/Voice Cathy: VR & CB to discuss further. One patient (voice) showed a decrease in participation - sometimes maintenance of scores or a decrease may be anticipated, particularly with degenerative disorders 0 points gain: many patients may show no gain in 3 domains and still show an improvement in the fourth domain – this is acceptable and may well relate to the goal / targeted area Where a patient shows no change across any domain – review the casenotes, is there a pattern, is there a specific group where gains are minimal? May not have attended appts and therefore discharged prior to completing goals / treatment. High impairment / activity gains: may in part relate to spontaneous recovery of stroke patients in the acute stages of care

What next in ABUHB SLT? Continued commitment to use TOMs E-form to go live in Autumn 2016 Awaiting outcomes from RCSLT pilot Implementation group continues to meet Plans for data reporting Add more info here: Input – need to consider our money, staff time ……….. Activities- what do we do to fulfil our mission assessing, enabling, Malcomess care aims Outputs – the volume of work accomplished by the project – quality/ quantity Outcomes – benefits or changes for participants Impact – long term consequences of intervention – fundamental change to society or system ( prudent health care) Going ‘live’ 19th October 2016 Toms integrated in to Induction Implementation group – further work.