1. RCSLT Outcomes Project TOMs CONNECT 17th November 2016
Kamini Gadhok
Outcomes Project Sponsor, RCSLT CEO
Kathryn Moyse
Outcomes Project Officer, RCSLT
Mark Bedwell
Technical Partner, Different Class Solutions Ltd
Dr Alison Stroud
Head of Speech and Language Therapy, Aneurin Bevan Health Board

2. Context
Challenges across healthcare, education and social care with regard to outcome measurement
Use of terminology and consistency of definitions
Historical focus on inputs, processes and outputs
Outcome measurement not embedded - variable use of outcome measures, PROMS and PREMs
Few validated outcome measures available
Shift to outcomes-based commissioning in some parts of the UK
Focus on national policies and frameworks promoting improvement in health outcomes

3. RCSLT work on developing an approach
Developing consensus within the SLT profession about use of terminology:
Inputs
Processes
Outputs
Outcomes
Adopting the Theory of Change framework to articulate the contribution of SLT interventions to ultimate outcomes

4. Selecting the approach
May 2014 – December 2014
RCSLT Board of Trustees opted for a pragmatic approach: identifying an existing outcome measure to begin to gather consistent data for the SLT profession
Commissioned a review of outcome measures used by SLTs to identify an existing tool for the data collection
Developed criteria for appraisal of outcome measure tools, as suggested by members (see next slide)
Appraised 60+ outcome measures, systems and frameworks against the criteria 4

5. RCSLT members’ ‘best fit’ criteria5

6. Identifying an existing outcome measure
December 2014
Therapy Outcomes Measure (TOMs) (Enderby and John, 2015) was identified as the measure most fit for purpose
It was acknowledged that:
The adoption of TOMs was a starting point for the profession’s journey on outcome measurement
Use of TOMs by the profession is an ‘opt-in’ process
TOMs would not be used as a ‘stand-alone’ option but employed alongside other measures or diagnostic assessments
TOMs is not applicable across all clinical areas and settings (i.e. universal services/Public Health)
(Parallel RCSLT work-streams are being established to consider how to fill these gaps)

7. Identifying an existing outcome measure
January 2015 – March 2015
Communicated to RCSLT members that TOMs had been identified as the ‘best fit’ outcome measure for the recording reliable, comparable outcomes data across the profession, and invited SLT services to ‘opt in’
Scoped options for national data collection system
RCSLT Board of Trustees decided on a stand alone model for data collection. A ‘Proof of Concept’ pilot was approved to develop an online tool using TOMs

8. ‘Proof of Concept’ Pilot Aims
To improve the collection of outcome data in order to identify the impact of therapy for individuals with speech, language, communication and swallowing needs
To investigate and minimise the burden of data collection, collation and analysis on speech and language therapy service leaders and practitioners
To investigate the practical challenges and benefits of benchmarking for quality assurance and identifying variation in outcomes associated with different services

9. ‘Proof of Concept’ Pilot Aims
To investigate the value of TOMs aggregated data reports in supporting service evaluation, quality assurance and business case development for individual services
To evaluate the usability and value of a stand-alone TOMs web-based application for SLT services (via direct data input or data transfer from an existing system) compared to data collection and reporting systems currently in use

10. The ‘proof of concept’ online tool
April 2015 – July 2015
Developed basic specification for the RCSLT online tool for measuring outcomes using feedback from members on data collection and reporting requirements
The online tool is being developed to support practitioners with:
Collecting and collating outcomes data using two methods:
Direct input of TOMs data into the online tool
Exporting of outcomes data from local systems to the online tool using a data transfer template
Evaluating and reporting outcomes 10

11. The ‘proof of concept’ pilot
August 2015 – present
Identified SLT services with experience of using TOMs to pilot the online tool
Representation from across the UK
Range of clinical areas and settings
Supported SLT services involved to develop relationships with key stakeholders within their organisation and with completing relevant information governance documentation and processes

12. Key
● Adult
● Paediatric
● Adult and Paediatric
Pilot Organisations 12

19. Pre-intervention
Post-intervention

20. Key challenges Two key areas of challenge
Information sharing and information governance
Data collection

21. Actions to address challenges
Information sharing and information governance
National stakeholder engagement (e.g. Information Governance Alliance, Information Commissioners Office, National Data Guardians) for advice and support on information governance
Developing resources to support SLT services engaged in the project to navigate local information governance documentation and engage local IG leads (e.g. Information Governance Resource Pack)

22. Actions to address challenges
Information sharing and information governance
Developing resources to support SLT services with understanding legislation about information governance more broadly
“What can I share? Exploding the myths about information sharing”
Webinar in collaboration with the Information Governance Alliance (IGA) and Information Commissioner’s Office (ICO)

23. Actions to address challenges
Data collection
National stakeholder engagement (e.g. NHS Digital, including UK Terminology centre)
Embedding standardised clinical terminologies within the online tool (ICD10/SNOMED)
Exploring different options for data export that will enhance the quality of the data and offer a more sustainable approach

24. Where are we now?
Refining the online tool and aggregated data reports in response to feedback from SLT services in the pilot
Iterative process
‘Agile’ methodology
Currently, the RCSLT database contains outcomes data for 10,500+ complete episodes of care from six SLT services involved in the pilot (November 2016)
Independent evaluation conducted by Bristol Speech and Language Therapy Research Unit to evaluate the “benefit vs. burden”
RCSLT Board of Trustees will discuss next steps in December 2016

25. Thanks for listening! For more information, please contact:
Kathryn Moyse RCSLT Outcomes Project Officer 25

26. Reference slides Case Study - Paediatric speech and language therapy service outcomes

27. Change in TOMs scores between initial and final across each domain

28. Change in TOMs scores between initial and final across each domain

29. Change in TOMs scores between initial and final across multiple domains

30. Distribution of change in TOMs scores between initial and final across each domain

31. Average change in TOMs scores between initial and final across each domain