1. The Importance of Evidence- Based Practice on Our Future
NORMA J. STUMBO, PH.D., CTRS, FALS
EDUCATION ASSOCIATES

2. Session Outcomes
At the conclusion of this workshop, participants will have an increased knowledge about:
Importance of specifying outcomes at the outset
Exit minus entry = outcomes
Types and qualities of outcomes
Importance of evidence-based practice (EBP)
What EBP can do for TR
What you can do toward EBP

3. Why It Matters Client Outcomes: The Why
Evidence-Based Practice: The How

4. Why are Outcomes Important?
External Accreditation
Third Party Payers
ATRA Standards of Practice
Health Care Consumer Groups
It’s the Right Thing to Do!

5. What are Outcomes?
Observable changes that result from intervention (Client status, functional status, well-being, care satisfaction, cost/resource utilization
Changes over specified time
Clinical results
Results of performance
Direct effects of service
Difference between input (assessment baseline) and output (discharge)
Straightest line between A and B
Both planned and unplanned
Both beneficial and harmful

6. Client Outcomes Intervention Entry Exit
Client characteristics at baseline
(assessment)
(e.g., health status, functional status, quality of life, etc.)
Client characteristics at end of treatment
(re-assessment)
(e.g., health status, functional status, quality of life, etc.)
Entry
Exit
Intervention
Difference between Point A/Entry and Point B/Discharge
= Outcomes

7. Typical Categories of Outcomes
Change in clinical status
Effect of tx. on pt. symptoms
Change in functionality
Effect of tx. on pt. lifestyle
Change in utilization of services
Effect of tx. on using future services
Recidivism
Patterns of relapse or re-entry

8. Outcome Qualities Predictable/Causal—direct result of intervention
Identifiable/Measurable
Achievable
Demonstrable/Documented
Predictable/Causal—direct result of intervention
Meaningful
Predetermined—target behavior BEFORE intervention
Accountable—deliverable every time

9. Outcome Measure Selection
Relevant/important to clients
Result from intervention
Incorporate into existing client & program documentation e.g. objectives
Understandable by professionals and caregivers
Data collection processes quantify results

10. What Do We Know For Sure? Outcome measurement depends on:
Specification of important, meaningful outcomes
Systematic programming/intervention (standardized practice)
Valid and reliable client assessment
Accurate and meaningful documentation/records
Systematic program evaluation and efficacy/effectiveness research
YOU!!! (yes, YOU!!!)

11. Therapeutic Recreation Outcomes
What are important TR outcomes?
What outcomes are important in your setting?
What TR service model do you use in your practice?
What are the needs of your clients?
What are the goals of your programs?
What outcomes do you program for?

12. What are Important Outcomes of TR Intervention?
Your Views…

13. Typical Categories of Outcomes in TR
Improve functional ability
Improved leisure awareness
Improved social skills
Improved leisure skills
Improved knowledge/utilization of Leisure resources
Improved community independence
Improved quality of life

14. What is Evidence Based Practice? The How
Targets outcomes based on standardized interventions
Promotes selection of treatments which have some evidence
Improves predictability and causality of service outcomes
Involves applying results of outcomes research to improve day-to-day TR practices

15. Why Evidence-Based Practice Needed?
Three concerns surfaced:
many physicians relying on personal judgment rather than research for treatment of patients
new knowledge exploding at almost direct, inverse relationship to time available to read and absorb it
managed care eroding independence of physician decisions

16. Why Do Healthcare Practices Need to Change?
The structures, incentives, and forces at work in the U.S. health system produce exactly what we should expect in the quality of care for chronic disease: highly variable patterns of care, widespread failure to implement recognized best practices and standards of care, and the persistent inability of provider systems to achieve substantive changes in patterns of practice. Moreover, after more than two decades of effort to improve clinical care management and to promote the adoption of evidence-based standards, these variations [still] persist. (Coye, 2001, p. 44)

17. Produced need for…
Systematic collection of data, over time, through near-patient research studies as well as the clinician’s reflective approach in applying this information in daily work with clients

18. Evidence-Based Practice
Evidence-Based Practice: Research Informing Practice
Therapeutic Recreation Practice
Therapeutic Recreation Research
Practice Based Research: Practice Informing Research

19. Definitions of Evidence-Based Practice
Process of systematically reviewing, appraising and using clinical research findings to aid in the delivery of optimum clinical care of patients.
Ability to track down, critically appraise…and incorporate this rapidly growing body of evidence into one’s clinical practice

20. Definitions of Evidence-Based Practice
Evidence-based practice can be described as selection of treatments for which there is some evidence of efficacy
That is, through evidence-based service delivery, each practitioner should feel confident that she or he is providing the best possible care that is known to produce the most desirable, intended, and meaningful outcomes

21. What is Evidence-Based Practice?
Evidence-based healthcare usually involves systematic research – and better yet, the accumulation of systematic research – as applied by conscientious specialists who have the ability to synthesize the research and incorporate it into daily practice decisions with clients. Its aim is to reduce wide variations in practice based solely on clinicians’ preferences or personal experiences, eliminating the worst practices, and embracing the best practices

22. What Does This Mean for You?
Evidence-based clinical judgment:
is neither solely evidence nor judgment
requires understanding of requirements to make satisfactory clinical decision
increases with opportunity and practice
reduces but does not eliminate clinical uncertainties
is currently grounded in Western, allopathic, and professionalized approach to medicine.

23. What Does This Mean for You?
Evidence-based healthcare is process of life-long, self-directed, problem-based learning in which caring for patients creates need for clinically important information about diagnosis, prognosis, therapy, and other clinical and healthcare decisions

24. Supporting Evidence-Based Practice
Evidence-based practice can be accomplished in three ways:
learning the 5 steps of evidence-based practice,
seeking evidence collected by others,
adopting protocols written by other who have done evidence-based practice research.
Ultimate expectation of evidence-based service delivery is improved, informed, and more consistent healthcare for all clients.

25. Steps to Evidence-Based Practice
Formulate a clear clinical question from a patient’s problem.
Will a middle-aged person with a recent spinal cord injury gain greater stress awareness through yoga or Tai Chi?
Search databases for relevant clinical evidence
Appraise the evidence.
Implement and use findings in practice.
Evaluate the impact of change in practice.

26. The Challenge Finding related and relevant research
Reading and applying research to practice
Developing/delivering evidence-based services

27. Changing How We Do Business
What did you learn about OUTCOMES?
What did you learn about EBP?
What impact could EBP make on your services?
What impact could EBP make on client outcomes?
How will you apply this to your daily practice?
What other resources are needed to
implement EBP?
What is your next step?

28. Your Turn
Questions?
Comments?
Thoughts?

29. Session Outcomes
At the conclusion of this workshop, participants will have an increased knowledge about:
Importance of specifying outcomes at the outset
Exit minus entry = outcomes
Types and qualities of outcomes
Importance of evidence-based practice (EBP)
What EBP can do for TR
What you can do toward EBP

30. Thank You!
Norma J Stumbo, Ph.D., CTRS, FALS
Facilitation of TR Services: An Evidence-Based and Best Practice Approach to Techniques and Processes, 2011, Venture Publishing