Measure Title:

    Functional Status Change for Patients with Neck Impairments

    Measure Type:

    Patient-Reported Outcome Performance Measure (PRO-PM)

     Measure Description:

    This is a patient-reported outcome performance measure (PRO-PM) consisting of a patient-reported outcome measure (PROM) of risk-adjusted change in functional status (FS) for patients aged 14 years and older with neck impairments. The change in FS is assessed using the Neck FS PROM. The measure is adjusted to patient characteristics known to be associated with FS outcomes (risk adjusted) and used as a performance measure (PM) at the patient, individual clinician, and clinic levels to assess quality.

    The Neck FS PROM is an item-response theory-based computer adaptive test (CAT) for patients with impairments related to neck problems including but not limited to cervical (neck) pain, radiculopathy, strain, sprain, stenosis, myelopathy, spondylosis or disc disorders. In addition to the CAT version, which reduces patient response burden, the Neck FS PROM is available at no charge for public use as a 10-item short form (static/paper-pencil). Scores are reported on a 0 to 100 continuous scale with higher scores indicating better functional status. The Neck FS PROM maps to the Mobility and Self-care constructs within the Activities and Participation domain of the International Classification of Functioning, Disability and Health. 

    Numerator Statement:

    The numerator is based on scores of patients with neck impairments who: a) received either a rehabilitation therapy, medical, or chiropractic episode of care;  b) had their Neck FS assessed at admission and at the end of the episode of care;  and c) were discharged from care.

    A Residual score is defined as an actual change score minus the risk-adjusted predicted change score. The Residual(s) are calculated at three levels:

    • Patient Level: The residual Neck FS Change score for the individual patient.
    • Individual Clinician Level: The average of residuals for change in Neck FS scores in patients who were treated by a clinician in a 12-month time period.
    • Clinic Level: The average of residuals for change in Neck FS scores in patients who were treated within a clinic in a 12-month time period.

    Numerator Details:

    • Patient Level:  The residual score for the individual patients with neck impairments is derived by applying the statistical risk adjustment model. 
    • Individual Clinician Level: The average of residuals in functional status scores in patients who were treated by a clinician in a 12 month time period for neck impairments. Clinician level: Average scores are calculated for all clinicians, however, in order to achieve a minimum reliability threshold of 0.7, performance is evaluated only for those clinicians that had a minimum of 20 patients in the previous 12 months. 
    • Clinic Level:  The average of residuals in functional status scores in patients who were treated within a clinic in a 12 month time period for knee impairment. Average scores are calculated for all clinics, however performance is evaluated only for large clinics (4 or more clinicians) that had a minimum of 40 patients, and small clinics (1-3 clinicians) that had a minimum of 10 patients per clinician, in the previous 12 months in order to achieve a minimum reliability of 0.7

    Denominator Statement:

    All patients aged 14 years and older with neck impairments who initiated an episode of rehabilitation therapy, medical, or chiropractic care and completed the Neck FS PROM at admission.

    Denominator Details:

    The target population is identified as individuals with neck impairments including but not limited to cervical (neck) pain, radiculopathy, strain, sprain, stenosis, myelopathy, spondylosis or disc disorders.

    Denominator Exclusions:

    Patients who are not being treated for a neck impairment. Patients who are less than 14 years of age

    Time Period for Data:

    Both Numerator and denominator aggregate the past 12 months of data

    Risk Adjustment Type, model method and variables:

     The methods used to develop the FOTO risk-adjustment neck model were the same as the methods described in detail in a publication by Deutscher et at, 2018.  Briefly, we used data from patients with neck pain treated in outpatient rehabilitation therapy clinics during 2016 that had complete outcomes data at admission and discharge to develop the risk-adjustment model. The data included the following patient factors that could be evaluated for inclusion in a model for risk-adjustment: FS at admission (continuous); age (continuous); sex (male/female); acuity as number of days from onset of the treated condition (6 categories); type of payer (10 categories); number of related surgeries (4 categories); exercise history (3 categories); use of medication at intake for the treatment of LBP (yes/no); previous treatment for LBP (yes/no); treatment post-surgery (lumbar fusion, laminectomy or other); and 31 comorbidities.The public domain short form and internet CAT produce a measure score that can be risk adjusted.

    Detailed risk model specifications:

    See the link to the risk adjusted Neck Data Coefficients below.

    Calculation Algorithm/Measure Logic

     STEPS TAKEN TO PRODUCE THIS MEASURE:

    Definitions:

    Patient’s Functional Status Score. A functional status score is produced when the patient completes the FOTO (neck) PROM administered by CAT or paper and pencil survey. The functional status score is continuous and linear. Scores range from 0 (low function) to 100 (high function). The survey is standardized, and the scores are validated for the measurement of function for this population.

     Patient’s Functional Status Change Score. A functional status change score is calculated by subtracting the Patient’s Functional Status Score at Admission from the Patient’s Functional Status Score at Discharge.

     Predicted Functional Status Change Score. Functional Status Change Scores for patients are risk adjusted using multiple linear regression methods described above.  The Patient’s Functional Status Change Score is the dependent variable. The statistical regression produces a Risk-Adjusted Predicted Functional Status Change Score.

     Risk-adjusted Functional Status Change Residual Score. The difference between the actual change and the predicted change scores (after risk adjustment) is the residual score  and should be interpreted as the unit of functional status change different than predicted given the risk-adjustment variables of the patient being treated. As such, the risk-adjusted residual change score represents risk-adjusted change corrected for patient characteristics. Risk-adjusted residual change scores of zero (0) or greater (>0) should be interpreted as functional status change scores that were predicted or better than predicted given the risk-adjustment variables of the patient, and risk-adjusted residual change scores less than zero (<0) should be interpreted as functional status change scores that were less than predicted given the risk-adjustment variables of the patient.

    Aggregated risk-adjusted residual scores: The average of residual scores of functional status (actual change - predicted change after risk adjustment) from a provider (clinician or clinic).  The aggregated scores are used to make comparisons between clinicians or clinics.                                                                                               

    STEPS:

    First, the patient completes FOTO’s functional status survey for the Neck at Admission, which generates the Patient’s Functional Status Score at Admission

    Second, patient completes FOTO’s functional status survey at or near Discharge, which generates the Patient’s Functional Status Score at Discharge

    Third, the Patient’s Functional Status Change Score (raw, non-risk-adjusted) is generated

    Fourth, a Risk-adjusted Predicted Functional Status Change Score is generated using a regression equation

    Fifth, a Risk-adjusted Functional Status Change Residual Score is generated for each patient.

     Sixth, the average residual scores per clinician and/or clinic are calculated, and scores for all clinicians/clinics in the database are ranked.  The quality score is the percentile of the clinician and/or clinic ranking.  The quality scores and its 95% CI can be compared to the benchmark (a score of zero) to determine if the performance is below, at, or above the predicted average.