The Wisconsin Pulmonary Rehabilitation Outcomes Project (WisPRO) Consensus Paper- A Supporting Statement by the WISCVPR Outcomes Committee

Committee Members: Mark Vitcenda, M.S. (Chair); Kim Beyer, B.S., Milwaukee; Corie Birkholz, M.S., Stevens Point; Karen Block, CRT, Mequon; Shirley Brusewitz, R.N., Stevens Point; Deb Corradini M.S., R.N., Madison; Barbra Fagan, M.S., Menomonee Falls; Denise Fergusson, B.S., Madison; Tracy Herrewig, M.S., Oshkosh; Sue Nordall, CRT, Woodruff; Michelle Schliesman, RRT, Beaver Dam; Charlie Steil, M.A., Eau Claire; Tammy Riebe, B.S., Sheboygan;, Madison; Lisa Wenzel, M.S., Madison; Janice Wierschke, R.N., Sheboygan.

Issue

Measuring outcomes is recognized as an essential component in the evaluation of the effectiveness of pulmonary rehabilitation programs. An outcome is the end result of a process. It is hoped that by collecting data a program will become more aware of it's current practices, patient populations and be able to evaluate a programs effectiveness. In pulmonary rehabilitation, it is the measure of a patient’s progress toward a defined goal. Outcomes are also data collected to demonstrate the efficacy of a program’s procedures. This is an important aspect of any program in order to justify the value of the program’s services both clinically and financially. In the changing health care environment, every program will be accountable for their costs and their processes. Therefore, the movement by pulmonary rehabilitation professionals to measure outcomes is a proactive commitment to high standards and quality programs.

Resources

The Wisconsin Pulmonary Rehabilitation Outcome Committee, with support of AACVPR and WISCVPR, was formed to address and develop a standardized set of pulmonary rehabilitation outcome measures. The Committee is a representation of various regions within the state of Wisconsin as well as diverse program experiences.

The Committee determined a general need to focus on collecting data to move from general, nonspecific outcome measures to more specific, patient-orientated measures that are able to be standardized for benchmarking purposes. The Committee surveyed members to examine what outcomes were being measured at the time, and what members felt were important aspects to be included in the project.

Implementation Plan

From the results of the survey, the Committee selected outcomes based on several criteria:

  • Is the measure clinically relevant and meaningful?
  • Is the measure easily obtained through current practices?
  • Is the measure controllable?
  • Does the outcome have the potential to be improved?
  • Is the measure reproducible?
  • Can the measure be compared between programs of varying sizes and resources?

The Committee followed outcome guidelines established by AACVPR. Four main domains were chosen: clinical, behavioral, health and economic (See Table 1).

Table 1: WISPRO Pulmonary Rehabilitation Outcome Domains

Clinical / Behavioral / Health / Economic
Functional / Smoking Cessation / Quality of Life / Medical Care Usage
Blood Pressure Management / Diet Management / Events
Dyspnea / Psychosocial / Financial
Exercise Habits
Lifestyle Behavior Compliance

The Committee also recognized the importance of following patients after discharge from outpatient (acute) rehabilitation. Therefore, a set of specific follow-up measures was developed to measure long-term changes in patient outcomes. Lastly, it was felt that the measures should permit flexibility in allowing programs to determine individual program goals while maintaining some standardization within the state. The final set of measures was reviewed by the Committee and sent to the WISCVPR Board of Directors. The project gained the endorsement of the Board in February 2001.

Goals/Benefits

These measures are NOT guidelines for individual patient care, or minimal or maximal standards of care, but should be considered performance measures that allow programs to compare their specific patient populations versus state benchmarks over time. These measures should be recognized as an initial attempt at standardizing basic pulmonary rehabilitation outcome measures for the state of Wisconsin. There may be changes to the measures as more experience is gained. The Committee will assess the data, review the project and report its progress to the WISCVPR Board of Directors in 2002.

WISCVPR realized the necessity of gathering outcomes consistently using standardized documentation. The WisPRO Committee developed an electronic format using the Internet to facilitate this process. Data will be entered on the WISCVPR web-site and immediate feedback will be generated through printable reports. The measures will be reported as aggregate data (percent of sample meeting outcome criterion or average change in a measure) comparing entry and discharge, or in the case of follow-up data, comparing follow-up and discharge.

Summary

In summary, the WISPRO Committee is committed to taking a proactive approach to measuring pulmonary rehabilitation outcomes and benchmarking program efficiency throughout the state of Wisconsin. A statewide database is expected to positively impact pulmonary rehabilitation through its flexibility and instant report generation. It is hoped that all pulmonary rehabilitation programs in the state, depending on their abilities and resource, will take part at some level in this process.