Developing, selecting and testing a core set of outcome-based quality indicators in Dutch physical therapy practice for patients with non-specific low back pain
The routine collection of treatment outcome data provides an opportunity to monitor, evaluate and improve quality of care in physical therapist practice. Such outcome data can be used at the individual level during the interactions between patients and professionals for goal setting, monitoring and evaluating treatment outcomes. When comparing aggregated outcomes at the group level, healthcare providers can reflect on their own performance and compare themselves with their peers. Furthermore, aggregated outcomes can be used for public reporting, e.g., as a supported tool enabling patients to choose a provider or for pay-for-performance initiatives.
We developed, tested and selected a core set of outcome-based quality indicators in Dutch primary care physical therapy practice for patients with non-specific low back pain (NSLBP). The core set includes relevant outcome domains and associated measures for monitoring and evaluating primary care physical therapy treatment, and their use is supported by routinely collected real-world data. Methods for developing, testing and selecting the core set of outcome-based quality indicators were conducted in four steps:
(1) Determining which outcome domains (e.g., pain or physical functioning) should be measured, and which measures would be appropriate (e.g., Numeric Pain Rating Scale (NPRS) or Patient Specific Functioning Scale (PSFS)) when evaluating physical therapy treatment. Consensus was reached using a modified RAND-UCLA Delphi method.
(2) Defining potential quality indicators based on the selected standard sets of outcome measures for patients with NSLBP. Quality indicators were quantified and expressed as mean scores or a percentage using a denominator and a numerator, with risk adjustment for baseline score, gender, age, and chronicity of complaints.
(3) Estimating the comparability and discriminability of aggregated outcomes between physical therapists or practices for all potential quality indicators using cohort data from a national clinical registry. Linear and logistic multilevel analysis was used to compare outcomes at the level of physical therapists and practices. The Intraclass Correlation Coefficient (ICC) was calculated for each quality indicator to estimate the variation in outcomes between physical therapists or between practices. ICCs >.10 were interpreted as adequate, indicating that the quality indicator is able to discriminate outcomes between physical therapists or practices.
(4) Selecting a final core set of quality indicators by reaching consensus through a series of focus group meetings with physical therapists, in which participants reflected on the perceived added value of using the presented indicators in daily practice for quality improvement. In addition, a focus group meeting was held with Dutch senior physical therapy researchers that were members of the development team of the revised Dutch physical therapy guideline for low back pain.
Applied LeaRRning Case
Philip J. Van der Wees, PT, PhD, professor of Allied Health Sciences, Radboud university medical center, Nijmegen, the Netherlands; The George Washington University; Washington, D.C.
Koen Verburg, PT, MS, PhD Candidate, Radboud university medical center, Nijmegen, the Netherlands
This case describes the research methods for developing, testing, and selecting a core set of outcome-based quality indicators in Dutch primary care physical therapy practice for patients with non-specific low back pain (NSLBP).
With this case we hope to contribute to continuous quality improvement for physical therapy management of patients with NSLBP and advance the field of implementation science.
“Commitment and alignment of interested parties is essential in selecting and using outcomes for quality improvement and transparency of care”
Koen Verburg, MS, PhD Candidate