Self-Care Management for Patients with Congenital Muscular Torticollis: % Caregivers Independent with Home Exercise Program
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1 Self-Care Maagemet for Patiets with Cogeital Muscular Torticollis: % Caregivers Idepedet with Home Exercise Program Team Leader: Rebecca D. Reder OTD, OTR/L Team Members: Vic Voegele PT, Elizabeth Oliverio PT, Melissa Miller PT, Jaet Polatka PT, Nac Krumm-Richardso PT, Michelle Kiger EBP, Carol Burch QI Coordiator, Beth Roell Coordiator, Roi Christopher Coach Report Date: 6/3/2010
2 KEY DRIVER DIAGRAM Project Name: Self Care Maagemet for Cogeital Muscular Torticollis: % Caregivers Idepedet with Home Exercise Program Project Leader: Rebecca D. Reder INTERVENTIONS Jue 3, 2010 KEY DRIVERS Caregiver Awareess Esure caregiver competece regardig: basic patholog of CMT importace of therap itervetio ad self mgmt evirometal adaptatios ad appropriate positioig Create a iteractive traiig CD for caregiver educatio SMART AIM Icrease the % of caregivers of patiets with CMT who ca idepedetl demostrate their core HEP from 10% to 60% b 6/30/10 (for Cohort) Caregiver capabilit & adherece Accurate assessmet of eed for additioal educatio Implemet use of evidece-based home exercise program Stadardize defiitios for choices re: assessmet of paret s capabilit Provide feedback loop to therapists re: data outcome Implemet Home Exercise checklist Implemet Self Mgmt Assessmet icludig Cofidece Ruler as a balacig measure for adherece & capabilit Develop budle of tools to support attaimet of AIM Trai staff i proper documetatio of outcomes Moitor data & discuss outcomes Assess effectiveess of caregiver educatio via retur demostratio GLOBAL AIM To improve the self-care maagemet aspect of CMT Therapist s use of effective commuicatio to ad traiig of caregiver Tx itervetio & use of modelig to positivel affect the caregiver s maagemet of child s coditio Implemet adult learig methods Utilize tools to idetif idividual learig prefereces to improve success Copright 2008 Ciciati Childre s Hospital Medical Ceter; all rights reserved. Ke tted box = ceholder for future additios Gree shaded = what we re workig o right ow
3 10/30/09 (=16) 11/06/09 (=26) 11/13/09 (=24) 11/20/09 (=29) 11/27/09 (=18) 12/04/09 (=19) 12/11/09 (=13) 12/18/09 (=20) 12/25/09 (=13) 01/01/10 (=17) 01/08/10 (=18) 01/15/10 (=16) 01/22/10 (=10) 01/29/10 (=21) 02/05/10 (=16) 02/12/10 (=21) 02/19/10 (=12) 02/26/10 (=22) 03/05/10 (=26) 03/12/10 (=21) 03/19/10 (=38) 03/26/10 (=20) 04/03/10 (=22) 04/10/10 (=23) 04/17/10 (=17) 04/24/10 (=23) 05/01/10 (=21) 05/08/10 (=32) 05/15/10 (=13) 05/22/10 (=14) % Idepedet - Completed Without Assistace Traiig 1/15/10 1:1 2/26/10 Self Mgmt 3/15/10 Co Measure COHORT OF 5: % Idepedet i Home Exercise Program for CMT Aotatios are for itervetios for Cohort of HEP Checklist 3/22-4/9 AND Rev Checklist 4/19 - ONGOING Revised Self Mgmt Tool 4/12 - ONGOING 0 Idepedet Media Ceterlie Goal (60)
4 10/30/09 (=75) 11/06/09 (=70) 11/13/09 (=80) 11/20/09 (=97) 11/27/09 (=57) 12/04/09 (=94) 12/11/09 (=72) 12/18/09 (=88) 12/25/09 (=51) 01/01/10 (=55) 01/08/10 (=68) 01/15/10 (=79) 01/22/10 (=72) 01/29/10 (=73) 02/05/10 (=71) 02/12/10 (=65) 02/19/10 (=66) 02/26/10 (=85) 03/05/10 (=86) 03/12/10 (=80) 03/19/10 (=80) 03/26/10 (=69) 04/03/10 (=82) 04/10/10 (=76) 04/17/10 (=89) 04/24/10 (=75) 05/01/10 (=80) 05/08/10 (=84) 05/15/10 (=71) 05/22/10 (=74) % Idepedet - Completed Without Assistace Traiig 1/25/10 1:1 2/26/10 Self Mgmt 3/15/10 % Idepedet i Home Exercise Program for CMT Data for Etire Pool of Therapists (40) Aotatios are for itervetios for Cohort of 5 ol Co Mea 3/29/ HEP Checklist 3/22-4/9 AND Revised Checklist 4/19 - ONGOING Revised Self Mgmt Tool 4/12 - ONGOING 0 Idepedet Media Ceterlie Goal (60)
5 Defiitios ad CMT Checklist I. TEST 4 I. TEST 1 What: Stadardized defiitios ad traiig Who (populatio): Cohort of 6 Where: Classroom Whe: 1/25/2010 Who executes Sr. Cli Dir Results: Adopted stadardized defiitios I. TEST 2 What: 1:1 Iterviews Who (populatio): Cohort of 5 Where: Coferece Call Whe: 2/26/10 Who executes: Sr. Cli Dir Results: Sharig of results idetified eed for further refiemet I. TEST 3 What: Develop HEP Checklist & stadardized defiitio of verbal ad phsical cues Who (populatio): Cohort of 5 Where: Webiar Metig Whe: From 3/22/10 To 04/9/10 Who executes: Sr. Cli Dir Results: Checklist tool was used for 37 visits. We saw the biggest jump i % of parets who are idepedet with their HEP sice we bega testig What: Itegrate HEP Checklist & defiitios with therapist trackig form Who: Cohort of 5 Where: Webiar Meetig Whe: 4/19/10 Who executes: Sr. Cli Dir Results: Icorporated the use of both tools ito practice for the cohort Data supports that we have sustaied improvemets usig the revised checklist ad the self care maagemet assessmet tool i tadem. to spread Jue 14 th
6 Self-Care Maagemet Assessmet Tool II. TEST 1 What: CaChild HEP Compliace Measure Who (populatio): Cohort of 5 Where: Webiar Whe: From 3/15/10 3/19/10 Who executes Sr. Cli Dir Results: Paretal ratig of compliace with HEP was a more reliable measure of a paret's reported uderstadig of what we were askig tha the CCHMC self maagemet assessmet as curretl worded (3 Q were 100%; 1 was 71%) II. TEST 2 What: CCHMC Self Mgmt Assessmet (4 compoets) Who (populatio): Cohort of 5 Where: Webiar Whe: From 3/15/10 3/19/10 Who executes: Sr. Cli Dir Results: Paretal ratig of adherece with HEP was a less reliable measure of a paret's reported uderstadig of what we were askig tha the Cachild Compliace Measure (2 Q were 100%; 2 were 29%) II. TEST 3 What: Testig of OTPT Self Maagemet Assessmet Tool (icludig Cofidece Measure) Who (populatio): Cohort of 5 Where: Webiar Meetig Whe: From: 4/12/10 4/26/10 Who executes: Sr. Cli Director Results: Paret idepedece i performig the HEP as judged b therapist is positivel associated with the paret s Cofidece Scale self report scores of a Cofidece Scale scores of 8 ad below were associated with a lower performace level II. TEST 4 What: Implemet a ew process for Itegratig ito practice the self-care mgmt assessmet tool (icludig Cofidece Measure) Who: Cohort of 5 Where: Webiar Meetig Whe: 4/26/10 - Who executes: Sr. Cli Director Results: Data supports that we have sustaied improvemets usig the self care maagemet assessmet tool ad the revised checklist i tadem
7 CMT Budle III. TEST 4 III. TEST 1 What: Idetif with cohort elemets of budle to be used with all CMT patiets Who: Cohort of 5 Where: Webiar Meetig Whe: 4/26/10 Results: Budle =Checklist, Self Mgmt Tool, Educatioal CD III. TEST 2 What: Elicit paret feedback o proposed cotet of educatioal CD (a ke elemet of the budle) Who (populatio): Cohort of 5 Where: Webiar Whe: 5/10/ /10 Who executes: Sr. Cli Dir Results: 11 parets gave valuable iput for cotets of Educatioal CD III. TEST 3 What: Icrease spread; trai additioal cohort of 11 i implemetatio ad use of curret budle of tools Who (populatio): Cohort of 11 Where: MOB 4 Whe: Jue 14, 2010 Who executes: Sr. Cli Dir Results: What: Roll out all compoets to the 40 therapists that treat CMT Who: 40 Therapists who treat CMT Where: MOB 4 Whe: Jul 2010 Who executes: Sr. Cli Dir Results:
8 Overall Learig/Challeges List 3 overall (coverig the whole course) learigs (both with the tests of chage ad use of the process improvemet model) 1. For ever problem, there is a solutio which is simple, eat ad wrog H.L. Mecke 2. Educatio b itself had ver little effect o chagig the outcome, while checklists ad utilizatio of the self maagemet questioaire & cofidece measure had a positive sustaied impact 3. A tremedous amout of learig occurs whe ruig SMALL tests of chage! List 3 overall (coverig the whole course) challeges 1. Logistics of implemetig the tests simultaeousl i ma differet locatios with bus cliical staff is extremel difficult 2. Gettig data out of EPIC i a timel fashio is difficult to impossible whe ew data eeds arise 3. CMT cliical outcome data does ot drop i EPIC automaticall - the outcome tracker is a maual sstem which requires the therapist to select last treatmet sessio
9 Implemetatio/Sustai Status (See the Implemetatio/Sustai checklist from Sessio #5) ivit 1. Traiig additioal staff i ew processes 2. Creatio of educatioal CD for parets 3. Creatio of budle 4. Traiig i Self Maagemet Collaborative Status 1. Scheduled for Jue 2. CD i devmt 3. All budle elemets complete except CD 4. SM Collaborative traiig i process
10 Next Steps to Lead Improvemet i Your Area (These ma iclude a step focusig o fiishig our project but must also iclude broader ext steps to lead improvemet) 1. Access: Use improvemet tools ad processes leared i I2S2 for improvig patiet access (ow a part of OP CSI) 2. CMT: Spread the work of improvig the outcome for this selfmaagemet measure for CMT to all who treat this diagosis 3. CMT: Clea up the moitorig of cliical outcome measures for CMT so that we will for the first time have 1 diagosis where we have: created a evidece-based CPG (guidelie ow published o Natioal Guidelie Clearighouse) built ito EPIC the ecessar data fields ad outcome measures moitored outcome data for a particular outcome measure realized actual improvemets i outcomes after applig improvemet sciece techiques leared i I2S2! 4. Self Maagemet: Use what I have leared ad appl it to the roll out of our latest iitiative traiig all staff i Self Maagemet Collaborative 5. Have our PI Coordiator atted I2S2
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