[Dysphagia] Outcome measures dysphagia

[helen.roberts at homerton.nhs.uk (Roberts Helen at Homerton Hospital NHS Trust)]

Thank you for everyone's advice on this.  I see both perspectives.  The
ultimate goal is to get the patient well, but whilst this is easier to
measure using patient-centred goals for dysphagia, it is often
inappropriate in the acute stages to do this.  I have limited
experience, but working with the patient's family, surrounding staff and
their environment is the way I often target intervention in these
situations.  The difficult thing I'm finding is measuring the change
objectively, directly related to speech and language therapy/pathology
input (trying to separate this from mood, general improvement etc).  I
can see the improvements and often so can the patient and family, it's
just the measuring, especially with budgets and the freezing of posts
that's going on.

Thanks again and any other suggestions/feed back on measures (specific
impairment or QOL) would be greatly appreciated.

Helen


-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Buckie,Marcia
Sent: 07 March 2007 9:41 
To: Irene Campbell-Taylor; dysphagia at b9.com
Subject: Re: [Dysphagia] Outcome measures dysphagia


"Since the only reason to intervene is to get the patient as close to
normal"


This seems too broad to me. If you measure outcome based on how much a
patient ate, efficacy measures would be skewed by appetite and food
preferences, or mood even.

Sometimes the assessment or recommendations are made so the patient can
eat more efficiently (take less time) or more comfortably..I guess these
are QOL measures, but the first does factor into caregiver burden, which
is a huge emphasis with the FIM, which CMS bases IPR reimbursement on.

Irene, another perspective to consider is this: many of us have spent
our entire dysphagia practitioner careers working under a rehabilitation
model, which does differ slightly from a medical model. We are always
being  asked to streamline our documentation to focus on "function" and
sometimes the documentation and rehabilitaton model does not capture the
assessment of physiological dysfunction that we are indeed assessing and
addressing.

So, my point is (and I think I have one) is that how I talk to a
radiologist about swallowing varies greatly from how I might with a PM&R
doc, a psychiatrist, a geriatrician, etc. in terms of outcome.

Marcia


-----Original Message-----
From: dysphagia-bounces at b9.com [mailto:dysphagia-bounces at b9.com] On
Behalf Of Irene Campbell-Taylor
Sent: Tuesday, February 27, 2007 13:21
To: dysphagia at b9.com
Subject: [Dysphagia] Outcome measures dysphagia

Someone once said that the easy way to become famous was to make the
simple appear complex. So is it with outcome measures. Since the only
reason to intervene is to get the patient as close to normal
intake/nutrition/hydration as possible, it's very easy to measure how
much more he/she is eating/ drinking/ gaining weight. Plate weight,
fluid intake are easy. Weights not so easy to get in LTC for example but
"progress' (or the lack of it) couldn't be simpler.

Dr I Campbell-Taylor
Clinical Neuroscientist
Exclusive Distributor:
www.interactivetherapy.com
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