Value in (Audiological) Health Care: Physician Quality
Reporting System, Interprofessional
Education/Practice and the International
Classification of Function
Robert Burkard
Department of Rehabilitation Science, University at Buffalo
The Ruth Symposium in Audiology & Hearing Science
James Madison University, Saturday, 10 October 2015, 3:50- 4:35 PM
Financial Disclosure: Employed by the University at Buffalo
and receives a salary; Member of ASHA Health Care Economics
Committee; Receiving an Honorarium from James Madison
University for the 2015 Ruth Symposium
Non-Financial Disclosure: No relevant non-financial
relationship exists
Outline:
• Healthcare (Costs)
• The Physician Quality Reporting
System (PQRS) and Audiology
• Interprofessional Education/Practice
• The International Classification of
Function
The Problem: Health
care in the United States
costs too much!
In 2014:
GDP: $17.4 Trillion
Spent on
Healthcare: $3.8
Trillion
Total Health Expenditure as a Share of GDP, U.S. and Selected Countries, 2008
http://www.washingtonpost.com/blogs/wonkblog/
wp/2013/03/26/21-graphs-that-show-americashealth-care-prices-are-ludicrous/
http://www.statista.com/s
tatistics/188105/annualgdp-of-the-united-statessince-1990/
http://www.forbes.com/sites#
/sites/danmunro/2014/02/02/
annual-u-s-healthcarespending-hits-3-8-trillion/
Cost Containment for Health Care
 Recently, several mechanisms for reducing cost
have been implemented:
 RAC (Recovery Audit Companies)
 Duplicate payment analysis
 Medicare screens for procedures reported together =>
new, combined procedure CPT codes
 Re-survey and re-validation of procedure value under
the assumption by RUC that all surveys are inflated
 Bundled payments under Medicaid reform
 Another concept that has been around for a while
but not mandated is the concept of “Pay for
Performance”
Audiology & Value Based Purchasing
• The potential biggest impact will be working to identify
procedure groups to bundle – such as the changes in
audiometric, immittance testing and vestibular testing
bundled codes:
92557: Comprehensive Audiometry Threshold evaluation
and Speech Recognition
92570: Acoustic Immittance Testing (tympanometry,
acoustic reflex threshold, acoustic reflex decay)
92540: Basic Vestibular Evaluation (spontaneous
nystagmus, positional nystagmus, optokinetic nystagmus,
foveal and peripheral stimulation)
• One could envision further efforts along these lines. So in
effect paying for a group of diagnostic procedures with a
single payment – the group of procedures is to result in
diagnostic AND functional information.
Cost Containment for Health Care
• Multiple organizations are recommending going
away from a “Fee for Service” model and replacing
it with Value Based Purchasing
• “Value should always be defined around the
customer, and in a well-functioning health care
system, the creation of value for patients should
determine the rewards for all other actors in the
system. Since value depends on results, not inputs,
value in health care is measured by the outcomes
achieved, not the volume of services…” M. Porter, What is
Value in Health Care? NEJM, 2010, 363: 2477-2481
• Fee for service:
o Encourages increased utilization
o More services results in more payment, but raises the
issue of the true medical necessity for these increased
services
Value (from the 2012 ASHA Health
Care Summit)
How Does One Code for Outcome?
Another phase of the overall change in the hearing healthcare
landscape is the change to ICD 10 coding:
o October 1, 2015: International Classification of Diseases, 9th
Revision, Clinical Modification ICD-10-CM
o ICD-9-CM approximately 18,000 codes, while ICD-10-CM
approximately 160,000 available codes provides more specificity
than ICD-9-CM:
ICD-9-CM:
389.18: Sensorineural hearing loss, bilateral
389.15: Sensorineural hearing loss, unilateral
ICD-10-CM: H90.3: Sensorineural hearing loss, bilateral
H90.41: Sensorineural hearing loss, unilateral, right ear,
unrestricted hearing on the contralateral side
H90.42: Sensorineural hearing loss, unilateral, left ear,
unrestricted hearing on the contralateral side
ICD-10-CM could be used with the International
Classification of Functioning, Disability & Health (ICF) for coding
level of severity (i.e., 0 is ‘no problem’ while 4 is ‘complete
problem’)
Physician Quality Reporting System (PQRS)
 Congress mandated PQRS to improve quality
of care for Medicare beneficiaries
 Since 2007, quality reporting has been
voluntary for services to Medicare Part B Fee
for Service beneficiaries
 The Patient Protection and Affordable Care Act
(PPACA) includes transition from incentive for
participation in PQRS to penalty for nonparticipation
 There are currently few measures specific to
audiology
http://www.asha.org/practice/health-care-reform/physician-quality-reporting-system/
2015 Rules - Providers
 Audiologists in group, private practice and
university clinics providing services for
outpatient Medicare Part B beneficiaries
 Individual NPI number is listed on the claim as the
provider performing the service with each
procedure code, not necessarily the provider being
paid for the service

Audiologists in group practices must be listed on the
claim as rendering providers, though payment goes to
the practice TIN, according to the Social Security Act
 Facility-based audiologists (hospitals, skilled
nursing facilities) do not participate
Why Should Providers Participate in PQRS?:
It is all about reimbursement
To avoid 2% penalty, must report:
•
9 measures covering at least 3 of the National
Quality Strategy (NQS) domains
•
OR (if less than 9 measures apply), report 1-8
measures “for which there is Medicare patient data.”
•
Each measure must be reported at least 50% of the
eligible provider’s Medicare Part B patient visits
http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/Downloads/July_25_2013_National_Provider_Call_Presentation.pdf
National Quality Strategy Domains
 Person and Caregiver-Centered Experience and Outcomes:
 Patient-reported data and involvement of patients and families in decision





making, self-care, activation, understanding the health condition, and
effective management of the condition.
Patient Safety:
 The safe delivery of clinical services in hospital and ambulatory settings,
including longitudinal assessment of episodes of care.
Communication and Care Coordination:
 Appropriate and timely sharing of information among health
professionals.
Community/Population Health:
 The use of clinical and preventative services to improve the health of the
population, being outcome-focused and longitudinal measurement.
Efficiency and Cost Reduction:
 Emphasize the use of evidence to best manage high priority conditions
and determine the appropriate use of healthcare resources.
Effective Clinical Care:
 Clinical care processes closely linked to outcomes based on evidence and
practice guidelines.
‘Quality’ Audiology Measure Development
Inclusion in current PQRS measures (must report)
 Referral for dizziness
Inclusion in current PQRS measures (can report- no cost/no
benefit)
 Documentation of medications
 Smoking Cessation counseling
 Pain assessment
 Falls prevention, Falls plan of care
 Screening for depression (tinnitus evaluation only)
Currently drafting 5 measures for future use
Audiology Quality Consortium
 Collaborative group of representatives from 10
audiology organizations working on PQRS:










Academy of Doctors of Audiology
Academy of Rehabilitative Audiology
American Academy of Audiology
American Academy of Private Practice in Speech
Pathology and Audiology
American Speech-Language-Hearing Association
Association of VA Audiologists
Directors of Speech and Hearing Programs in State
Health and Welfare Agencies
Educational Audiology Association
Military Audiology Association
National Hearing Conservation Association
Barriers to overcome
 Largely
a diagnostic profession
 Need
to move profession towards outcome/quality
reporting
 Cost of
code development
o Identify need, concepts, and candidate measures
o Develop Technical Specifications
o Alpha testing for feasibility
o Testing – Reliability and Validity
What is included in a Quality Measure for PQRS?
Submission to the National Quality Forum (NQF):
A description of the measure: What is the measure of
interest?
Instructions: e.g., how often reported
Denominator: Age AND relevant ICD-10 codes AND CPT
procedures performed
Numerator: Patient population, relevant definitions,
Exclusions, coding options
Rationale: A description of why this is a measure of clinical
quality
Clinical Recommendation Statement: What is the evidence
base to support this measure?
Demonstrating the Value of a Measure
Importance of the measure
High Impact
Opportunity for improvement
Evidence that supports the focus of measurement
Scientific acceptability of the measure
Reliability, validity, risk adjustment
Usability
Demonstration of understanding and usefulness for public reporting and
quality improvement
Discuss the feasibility of the measure
Demonstration the measure can be implemented
National Quality Forum: Guidance for Measure testing and Evaluating Scientific
Acceptability of Measure Properties. January 2011
Testing of Reliability/Validity
“Reliability refers to the repeatability or precision of measurement.”
Types of reliability:
• Inter-rater: agreement between 2 raters
• Test-retest: agreement between two administrations of the same test
items
• Internal consistency: Extent to which item responses obtained at the same
time agree with one another
“Validity refers to the correctness of measurement. Validity of data elements
refers to the correctness of the data elements as compared to an authoritative
source. Validity of the measure score refers to the correctness of conclusions
about the quality of measured entities that can be made based on the
measure scores (i.e., a higher score on a quality measure reflects higher
quality).”
Types of validity: face*, criterion, concurrent, predictive, construct,
contrasted groups, convergent, discriminative
National Quality Forum: Guidance for Measure testing and Evaluating Scientific
Acceptability of Measure Properties. January 2011
Example of Reliability Testing of a PQRS Measure
Inter-rater Reliability:
• Find 5-10 clinical sites
• Each site must regularly use the proposed quality measure
(i.e., see patients of the correct age, with the relevant ICD-10
codes and doing the appropriate CPT procedures)
• Using a power analysis, identify the number of observations
needed across sites
• Have two on-site clinicians perform the quality measure, code
for ICD-10 and CPT
• Perform inter-rate reliability using the kappa statistic or
intraclass correlation coefficient (ICC)
Example of Validity Testing of a PQRS Measure
Face Validity:
• Identify 10-20 topic experts
• Each expert must have substantial clinical experience with the
relevant clinical population
• Each ‘Expert’ cannot have been involved in the measure
development
• The expert panel reaches consensus about the face validity of
the measure through a systematic and transparent process,
and concludes that:
a. the measures assess the underlying quality measure
they are meant to assess, and
b. that the quality measure truly can distinguish good
quality from poor quality clinical care
• It is fine for the same folks who do the reliability measures to
serve on the expert pane for validity
• Can use the expert panel to justify exclusions
The Five Measures: Ototoxicity, BPPV,
Cochlear Implant Evaluation, Tinnitus
Evaluation, Quality of Life
These proposed Audiology quality
measures were relatively recently
assessed for reliability and validity by the
Audiology Quality Consortium passed
their validity assessment. However, the
reliability results were inadequate,
primarily because clinicians could not
agree on the CPT and/or ICD codes.
Qualified Clinical Data Registry (QCDR) Reporting
The qualified clinical data registry (QCDR) reporting mechanism was
introduced for the Physician Quality Reporting System (PQRS)
beginning in 2014. A QCDR will complete the collection and submission
of PQRS quality measures data on behalf of individual eligible
professionals (EPs). For 2015, a QCDR is a CMS-approved entity that
collects medical and/or clinical data for the purpose of patient and
disease tracking to foster improvement in the quality of care provided to
patients. Individual EPs who satisfactorily participate in 2015 PQRS
through a QCDR may avoid the 2017 negative payment adjustment (2.0%). To be considered a QCDR for purposes of PQRS, an entity must
self-nominate and successfully complete a qualification process.
The 2015 Medicare Physician Fee Schedule (MPFS) Final Rule includes
the finalized, detailed information regarding this reporting mechanism.
Please note: A QCDR is different from a qualified registry in that it is not
limited to measures within PQRS; please refer to the documents
referenced below for more information.
https://www.cms.gov/medicare/quality-initiatives-patient-assessmentinstruments/pqrs/qualified-clinical-data-registry-reporting.html
Interprofessional Education/Practice: IPE/IPP
The need for addressing the coming changes in
health care was discussed late in 2011 by ASHA’s
Health Care Economics Committee
This was discussed by the ASHA Board of
Directors, and they decided to provide fiscal
support for a 2012 Health Care Summit, for both
Speech-Language Pathology and Audiology.
Summit, at ASHA National Office, 10/5/1210/7/12
The ASHA ad hoc committee on Interprofessional
Education (IPE) was created in the spring of 2013 by
the ASHA Board of Directors with the following
charge:
Resolved, That an ad hoc committee be established and
charged to develop specific actions that address education and
core competencies of interprofessional education related to
reimbursement models for students and members
The membership of this committee included: Bob Burkard
(chair), Kenn Apel, Diane Jette, Nancy Lewis, Robert Moore,
Judy Page, Betty Rambur, Robert Turner, Neil Shepard (Board
of Directors liaison and monitoring officer), Lemmie McNeilly
(ASHA chief staff officer for speech-language pathology), Janet
Brown (ASHA ex officio), Ellen Fagan and Loretta Nunez
(ASHA staff consultants).
What is Interprofessional Education?
Interprofessional education
“When students from two or more
professions learn about, from and with each
other to enable effective collaboration and
improve health outcomes” (WHO, 2010).
Core Competencies for Interprofessional
Collaborative Practice, Report of an Expert Panel:
May 2011
Sponsored by:
American Association of Colleges of Nursing
American Association of Colleges of Osteopathic
Medicine
American Association of Colleges of Pharmacy
American Dental Education Association
Association of American Medical Colleges
Association of Schools of Public Health
General Recommendation:
Recommend the BOD to endorse the IPEC Core
Competencies for Interprofessional Collaborative
Practice included in the domains of Values/Ethics for
Interprofessional Practice, Roles/Responsibilities for
Collaborative Practice; Interprofessional
Communication; Interprofessional Teamwork and
Team-Based Care.
Specific Recommendations (4 ‘Topics’)
TOPIC 1:
Educating students, faculty, practitioners
about IPE/IPP and its Value
TOPIC 2:
Connections with other organizations
TOPIC 3:
Research Agenda for IPE/IPP
TOPIC 4:
Certification, Accreditation, Licensure
The 2013 Cochrane review:
Reeves, Perrier, Golsman, Freeth and Zwarenstein, 2013
IPE within the Health Sciences
Interprofessional Education (IPE) is being proposed in
health care education to increase the value
(Quality/Cost) of service delivery in health care. While
it is imperative that we continue to educate/train our
clinicians to deliver those services as professionals
within their specific disciplines, it is also evident that
the siloed approach to education has resulted in
suboptimal outcomes, as well as high costs. A
fundamental assumption of IPE is that if health
professionals train together, and work as a team, the
practice and delivery of care will be enhanced. One
would expect to drive costs down while maintaining or
even improving outcomes.
IPE Subgroup of the Curriculum and Assessment Task Force (UB)
Status of IPE Nationally (and Internationally)
• IPE has often (but not universally) been limited to a small set of
health-care disciplines. The disciplines included most frequently are:
Medicine, Nursing, Pharmacy and Public Health.
• To date, there is limited evidence that IPE leads to increased value in
health-care delivery. The collection of key evidence will be an
important component of IPE assessment
• Barriers to academic IPE include scheduling challenges and resource
constraints.
• A number of professions have included, or are in the process of
planning to include, IPE in their certification and accreditation
guidelines.
• A number of organizations have embraced the IPEC Core
Competencies for Interprofessional Collaborative Practice, included
in the domains:
Values/Ethics for Interprofessional Practice
Roles/Responsibilities for Collaborative Practice
Interprofessional Communication
Interprofessional Teamwork and Team-Based Care
IPE Subgroup of the Curriculum and Assessment Task Force (UB)
Some Key Questions/Issues Regarding IPE
• Development of appropriate program content and curricular materials.
• Investigation of the use of simulation centers, and the extent of “fidelity”
and realism of the simulation. Costs of using a highly intensive
simulation environment for training can be prohibitive.
• Addressing the significant scheduling challenges, particularly if the IPE
program is to target several health professions contemporaneously.
• Consideration of modes of delivery than are cost-effective and minimize
duplication of effort. In particular, modular units may provide greater
opportunity for multiple uses across disciplines.
• Physical presence and co-location. To what extent is the physical
presence of all parties involved in IPE training needed or required. How
would an on-line component figure within IPE? Are electronic-media
simulations a good substitute for the Simulation-Center IPE activities?
• How to evaluate the value of IPE programs? This calls for the
development of an assessment plan for IPE programs and accumulation
of evidence of better outcomes being attained through IPE. In addition
to practical import, this may provide a research topic for assessment
studies.
IPE Subgroup of the Curriculum and Assessment Task Force (UB)
The International Classification of Function (ICF)
Scope of Practice of Audiology (Approved by Legislative Council of ASHA in 2003):
Members of the coordinating committee include Donna Fisher Smiley (chair), Michael Bergen, and
Jean-Pierre Gagné with Vic S. Gladstone and Tina R. Mullins (ex officios). Susan Brannen, ASHA vice
president for professional practices in audiology (2001–2003), served as monitoring vice president.
“Audiologists provide comprehensive diagnostic and treatment/rehabilitative
services for auditory, vestibular, and related impairments”.
Under ‘Framework of Practice’, this Document embraces the ICF:
“The World Health Organization (WHO) has developed a multipurpose
health classification system known as the International Classification of
Functioning, Disability, and Health (ICF) (WHO, 2001). The purpose of this
classification system is to provide a standard language and framework for the
description of functioning and health. The ICF framework is useful in
describing the role of audiologists in the prevention, assessment, and
habilitation/rehabilitation of auditory, vestibular, and other related
impairments and restrictions or limitations of functioning.”
http://www.asha.org/docs/html/sp2004-00192.html
The ICF is organized into two parts. The first part deals with Functioning and
Disability while the second part deals with Contextual Factors. Each part has two
components. The components of Functioning and Disability are:
Body Functions and Structures: Body Functions are the physiological functions of
body systems and Body Structures are the anatomical parts of the body and their
components. Impairments are limitations or variations in Body Function or
Structure such as a deviation or loss. An example of a Body Function that might be
evaluated by an audiologist would be hearing sensitivity. The use of tympanometry
to access the mobility of the tympanic membrane is an example of a Body Structure
that might be evaluated by an audiologist.
Activity/Participation: In the ICF, Activity and Participation are realized as one
list. Activity refers to the execution of a task or action by an individual. Participation
is the involvement in a life situation. Activity limitations are difficulties an
individual may experience while executing a given activity. Participation restrictions
are difficulties that may limit an individual's involvement in life situations. The
Activity/Participation construct thus represents the effects that hearing, vestibular,
and related impairments could have on the life of an individual. These effects could
include the ability to hold conversations, participate in sports, attend religious
services, understand a teacher in a classroom, and walk up and down stairs.
http://www.asha.org/docs/html/sp2004-00192.html
The components of Contextual Factors are:
Environmental Factors: Environmental Factors make up the physical, social,
and attitudinal environment in which people live and conduct their lives.
Examples of Environmental Factors, as they relate to audiology, include the
acoustical properties of a given space and any type of hearing assistive
technology.
Personal Factors: Personal Factors are the internal influences on an individual's
functioning and disability and are not a part of the health condition. These
factors may include but are not limited to age, gender, social background, and
profession.
Application of WHO
(2001) Framework to the
Practice of Audiology
http://www.asha.org/docs/html/s
p2004-00192.html
ICF Core Set for Hearing Loss
There is currently no single questionnaire in audiology that
covers the broad perspective that the ICF represents nor a
consensus on the most appropriate instrument that
assesses the effects of hearing loss on the lives of adults as
well as treatment outcomes. Initiated by the Nordic
Audiological Society (NAS), the ICF Research Branch, the
Classification, Terminology and Standards Team at WHO, the
International Society for Physical and Rehabilitation Medicine
(ISPRM), the International Federation of Hard of Hearing
People, the International Society of Audiology, and the Swedish
Institute for Disability Research (SIDR) have teamed up to tackle
this issue by proceeding to develop the first version of the ICF
Core Sets for hearing loss. The project is being run under the
leadership of SIDR and with the financial support of the Oticon
Foundation.
http://www.icf-research-branch.org/icf-core-sets-projects/other-health-conditions/icf-core-set-for-hearingloss.html
ICF Hearing loss Core Set Process
The preparatory phase of the project includes the following preparatory
studies:
-A systematic literature review was performed to identify variables
focusing on individuals with hearing loss, and to identify and re-classify
the concepts addressed in measurement tools with the ICF as a reference.
A paper on the results of the literature review is currently being written.
-A qualitative study (focus groups in the Netherlands and South Africa),
aimed at identifying relevant aspects of functioning and contextual
factors from the patient perspective was conducted. Additionally,
individual interviews were performed in South Africa in order to account
for cultural differences within the country.
-A worldwide survey has been completed to gather the opinion of
international experts who have an expertise in hearing and hearing loss.
-To describe common problems experienced by individuals with hearing
loss from a clinical perspective, data within a multicentre cross-sectional
study have been collected from centres in South Africa, Brazil, China,
Sweden and India.
http://www.icf-research-branch.org/icf-core-sets-projects/other-health-conditions/icf-core-set-for-hearing-loss.html
ICF and Hearing Loss Core Set Conference
The results of these preparatory studies were presented at the
international consensus conference, a multi-stage, iterative, decisionmaking and consensus process that took place from 4-6 May 2012 in
Helsingør, Denmark. At this consensus conference, 21 hearing loss
experts, including 4 persons with hearing loss, from 14 different
countries worldwide and working in a broad range of professions (i.e.,
audiology, speech/ language pathology, rehabilitation sciences,
audiological medicine, psychology, head and neck surgery, hearing
device specialty/technical audiology) decided which ICF categories
should be included in the first version of the ICF Core Sets for hearing
loss.
117 ICF categories were selected for inclusion in the Comprehensive ICF
Core for hearing loss These categories can be taken into account when
conducting a comprehensive, multidisciplinary assessment. Based on
the Comprehensive ICF Core Set, 27 ICF categories were selected for the
Brief ICF Core for hearing loss. The Brief ICF Core Set can be used in
settings in which a brief description and assessment of functioning of a
person with hearing loss is sufficient. It can also be used for research, in
collecting data for population studies and a variety of other purposes.
http://www.icf-research-branch.org/icf-core-sets-projects/other-health-conditions/icf-core-set-for-hearing-loss.html
ICF Comprehensive and Brief Core Sets: Summary
Body Functions (physiological functions of body systems (including
psychological functions):
Comprehensive: 22; Brief: 7
Body Structures (anatomical parts of the body such as organs, limbs and their
components):
Comprehensive: 5; Brief: 4
Activities and Participation (execution of a task or action by an individual and
involvement in a life situation):
Comprehensive: 42; Brief: 9
Environmental Factors (make up the physical, social and attitudinal
environment in which people live and conduct their lives):
Comprehensive: 48; Brief: 7
Can the ICF be used to assess hearing/vestibular function and document the
effects of therapeutic intervention?
It can comprehensively assess all aspects of ’functioning, disability and health’
5 point Likert scale of
impairment for Body
Functions, Body Structures,
and Activities and
Participation
10 point Likert Scale for
Environmental Factors:
ICF 2001
But…
The strength of the ICF– its broad coverage of the varied aspects of
functioning- is also its Achille’s Heel
It is often very non-specific, and subject to individual interpretation
The 5 point (10 point?) Likert scale is quite subjective, and often based on
clinician opinion. As such, the ranking of function is open to bias and even
fraud
Many of the factors would be outside of the scope of practice of audiology
(emotional and cognitive factors, interpersonal interactions, etc)
For use in documenting progress in individual patients, the 117 items in the
Comprehensive Hearing Loss Core Set is clearly nonusable. Even the 27
items in the Brief Core Set is likely to not be usable in the busy clinical
setting.
However, for experimental studies aimed at providing an evidence base for
our clinical practice, the ICF and the various core sets are clearly useful for
exploring the full range of impairments found in those with hearing
(vestibular/balance) problems
Ad Hoc Committee on the International Classification of
Functioning, Disability, and Health
RESOLVED, That the American Speech-Language-Hearing Association
(ASHA) Board of Directors (BOD) establish the Ad Hoc Committee on the
International Classification of Functioning, Disability and Health (ICF)
charged with applying the International Classification of Functioning,
Disability and Health (ICF) framework to goal setting and outcomes
measurement, and helping members focus on function by advising,
providing input, reviewing, and promoting the following products and
activities:
Develop simple modules to educate members on use of the International
Classification of Disabilities and Function (ICF) framework to develop
functional treatment goals and determine outcomes.
Develop standard templates and examples of functional goals using the
ICF framework.
Promote use of the ICF framework among members as the standard,
acceptable practice in the treatment of communication and swallowing
disorders; …
http://www.asha.org/uploaded
Files/ICF-Hearing-Loss.pdf
http://www.asha.org/
uploadedFiles/ICFHearing-Loss.pdf
Summary:
We spend way too much on healthcare in the USA. Through
Obamacare, we are moving from a fee for service payment model to
paying for value in health care.
Value is Quality/Cost, and we need to figure out ways of driving down
costs without compromising quality of care.
PQRS strives to create practical, valid and reliable quality measures of
care; we need more Audiology quality measures
Interprofessional Education/Practice may be one approach that can
maintain or increase quality of care while driving down costs, but we
need more data to confirm this.
The International Classification of Function goes beyond the diseasebased approach of ICD, and includes not only Body Functions and Body
Structures, but also Activities and Participation as well as
Environmental Factors. It also includes a 5 or 10 point Likert scale of
severity that could be used to quantify improvement from therapeutic
intervention. The ICF can be adapted to measure non-medical aspects
of (dis)ability such as participation in desirable activities.
Acknowledgements:
ASHA Health Care Economics
Committee
ASHA Ad hoc Committee on IPE
ASHA ad hoc Committee on the ICF
The Audiology Quality Consortium
IPE Subgroup of the Curriculum and
Assessment Task Force (UB)
Robert Moore
Neil Shepard
Lisa Satterfield
Pam Mason
Janet Brown
Questions?