By James Sliwa, DO, Chief Medical Officer, Chief Quality and Safety Officer, and Senior Vice President, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago)
In rehabilitation, a lack of sensitive and objective outcomes measures makes it difficult to predict how and where patients will achieve the best, fastest outcomes. As a result, the true value of various levels of post-acute care is unclear.
This matters. The field of rehabilitation is a multi-billion dollar healthcare sector, one that is growing rapidly due to evolving demographics. Approximately 12.8 percent of the United States’ population lives with some form of disability — a rate that is projected to grow as once-fatal diseases become chronic, and as the population ages.
It is imperative that patients receive the best, most appropriate and most efficient level of care, but determining a course of action is not cut and dry. Existing assessment tools in rehabilitation serve as the foundation for determining access to, quality of, and reimbursement for medical rehabilitation services. Yet these very tools represent a minimum data set of patient progress.
Long overdue is a quantitative, objective, standardized assessment tool that will reliably measure and even predict patient progress across the full range of rehabilitation and recovery, at all levels. For this reason, we have invested years of development and millions of dollars to develop the Ability Quotient™ (AQ), a novel outcomes assessment system.
The AQ at a Glance
The AQ is poised to reform the field of rehabilitation and change the trajectory of patient recoveries — allowing clinicians, scientists and insurers to better measure relevant outcomes and, eventually, to predict patient progress, care and cost.
It builds upon current assessment systems in several critical areas:
- The AQ measures widely accepted task-based activities of the core functional domains: self-care, mobility and cognition. It also incorporates an assessment of foundational skills (e.g., balance). Our research has shown that these building blocks are prerequisite for making progress in higher-level, task-based functional skills (e.g., dressing).
- Much like a ruler or thermometer, the AQ measures change in equal increments. This difference is a significant one, as it allows clinicians to detect patient improvement uniformly and precisely, regardless of level of functional ability.
- The AQ’s predictive modeling capability allows us to predict recovery by visualizing a patient’s progress and comparing it with the recovery of patients having similar impairments.
- By measuring foundational skills, and leveraging current and predictive data to target treatment, the AQ facilitates precision rehabilitation — individual, patient-directed care.
In short, the AQ has the potential to inform decisions regarding the most effective therapeutic interventions, support a more efficient allocation of resources, direct patient referral to the most appropriate level of care, and facilitate better, faster, reliable patient outcomes.
The AQ Phase I Pilot Study & Results
Beginning in 2018, we piloted the AQ, tracking the progress of 120 stroke inpatients separated into pilot and control groups.
In the pilot group, patients were evaluated using the AQ system. In the control group, patients were evaluated using existing outcomes assessment systems.
Clinicians in the pilot group incorporated the AQ into daily team conferences, in which patients’ respective care teams came together to discuss patient progress. Discussions were informed and directed by the AQ Dashboard, an interactive interface that allows clinicians to graphically view a patient’s long-term goals, current functional performance, and actual and predicted progress compared with the database of patients having similar impairments. Importantly, the AQ Dashboard empowered clinicians to redirect treatment when a patient was not keeping pace with expected milestones.
Patients in the AQ pilot group made progress at a statistically significant greater rate than similar patients in the control group.
In 2020, we will expand the AQ pilot (Phase II) to include all of our adult inpatient services, a study population that will consist of more than 3,000 patients. This is essentially beta testing of the AQ throughout our large active inpatient environment.
Subsequent to our beta testing over this next year, we intend to share the basic AQ assessment system with the world, free of charge, for all to use. In doing so, it will benefit all providers and continually raise the bar for outcomes and value.
In the field of rehabilitation, it’s time for a transformative outcomes assessment system that can benefit patients and payors worldwide. The future is bright.
About Dr. James Sliwa
Through his medical expertise and leadership, James Sliwa, DO, is focused on driving the highest level of performance for patient care, safety and outcomes. As Chief Medical Officer and Chief Quality and Safety Officer, he is responsible for overseeing patient quality and safety throughout the Shirley Ryan AbilityLab system of care. Dr. Sliwa has been a practicing physician for Shirley Ryan AbilityLab since 1984, specializing in serving a medically complex population. He has also led development of the Ability Quotient™ (AQ) and its implementation into clinical care. He earned his BA from Indiana University and his DO from the Chicago College of Osteopathic Medicine. He completed his residency in Physical Medicine and Rehabilitation at Northwestern University/Shirley Ryan AbilityLab (then the Rehabilitation Institute of Chicago).
About Shirley Ryan AbilityLab
Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. The organization expands and accelerates leadership in the field that began at RIC in 1953. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Upon opening in March 2017, the $550 million, 1.2-million-square-foot Shirley Ryan AbilityLab became the first-ever “translational” research hospital in which clinicians, scientists, innovators and technologists work together in the same space, surrounding patients, discovering new approaches and applying (or “translating”) research real time. This unique model enables patients to have 24/7 access to the brightest minds, the latest research and the best opportunity for recovery. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization. For more information, go to www.sralab.org.
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