Case management insight: How we created our own outcome measure

Bridge Case Management, which works with clients following road traffic or work-related injury, recently developed a new outcome measure specific to its case management work. Here, in an article written collectively for NR Times, its team shares details of the process and importance of this development.

An outcome measure is a tool which enables a person to analyse the effectiveness of a specific service or intervention.

At Bridge Case Management, we have pondered how to ‘bridge’ the need to measure the effectiveness of case management as a service.

Two of our clinical leads, Emma McClean and Sian Bailey have been exploring this further. They started by using an outcome measure called TOM (therapy outcome measures) developed by Professor Enderby.

TOM has amassed a 40-year research evidence base and is a well-established, reliable, and valid assessment tool.

The TOM is comprised of multiple short assessments such as pain and muscular skeletal health, however, due to the unforgiving nature of road traffic/work accidents, our clients usually have multiple facets, which no one specific assessment could capture.

Emma and Sian have developed an innovative measure specific to case management, sensibly titled the CM-TOM (case management- therapy outcome measure’s) with the full support of Professor Enderby.

The new outcome measure is due to be published soon in the latest edition of her book “Therapy outcome measure, user guide and scales” from J&R Press.

This means it can be purchased across the industry, increasing the data, research and evidence base, internationally.

The CM-TOM

We have launched the CM-TOM project with our clients, securing consent to collect data, and have ensured that we meet ethical standards for our research. We are collating scores for the four TOM domains of:

• Impairment
• Activity
• Participation
• Wellbeing/Distress

We have added a fifth domain of client engagement and adapted the Impairment domain to reflect the complex nature of case management clients by looking separately at their physical, psychological and cognitive impairments.

These domains are scored using an ordinal scale of 0-5 in 0.5 increments, which enables 11 possible points on the scale, rated by the case manager.

We are also collecting data on whether the client lives in a rural or urban area, whether they have pre-existing medical conditions, and whether they have pre-existing socio-economic considerations.

We know from experience that these can be a barrier to rehabilitation, and so some client may require additional funding to create the same rehabilitation outcome, compared to other groups, but we want to be able to robustly demonstrate this.

To ensure validity, training is required in order to use the tool, along with regular calibration sessions to ensure consistency. Following training, CM-TOM can then be used by any case manager.

Each piece of client data, which will be gathered over time throughout their case management journey, will allow the case manager to make clinical and ethical judgements based on their client’s own journey and be able to compare the results back to a non-injured client and/or the person they were prior to their injuries.

Case study

James is a client in his 30’s, married with a young child and pre-accident held a steady job as an engineer, but was then involved in a road traffic accident where he sustained leg fractures, wrist fractures and a concussion.

We complete the CM-TOM at the same time as the initial assessment, and measured the impact of the accident on his life. We then repeated the measure every 3 months, and observed changes in the scores. We would normally hope to see uplifts in a client’s scores, in many of the above headings, as therapy is put in place, and their physical health and mental wellbeing needs are being supported.

However, in James’ case although we saw a steady improvement in physical function, there was little improvement in overall wellbeing, which was due to psychological needs not being met due to lack of funds/resources to treat his PTSD.

Our aim is to utilise the data gathered from CM-TOM to evidence case management recommendations and identify barriers to rehabilitation, generating evidence to share with funding parties.

On an individual level, such as in James’ case, we can use his scores to show an improvement in physical scores due to engagement in regular physiotherapy, as well as a lack of progress in psychological aspects of recovery due to lack of input around mental health needs.

On a larger scale, collating the scores across Bridge Case Management and the industry as a whole, would allow us to identify patterns that can be shared and addressed to improve the quality of case management interventions and best practice.

What next?

The overall goals for the CM-TOM project is to create data which can be analysed to support the development of evidence base practice for case management interventions across the industry. We will then be able to demonstrate, through statistics and research, the justification for rehabilitation recommendations.

It will also highlight barriers to progress that could be overcome with appropriate interventions and/or funding, enabling case managers to more confidently add weight to their recommendations, which will have a community wide impact.

We have begun to gather data at Bridge Case Management, using an in-house bespoke collection form, which auto populates a database, collecting data using the CM-TOM and other relevant data which we know from experience can influence rehabilitation outcomes, such as socio-economic considerations.

There is potential to develop a national database with Professor Enderby, so greater amounts of data could be gathered and analysed across the country, which would significantly boost the case management evidence base.

The data is centred around the WHO ICD-11 international classification of diseases. This will enable us not only to compare data, such as the outcomes of therapy for clients with acquired brain injuries within our team, but potentially enable data comparison and amalgamation nationally and across the world.

CM-TOM could support greater data analysis and research opportunities, and vastly grow the case management evidence base, resulting in timely, high quality intervention, resulting in better outcomes for our clients following an accident.