Review of the AIFE – United Professionals outcome measure tool
By Stephanie McDonald, UPCM clinical lead, Unite Professionals
Unite Professionals strive to provide high-quality case management and as a result, have considered numerous ways to ensure that this is achieved.
One innovative idea is the implementation of a unique outcome measure tool which delivers a number of benefits.
Outcome measures are tools which are used to assess the effectiveness of a treatment, intervention or programme by evaluating changes in a client’s health status, behaviour or overall wellbeing.
They can be objective, such as functional assessments or subjective, relying on patient-reported outcomes like pain levels or quality of life.
Outcome measures are widely used in clinical practice to track progress and ensure evidence-based decision-making.
The Areas of Impact on Function and Employment (AIFE) score is an outcome measure tool, originally developed by Jo Evans at Unite Professionals around 13 years ago, specifically for use within case management.
It has not been standardised within the case management industry, however, it has been used as a standard tool at Unite Professionals, which has been refined and improved by the clinical lead team over the years, ensuring that it captures information about the client’s functional abilities, along with an overview of their progress throughout their rehabilitation journey.
The AIFE measures the severity of impairment faced by individuals across a number of domains, including employment status, personal activities of daily living, domestic activities of daily living, transfers, mobility, continence, psychological, pain, sensation, sleep, relationships and cognitive.
It is a tool used by case managers at Unite Professionals, based on their observations and discussions with clients to determine their pre-injury status, along with their status during the Immediate Needs Assessment (INA).
By using it to set a baseline, and then re-scoring at appropriate points along the client’s rehabilitation journey, we can begin to build a picture of the impact of case management.
Measuring outcomes is important for recognising excellent case management practice, alongside understanding barriers to rehabilitation.
It is an evidence base to support comprehensive rehabilitation plans that truly enable the client’s rehabilitation, improving the quality of case management services, in a cost-effective way.
It is worth noting that in some cases, maintaining a client’s performance can also be a good outcome, it is not always about improvement in all of the domains.
Case managers use the AIFE to provide evidence of the need for specialist intervention, specialist provision or to produce a rationale for a specific service or piece of equipment.
This helps to formulate a rehabilitation plan which is client focused, and evidence based.
Throughout my case management journey, I have used several different outcome measures, including Patient Reported Outcome Measures (PROMs) and Therapy Outcome Measures (TOMs).
There are a wide variety of high-quality PROMs which have been used extensively, and they are often used to determine the cost-effectiveness of particular interventions. However, drawbacks include difficulty in selecting appropriate measures, particularly for case management, and that questionnaires can be burdensome for clients to complete.
TOMs have been adopted by a number of case management companies in recent years and appear to be effective in showing a client’s progress, however in training sessions it has been very evident that there is a large discrepancy between individuals as to how the domains are scored.
One study concluded that TOMs was an ‘ok fit’ for community rehabilitation clients rather than a ‘best fit’, and that it should only be used as a variety of outcome measures (Caldwell et al, 2015).
In reflecting on the AIFE, it has a number of benefits including that it was created explicitly for use within the case management industry and is quite specific in its scoring across all of the domains, which helps to provide consistency in the scoring of individuals.
It incorporates a risk assessment score and has been used at Unite Professionals extensively with success in providing evidence-based rehabilitation and capturing the client’s rehabilitation journey. Clients, case managers and stakeholders are easily able to see progress in a domain with the use of a traffic light system.
Improved scores are highlighted in green, scores that are the same are highlighted in amber and scores that have declined are highlighted in red.
The AIFE could perhaps benefit from a self-report measure to be added for individuals who want to be involved in the recording of the outcome measure.
This could save time for case managers during the assessment; however, the tool is currently designed for case managers to complete and therefore would need to be redesigned for this purpose.
It must be noted that the participant may lack insight into their own situation or may become tired or lose interest after the first set of questions, which could bias the result.
Case managers often work with individuals who have difficulty with concentration and memory following traumatic injury. Therefore, the self-report method would need to be considered on a case-by-case basis.
In conclusion, outcome measure tools are a useful way of measuring the effectiveness of treatments by evaluating change in a client’s health.
The AIFE, which has been specifically designed for use in case management, has successfully supported case managers to construct comprehensive rehabilitation plans and identified excellent case management practice, along with barriers to rehabilitation.
This has enabled us to continue to deliver the highest standards of practice within case management demonstrated by sustained and meaningful outcomes for each client.
