Single Subject Designs, Joint Commission, Ethical Considerations, & Group Presentations

Multi-Component: ABCD Design

(A) Baseline (B) Social Skills Training Tx (C) Reward for working [added Tx] (D) 3rd Tx ??

What the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

A non-profit organization that accredits over 22,000 healthcare organizations and programs in the country. The oldest & largest accreditation commission in the U.S.

Accreditation Standards: Accreditation

Accreditation standards are set expectations for the performance of each organization and help to measure, assess, and improve performance JCAHO accreditation supports patient knowledge that providers meet the highest quality and safety standards

when would an OT be involved in a KPI?

An OT might take the information from a KPI to develop a more effective way of practicing taking a lower performing area on the KPI to conduct a CQI project. An OT might help collect data for the KPI.

What is the IRB primarily responsible for?

Approving research on human subjects

OT's Role through JCAHO?

As OTs, we are able to use our profession's wide variety of knowledge and apply it to ensure JCAHO's standards are being met at healthcare facilities Ex: Consultative Role

Ethical Considerations: Related to productivity

Being directed to charge for services not provided, treating clients in groups when reimbursement guidelines do not allow such configurations, or using students or other service extenders to provide "billable" service when not permissible within the applicable regulations (fraud)​

Ethical Considerations: Related to productivity Part 2

Being directed to rate clients' functional performance as more impaired than is supported by objective data, providing services that are not medically necessary (overtreatment), or coercing participation in services despite the client's objections (client rights)​

Ethical Considerations: Related to productivity Part 3

Being required to meet productivity standards that are not realistically achievable in the typical workday; feeling forced to comply with employer directives to "keep the job" rather than "do the right thing"; or deciding whether to report a coworker, manager, or organization when violations are suspected or verified​

Elements of the proposal: Aim

Built off the research question. This is the purpose of your study & intention to accomplish through this research

What Documents are Needed

CITI Training Form A [Request for Institutional Review & Assurances] Form B [Exempt Form - Not always needed] Form C [Expedited Review] Consent Form Form E [Amendment Form]

Who administers the tool?

Called a "Surveyor" They come unannounced, at least every 39 months, to evaluate standards during a "visit" Certified through the Joint Commission Ex: Nurses, Doctors, Administrators, etc...

Types of SSD

Case Report Pre/Post Design Basic (AB) and Experimental Withdrawal (ABA) Designs Multi-phase and Multiple Baseline Designs Changing Intensity or Alternating Treatment Designs

what would an OT do to make changes on a KPI?

Develop initiatives within the facility to improve upon practices to increase performance areas on the KPI. Look at other outcome measures for programs. Look at literature to determine evidence based practice to improve upon areas within the KPI for their facility.

Multi-Phase Design: Changing Intensity or Alternating Treatment Design

Does not establish causality Examines multiple interventions or differing intervention intensity Important to attend to sequence ABC, ABAC etc.

Multi-Phase & Multiple Baseline Designs

Examines causality Examines change across behaviors, settings & subjects Process: AB-Change demonstrated-Change Target/Participant/Setting-AB-Change Demonstrated-Change Target/Participant/Setting Built-in replication

What do the results mean in the SAFER tool?

Follow-up is individualized based on placement in the matrix. Sites must complete Evidence of Standards Compliance (ESC). 1. All Requirements for Improvement (RFIs) due in a 60 day ESC 2. All findings require an ESC 4. Findings of higher risk require 2 additional ESC fields

OT's Role with SAFER tool?

Gain certification through the joint commission Conduct a needs assessment/list of RFIs based on their own observations and experiences Once surveyor arrives, OT could present and discuss official list of RFIs, so that surveyor could take the information and plot it on SAFER matrix Help complete ESC's for submission

What does the IRB ensure?

IRB also ensures, when required, that human subjects only volunteer to participate in research after providing legally effective informed consent. The IRB may approve, require modifications (to secure approval), or disapprove research.

Risks of the SAFER Tool Measure

Identifies Requirement for Improvement (RFI) noted in the final report after the Joint Commission finishes their final report. The RFIs are plotted on a matrix indicating the likelihood the RFI could cause harm to patient(s), staff, and/or visitor(s) and then the scope at which the RFI was observed (limited, pattern, widespread).

What is a KPI

KPI = Key Performance Indicators Keeps track of business performance Typical in any healthcare setting Ensures businesses are meeting objectives by tracking and measuring outcomes Shows direction an organization is moving in by providing objective data to measure and compare business efficiencies to past performances.

Define Single Subject

Look for relationships between variables through the study of a single participant . Often over time: ~Utilizing repeated measurement of the sought-after outcome ~Sequential application, withdrawal or modification of studied intervention

Hot Topics

Looking at the literature and how it impacts/informs our practice 1. Research to inform interventions 2. Policies and how they impact practice (i.e. setting, population, diagnosis related, etc) 3. Knowledge translation (research → practice)

Basic (AB) or Experimental Withdrawal (ABA) Design

Multiple observations of dependent variable, baseline (A) and treatment (B) phases. Detect preliminary data trends Establish measurement accuracy Reflects clinic operations AB pre-experimental, cannot infer causality ABAB experimental

SSD: Case Reports

No established baseline or transition to intervention plan No control for extraneous events Change in outcome may or may not be resultant from intervention Good starting point

What oversight does OSHA have regarding workplaces?

OSHA provides workers with the right to safe and healthful working conditions by establishing rules that ensure that the workplace is free from job hazards

OT's Role with OSHA

OTs can contribute to workplace safety by: ~Providing pre-placement screenings, physical examinations, & job placement assessments ~Managing work-related injuries and illnesses through therapeutic interventions, ~Making recommendations for changes in the work environment or tasks, ~Following up with the individuals when they return to work ~Creating health promotion programs

OSHA

Occupational Safety and Health Administration, a government agency in the Department of Labor to maintain a safe and healthy work environment

Accreditation Standards: To Receive Accreditation

On site survey at an unannounced time Patient records reviewed at random to review compliance with standards

How does one file a complaint with OSHA

Online: Fax/Mail/Email: [OSHA Complaint Form] Telephone [800-321-6742] In Person [visiting your local OSHA office]

What is the purpose or function of OSHA

Outlines employer responsibilities that include providing a hazard-free work environment, Appropriate tools and equipment that are maintained for safety, Work training that is accessible and understandable, Labeling and safe handling of hazardous materials, Access to employee medical records and work-related injuries and illnesses

common KPIs in healthcare

Patient wait times, infection rates, patient safety, falls, patient satisfaction, likelihood to rate facility to others, bed occupancy rate, average hospital stay, staff-to-patient ratio, claims denial rates, number of mistake events,

Who does OSHA Cover

Private sector workplaces State and local government workers Federal government workers

How does OSHA impact OT

Protection on the job: Includes information on important subjects such as fall prevention, utilization of safety harness, and lifeline Examples: 1920: Discusses Bloodborne Pathogens 1915: Discusses use and access to first aid equipment in the workplace 1904: Discusses work related injuries, and use of daily stretches, kinesiology tape

Joint Commission Survey Analysis For Evaluating Risk (SAFER) Tool

Provides HCOs information they need to prioritize and focus corrective action plans in areas that are most in need of compliance activities and interventions

Other Risks of SAFER Tool: Scope * Likelihood of harm

Scope of patients impacted (or potentially impacted) by an issue of noncompliance ~Shift from historical approach of "counting" observations ~Now we want to assess the patient impact, or potential impact, of an issue.

People not covered by OSHA:

Self employed workers Immediate family members of farm workers Workplace hazards regulated by another federal agency

What is the Purpose of JCAHO

Strives to continually improve and enhance the quality and safety of healthcare delivery in the United States. Ex: hospitals, health care orgs., home health

What is the Aim in a Quantitative Research?

The Hypothesis if your research

Ethical Considerations: Framework for Ethical Decision Making

What is nature of perceived problem? Who are the players? What information is known? -> What additional information is needed? What resources are available to assist? What are the options & likely consequences of each point?

Other things OT can do for Joint Commission

Work as the Chief Diversity, Equity, & Inclusion Officer Health care Quality Evaluation Disease Specific Care -Stroke Rehab [review certification programs for this specialization]

What does standards include?

accuracy of patient identification, effective communication, safe medication use, reduced healthcare associated infections, Good for 3 years

What is the institutional review board [IRB]?

institutional review board an administrative body of an institution essential goal is to protect human subjects enrolled in clinical research required to have at least 5 members

resources to utilize for networking as an OT

our professors, fieldwork sites/coordinators/educators, past jobs or experiences, social media, AOTA, ILOTA, WFOT, continuing education, commun OT

What is Commun OT

place for AOTA members to interact, engage, and share to build a professional online community. This is a place to ask occupational therapy questions, share ideas, and respond to others.

Networking in OT

recruiting participants, giving other ideas or perspectives, enhances collaboration, access to more resources

Why was OSHA Created

with the Occupational Safety and Health Act of 1970 Works to ensure safe and healthful working conditions for workers by setting and enforcing standards and providing training, outreach, education and assistance

Elements of the proposal: The Background & Significance

•Demonstrate your understanding of topic to be researched through succinct, up-to-date literature review •Showcase why your topic is important, the impact your research will provide •Link this area to the aim of your study •You will need to do a literature review to gain understanding of this area to write an effective background section •Think about your 'so what'

Elements of the proposal: Problem

•defining the research topic area

Elements of the proposal: Question

•demonstrates what you are seeking to find out