the atoms project: measuring assistive technology outcomes dave l. edyburn, roger o. smith, todd d....
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The ATOMS Project:Measuring Assistive Technology Outcomes
Dave L. Edyburn, Roger O. Smith, Todd D. Schwanke & Kelly S. Fonner
Center for Rehabilitation Sciences & Technology
Closing the Gap Conference, Minneapolis, MN October 17, 2002
View: Universal Access Features
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October 2002Update: The ATOMS Project 2
© 2002 Center for Rehabilitation Sciences & Technology
Copyright
• This Microsoft PowerPoint file has been made available as an accessible, electronic handout for the participants of the presentation.
• You must obtain permission from the ATOMS Project before copying or further distributing this presentation.
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October 2002Update: The ATOMS Project 3
© 2002 Center for Rehabilitation Sciences & Technology
ATOMS Projects Vitals
• Based at the University of Wisconsin – Milwaukee
• National consortium
• 5 year AT outcomes project
• NIDRR funded (US Dept of Education) DRRP - Disability and Rehabilitation Research Projects
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October 2002Update: The ATOMS Project 4
© 2002 Center for Rehabilitation Sciences & Technology
ATOMS Project Consortium
Steve Mendelsohn
Helen HayesHospital
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October 2002Update: The ATOMS Project 5
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcomes Vision and Needs?
• What do you think an outcomes system should look like in 10 years?
• How would you want to use it?
Audience Vision
Audience Need
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October 2002Update: The ATOMS Project 6
© 2002 Center for Rehabilitation Sciences & Technology
The Atoms Project Response
• Difficult questions for response, aren’t they?
• The ATOMS Project hopes to help clarify the field’s 10 year vision.
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October 2002Update: The ATOMS Project 7
© 2002 Center for Rehabilitation Sciences & Technology
Overall ATOMS Project goal
• Explore, Pilot, and Test AT Outcome Measurement Ideas to Recommend an AT outcomes system
(Go Where No One Has Gone Before)
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October 2002Update: The ATOMS Project 8
© 2002 Center for Rehabilitation Sciences & Technology
Our Overall Approach Reflected as the ATOMS Project Logo
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October 2002Update: The ATOMS Project 9
© 2002 Center for Rehabilitation Sciences & Technology
Challenges to an AT outcomes system
• Diversity of perspectives of need for outcomes data
• Diversity of populations
• Diversity of domains for which we'd like outcomes data
• Requirements for a data system to use reliable and valid measures
• AT is only one of many interventions and it is an rarely used in isolation
• Outcomes methodology has advanced, but so have new outcomes measurement ideas
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October 2002Update: The ATOMS Project 10
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (1)- Context and Baseline
Environment
Task
Person
Function
BaselineContext
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October 2002Update: The ATOMS Project 11
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (2)- Interventions
Environment
Task
Person
Function
BaselineContext
Interventions:
Includingthe Use ofAssistive
Technology
Intervention Approaches
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October 2002Update: The ATOMS Project 12
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (3) - Outcome
Environment
Task
Person
Function
BaselineContext
Interventions:
Includingthe Use ofAssistive
Technology
Intervention Approaches
Enhanced
Function
Outcome
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October 2002Update: The ATOMS Project 13
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (4) - Interventions Detailed
Environment
Task
Person Functional
Performance
BaselineContext Intervention Approaches
Enhanced
Functional
Performance
Outcome
Reduce the Impairment
Use Assistive Technology Devices
and Services
Use Assistive Technology Devices
and Services
Redesign the Activity
Compensate for the Impairment
Redesign the Environment
Use Personal Assistance
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October 2002Update: The ATOMS Project 14
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (5) - with Pre-interventions
Environment
Task
Person Functional
Performance
BaselineContext Intervention Approaches
Enhanced
Functional
Performance
Outcome
Reduce the Impairment
Use Assistive Technology Devices
and Services
Use Assistive Technology Devices
and Services
Redesign the Activity
Compensate for the Impairment
Redesign the Environment
Use Personal Assistance
Universal Design
Health Promotion
Pre-intervention
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October 2002Update: The ATOMS Project 15
© 2002 Center for Rehabilitation Sciences & Technology
AT Outcome Model (6) - with Costs
Environment
Task
Person Functional
Performance
BaselineContext Intervention Approaches
Enhanced
Functional
Performance
Outcome
Reduce the Impairment
Use Assistive Technology Devices
and Services
Use Assistive Technology Devices
and Services
Redesign the Activity
Compensate for the Impairment
Redesign the Environment
Use Personal Assistance
Universal Design
Health Promotion
Pre-intervention
$$
$$
$$
$$
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October 2002Update: The ATOMS Project 16
© 2002 Center for Rehabilitation Sciences & Technology
Face the Challenge or Run?
• Does that mean that a coordinated outcome system is too difficult and that we are stuck with a fragmented, haphazard, homemade, anarchistic system?
• Is a more cohesive and comprehensive AT outcomes approach possible?
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October 2002Update: The ATOMS Project 17
© 2002 Center for Rehabilitation Sciences & Technology
Strategies
• Computerized data collection
• Centralized database
• Customized or multiple interfaces for various user perspectives
• Decision analysis data elicitation strategies
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October 2002Update: The ATOMS Project 18
© 2002 Center for Rehabilitation Sciences & Technology
General ATOMS Project Timeline
Year 1-2: Needs assessment & field feedback
Year 2-3: Instrument/methodology exploration & development
Year 3-5: Pilot ideas
Year 5: Propose AT outcomes methods & system
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October 2002Update: The ATOMS Project 19
© 2002 Center for Rehabilitation Sciences & Technology
ATOMS Specific Activities
1. Needs Assessment Field Scans Stakeholder Focus Groups Existing Database Analyses
2. Exploratory R&D Projects
(Instrument Development)
3. Abandonment Analysis
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October 2002Update: The ATOMS Project 20
© 2002 Center for Rehabilitation Sciences & Technology
Field Scans Types
• Current Instruments (1,2)
• Newer methodologies & instrumentation (4,5,6)
• Feedback from field (focus groups)
• Literature reviews (3,7,8,10,12)
• Legal/Policy (9)
• Conference scientific reviews (11)
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October 2002Update: The ATOMS Project 21
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 1 – Instrument Update and Review
Formal and informal tools
Commercial and program specific tools
Specific and general tool
• Instrument nomination form• Identification of gaps and overlaps• Searchable directory• Identification of type of measurement domains
addressed
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October 2002Update: The ATOMS Project 22
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 2 – Coverage of AT in Current/Emerging Health & Rehabilitation Outcome Measures
~100 instruments selected for review (2 scored two-ways)Preliminary review reveals: N = 41 fail to acknowledge the use of assistive
technology in their outcome scoring N = 47 lower the outcome score if AT is used (nude
independence) (most examine limited types of AT) N = 24 allow for AT to elevate the outcome score,
but many do not differentiate among type of aids and assistance
Of the 102, 4 acknowledge that AT contributes to outcomes and isolates the outcome.
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October 2002Update: The ATOMS Project 23
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 3 – Inventory of Measures Used in AT Research and Design Activity
Do AT developers use appropriate outcomes instruments and methodologies for their projects?
How severe is the problem? Or how is this perceived by product developers?
Request methodology of grant proposals from PI’s – 2001 funding (NIH n=34, NIDRR n=27)
Survey of product developers• Technology Exhibitors, RESNA&AOTA National
Conference 2002 n=78• Random sample (n=500/1100) from ABLEDATA
Directory of Manufacturers
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October 2002Update: The ATOMS Project 24
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 4 – Ascertain Next Generation Data Collection Technology
• Factors considered for review of Technology & Methodology Content/outcomes information Scaling potentials Data collection processes/protocol Equipment (hardware/software) characteristics e.g.
interface, portability, cost, durability Data handling protocols Data Reporting
~ 50 hardware & software technologies being reviewed
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October 2002Update: The ATOMS Project 25
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 5 – Evaluate Cost Comparison Methods
• Helen Hayes Hospital: Frances Harris, Ph.D.
• Initiating methodology review of cost comparison methods and how various approaches match the needs for AT Outcomes measurement procedures that include cost variables. Methods of measuring costs Methods of comparing costs
• Cost-comparison literature review relevant to assistive technology
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October 2002Update: The ATOMS Project 26
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 6 – Assess Application of Decision Analytical Approaches
• Multi-attribute Utility (MAU) Theory Application analysis (selected articles) 47 Engineering articles using MAU methods 60 Health-related articles using MAU methods 32 General articles on MAU methodology
• Bayesian Approach analysis (initial search) 3797 articles, MEDLINE (1966-present) 140 ERIC (1967-present) 1573 Engineering Village (1970-present)
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October 2002Update: The ATOMS Project 27
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 7 – Review Taxonomies of Outcome
What intersection of domains across taxonomies provide common language for a more universal AT outcomes discussions?
• e.g. Nagi Model (1965) ICIDH (1980, 1993) Rehabilitation Indicators (1983) NCMRR Research plan (1993) Quality of Life Taxonomy (Spilker & Revicki, 1996) Characterization of Rehabilitation Services (Duncan, Hoenig ,
Samsa , & Hamilton 1997) Institutes of Medicine Model (1997) ICIDH-2 draft (1997) ICF (2002)
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October 2002Update: The ATOMS Project 28
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 8 – Identify Strategies for Isolating ATOutcomes
Compare methodologies that can isolate & quantify the outcomes of assistive technology. ~410 articles
e.g. Multi-variate regression analyses Structural equation modeling Direct consumer qualitative input (perceived benefit /
satisfaction of a device) Randomized controlled trials Sequential Clinical Trials Time-series concurrent differential (TSCD) Qualitative
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October 2002Update: The ATOMS Project 29
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 9 – Describe Legal Implications of AT Outcomes Instrumentation
• What are legal & ethical issues related to AT outcomes systems? -- Steven Mendelsohn
Legal, responsible, & ethical data collection procedures
Potential legal ramifications of AT outcomes data (positive and negative)
Implications of AT outcomes for policy-making
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October 2002Update: The ATOMS Project 30
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 10– Review of Special Education Technology Literature
• Review of 31 special education technology journals
• Reviews published in Journal of Special Education Technology (1999, 2000, 2001)
• >2700 articles• Iteration with outcome filter to identify
relevant articles.• Summarize and report findings.
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October 2002Update: The ATOMS Project 31
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 11– Technology Conference Program Review
• Last two years of CTG, CSUN, RESNA, and TAM conferences reviewed as fugitive literature.
• Identify relevant papers on AT Outcomes.
• Summarize and report findings.
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October 2002Update: The ATOMS Project 32
© 2002 Center for Rehabilitation Sciences & Technology
Field Scan 12– Chronology of Assistive Technology Outcomes Measurement
• Literature review reveals that At outcomes have been measured differently over the decades
• This is consistent with what types of outcomes studies have been performed and the mandate for accountability
• This field scan will develop a chronology map and accompanying discussion
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October 2002Update: The ATOMS Project 33
© 2002 Center for Rehabilitation Sciences & Technology
Quiz on the field scans:
• Just Kidding….
• Lots of data from field scans. What do we hope to learn?
• Technical reports
• Compendium document
• Consensus meeting
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October 2002Update: The ATOMS Project 34
© 2002 Center for Rehabilitation Sciences & Technology
Stakeholder Focus Groups
• Direct Feedback from field
• Consumer/User groups (4)
• Service Directors (for records & documentation assessment),
• Payors of AT devices & services,
• Researchers, Developers, & Manufacturers, and
• Parents & Caregivers.
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October 2002Update: The ATOMS Project 35
© 2002 Center for Rehabilitation Sciences & Technology
Service Director Focus Group – April 2002
• Modified NGT developed current list of identified AT Outcomes data domains (“If we had a magic wand”)
1. Change in performance/function (body, structure, activity)2. Change in participation3. Usage and why or why not4. Consumer satisfaction (process, devices)5. Goal Achievement6. QOL7. Cost8. Demographics9. AT interventions (services + devices)10. Environment context
• List is similar to DeRuyter (1998)
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October 2002Update: The ATOMS Project 36
© 2002 Center for Rehabilitation Sciences & Technology
Databases – National
• National Health Information Survey-Disability (NHIS-D)
• Assistive and information technology survey (NIDRR/RESNA/University of Michigan)
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October 2002Update: The ATOMS Project 37
© 2002 Center for Rehabilitation Sciences & Technology
Databases – Clinical
• UW-Stout
• University at Buffalo (SUNY)
• HHH
• PROVAIL
• What data are being collected?
• Are available data sufficient for analysis?
• Is there an intersection of outcome data fields among existing service file systems?
• Can clinical programs adapt to collecting more data?
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October 2002Update: The ATOMS Project 38
© 2002 Center for Rehabilitation Sciences & Technology
Clinical Database Update
• Data fields Commonalities (few) and differences (numerous) Setting & funding specific (education, vocation,
hospital, university) Stakeholders (variable) Electronic records (variable & minimal)
• Potentials VR data Willingness of clinical programs to modify data
collection
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October 2002Update: The ATOMS Project 39
© 2002 Center for Rehabilitation Sciences & Technology
Exploratory R&D Projects (Instrument Development)
a) AT Device Inventory
b) AT Services Inventory
c) Cost Identification Feasibility Study
d) Assistive Technology Approach Isolation Measure (Subjective)
e) Web-based visualization
f) Environmental access assessment (WebAUDIT, MED-AUDIT)
g) Computer branching questioning (TTSS)
h) AT supplements to existing instruments (SFA-AT)
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October 2002Update: The ATOMS Project 40
© 2002 Center for Rehabilitation Sciences & Technology
Public School AT Outcome Pilots & Collaborative Activity
a) Ohio
b) Colorado
Colorado
Ohio
Colorado
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October 2002Update: The ATOMS Project 41
© 2002 Center for Rehabilitation Sciences & Technology
NIDRR DRRP Coordination
• CATOR (Consortium of Assistive Technology Outcomes Research) http://www.atoutcomes.org
• ATOMS Project
http://www.atoms.uwm.edu
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October 2002Update: The ATOMS Project 42
© 2002 Center for Rehabilitation Sciences & Technology
Dissemination: What to Expect
• ATOMS Project Website Products
• Special Issues of Journals
• Conference Presentations
• 2003-2004 Symposium
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October 2002Update: The ATOMS Project 43
© 2002 Center for Rehabilitation Sciences & Technology
Dissemination: ATOMS Project Products in the Works
AT Outcomes Primer Study Group Outline Test Your Knowledge of AT Outcomes FAQ’s Course Guide (syllabi and more) Drafts of Instruments Technical Reports Compilation of Needs & Current Outcome
Directions Implications for Next Generation AT Outcomes
System
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October 2002Update: The ATOMS Project 44
© 2002 Center for Rehabilitation Sciences & Technology
Needs Assessment Participation Opportunities
• Conversation
• Product developer survey
• Instrument collection
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October 2002Update: The ATOMS Project 45
© 2002 Center for Rehabilitation Sciences & Technology
Contacting the ATOMS Project
Completing interest survey
Web: www.atoms.uwm.edu
Email: [email protected]
Voice: (414) 229-6568
TTY: (414) 229-5628
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October 2002Update: The ATOMS Project 46
© 2002 Center for Rehabilitation Sciences & Technology
Questions, Answers and Discussion
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October 2002Update: The ATOMS Project 47
© 2002 Center for Rehabilitation Sciences & Technology
Thank-you…. . . . for your attention!
Slides about the universal access features of this PowerPoint presentation follow.
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October 2002Update: The ATOMS Project 48
© 2002 Center for Rehabilitation Sciences & Technology
Universal Access Features
• The “speaker notes” associated with each slide in PowerPoint are used as a Universal Access feature.
• They contain long text descriptions of the graphics because it was not feasible to do this with PowerPoint’s “alternative text” function. The descriptions can be used by new presenters and presentation attendees, in addition to being used for accessibility by people with vision or cognitive impairments.
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October 2002Update: The ATOMS Project 49
© 2002 Center for Rehabilitation Sciences & Technology
Viewing the Speaker Notes(does not work within PowerPoint Viewer 97 or 98)
• In the “Slide Show” view within PowerPoint: Windows: right click on the slide or use the context key
to bring up the context menu and then select “speaker notes”
Mac: [Ctrl] + click on the slide to bring up the context menu and then select “speakers notes”
• The notes can also be seen as a frame or pane in the “Normal” view or directly by using the “Notes Page” view.
• When in “Normal” view, F6 is used to switch between the slide, notes and outline panes respectively.
Go back to the opening presentation slide