At the March 2017 Café Chat, Chair of our Board of Trustees, Dr. G. Duncan Finlay, introduced Plymouth Harbor to the Florence A. Rothman Institute (FARI), where he serves as President and CEO, and The Rothman Index.
According to Dr. Finlay, healthcare in the United States is beset by upward spiraling and financially unsustainable costs and quality that is disappointing at best. Early efforts to address this issue have had inconsistent results in terms of quality and cost measurements. These approaches are commonly patient-centered, and thus require a means to accurately measure and follow a patient’s condition at any level of care, from hospital care through skilled nursing, home health care, and assisted and independent living organizations.
The Rothman Index
This is where the Rothman Index (RI), an acuity metric developed at Sarasota Memorial Hospital, comes in. The RI is a score of a patient’s general condition that is calculated automatically from information that is routinely collected in the electronic medical records (EMR) system. The score is displayed in a graphical format that depicts the patient’s condition over time. The RI has been validated with over 30 peer-reviewed articles and is used in over 60 hospitals nation-wide. Preliminary studies in skilled nursing facilities appear to support its accuracy outside the hospital.
Plymouth Harbor’s Involvement
FARI wanted to explore if this same index could be constructed for persons living independently, and as a result, asked Plymouth Harbor residents for their participation in a trial study where patients conduct their own medical self-assessments, answering a series of questions. The study officially began on May 9, 2017, with 46 independent living participants. A total of 30 females and 16 males participated, with an average age of 83. These volunteers answered 14 ‘yes’ or ‘no’ questions about possible symptoms pertaining to their own body systems.
The same self-assessment was then repeated on a second occasion separated by more than 24 hours — with an average separation time of 11 days. Then, the volunteers had a Registered Nurse independently perform a standard head-to-toe assessment for comparison.
The study was able to demonstrate significant inter-rater reliability (agreement) in 11 of the body system questions on the first pass, and in 10 questions on the second. The individual answers were consistent between the first and second answer periods.
Future plans include asking volunteers to use a handheld device, which was demonstrated at the Café Chat, to measure their own vital signs (blood pressure, pulse, respirations, and oxygen levels) and then answer the same questions on a smart phone. These will be combined to create a Rothman Index score and graph, which will give a picture of each volunteer’s overall wellness during the monitoring period. Please stay tuned for more information on this future study.