How Long Will Treatment for Aphasia Last? ASHA’s outcomes-data collection system links patient variables to the amount of aphasia treatment needed to meet functional goals. On the Pulse
Free
On the Pulse  |   October 01, 2016
How Long Will Treatment for Aphasia Last?
Author Notes
  • Rob Mullen, MPH, is director of the National Center for Evidence-Based Practice in Communication Disorders. rmullen@asha.org
    Rob Mullen, MPH, is director of the National Center for Evidence-Based Practice in Communication Disorders. rmullen@asha.org×
Article Information
ASHA News & Member Stories / Language Disorders / Aphasia / On the Pulse
On the Pulse   |   October 01, 2016
How Long Will Treatment for Aphasia Last?
The ASHA Leader, October 2016, Vol. 21, 38-39. doi:10.1044/leader.OTP.21102016.38
The ASHA Leader, October 2016, Vol. 21, 38-39. doi:10.1044/leader.OTP.21102016.38
How can audiologists and speech-language pathologists demonstrate their effectiveness? As payers increasingly look to quality and outcomes as the basis for reimbursement, all health care providers need to prove the value of their services.
Data from ASHA’s National Outcomes Measurement System (NOMS)—already under way for speech-language treatment and in development for audiology treatment—can help providers quantify patient improvement. Further analysis may lead to insights on, for instance, what treatments work best for which patients and how much treatment will be necessary.
Take aphasia treatment, for example. NOMS data indicate that 71 percent of patients with aphasia who receive speech-language treatment made functionally significant improvement. But analysis of the data can yield further information, such as what factors affect how much treatment a given patient will need.
Typical aphasia caseloads
People with aphasia represent 12.1 percent of all patients reported to NOMS, with variable distribution across treatment settings—ranging from a low of 6.7 percent of patients in skilled nursing facilities (SNFs) to 23 percent of outpatients. And although outpatient settings see proportionately more aphasia patients than do inpatient settings, outpatients typically have less severe aphasia (see the chart below).
NOMS uses seven-point, multi-dimensional scales (known as functional communication measures, or FCMs) to obtain clinician-generated ratings of initial severity and outcomes. The most frequently scored FCMs for patients with aphasia are language-related: spoken language expression (65.7 percent) and spoken language comprehension (49.1 percent).
NOMS participants also frequently score FCMs for swallowing (28.1 percent), memory (18.6 percent) and reading (17.8 percent) for patients with aphasia.
NOMS data analysis can address a key question—one of tremendous interest to clinicians, administrators, payers and, of course, patients and their families: What factors predict the amount of treatment needed? Although “need” is difficult to quantify, the amount of treatment delivered can be examined relative to reported gain. The total amount of speech-language treatment received by patients with aphasia varies considerably by treatment setting, ranging from a median of 1.8 hours in acute care hospitals to 10.6 hours in outpatient settings.
What determines treatment length?
Staff from ASHA’s National Center for Evidence-Based Practice in Communication Disorders analyzed data (1998 to the present, with 9,714 cases included in the analysis) to test the association between hours of treatment provided and observed gains on the FCMs for SNF residents with aphasia (see the charts below). Two key factors account for approximately 47.2 percent of the variance:
  • Severity (based on the initial FCM score on spoken language expression at admission) accounted for 28.7 percent of the variance in the amount of treatment for patients whose treatment goals were met.

  • Complexity (based on the number of FCMs being treated and the extent to which patients had a concomitant cognitive disorder, motor speech disorder and/or dysphagia) accounted for 18.5 percent of the variance in the amount of treatment for patients whose treatment goals were met.

Medical diagnosis did not account for a significant proportion of the variance in the number of hours of treatment provided, nor did several other factors that are routinely collected, such as gender and age.
The data also indicate that African-American and Hispanic patients have less successful outcomes than do non-Hispanic white patients across several FCMs—spoken language expression, spoken language comprehension, reading and writing—even when treatment setting and severity are considered. Further analysis is necessary to investigate potential explanations for this finding. For example, perhaps patients whose primary language is Spanish were scored as more severe by clinicians who do not speak Spanish than by those who are bilingual.
1 Comment
October 16, 2016
Shirley Morganstein
NOMS and what else?
Those of us who work in a setting that employs the LPAA philosophy will always have difficulty quantifying improvement using the NOMS. That is because it does not capture the kind of goals and outcomes PWA's address in treatment. There is a growing body of research validating the ability to quantify the qualitative changes that people with aphasia make in treatment; I refer those interested to www,aphasiaaccess.org for information on this subject. One needs to step outside the dictates of third party payers, who will always seek to reduce the cost of service provision. Let us counter with EB research to detail the quality of life improvements that matter, and support fiscal subsidies for our services.
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2016
Volume 21, Issue 10