RESNA Annual Conference - 2020

Quality Assurance Reporting: Common Reasons for Loss to Follow-Up

Richard M. Schein1, Mark R. Schmeler1, Vince J. Schiappa1, Gede Pramana1, & Greg Packer2

1University of Pittsburgh, Department of Rehabilitation Science and Technology

2Van. G. Miller/U.S. Rehab


The healthcare industry is punctuated with administrative and regulatory complexities that make it difficult for health systems to achieve what is now called the Quadruple Aim of healthcare: 1) improve the patient experience of care; 2) improve the health of populations; 3) reduce the per capita cost of healthcare; and 4) reduce clinician and staff burnout. [1] The complexities found in outcomes improvement are particularly challenging, as health systems measure and report on hundreds of these outcomes annually. Until recently, quality of care was hard to describe, measure, or report. A landmark in the quality movement in health care was the publication of the Institute of Medicine's (IoM) report 'to err is human: building a safer health system' in 1999. [2] Since the publication of this report, Quality Assurance (QA) in health care has steadily become a top priority for health care providers. In the United States, then called the Health Care Financing Administration, which was renamed the Centers for Medicare and Medicaid Services in July 2001, initially developed a set of quality indicators to assess the quality of care delivered to Medicare beneficiaries. [3] Other institutions have made their own set of quality indicators since then, which has led to a huge number of quality initiatives and thereby, to a completely new field in health care research. The IoM released a second report [4] where it proposed that the necessary changes should be translated into six dimensions of health care: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. [5]

Customer service in health care can be attributed to patient-centeredness or patient experience, which have become part of the accepted quality indicators of provided care. Patient-reported outcome measures (PROMs) fall within the patient experience outcome measure category. PROMs defined by the Food and Drug Administration as any report of the status of a patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else. [5] Patients can report on a number of domains that are important for evaluating an intervention including symptom experiences (e.g., pain, fatigue, nausea), functional status (e.g., mobility, bowel, or urinary functioning), wellbeing (e.g., physical, mental, social), quality of life, and satisfaction with care or with a treatment. [6-8]

Follow-up is the act of making contact with a patient or caregiver at a later, specified date to check on the patient's progress since their last appointment. Such information is useful for benchmarking, identify misunderstandings, answer questions, make further assessments and adjust approaches. In addition, follow-up helps to promote a good working relationship between the clinic and/or supplier entity and its patients. [9]

The purpose of this paper was to document the type and frequency of common data responses why an individual was listed as 'not active' before and after delivery for being assessed for a mobility device in the Functional Mobility Assessment (FMA) and Uniform Dataset (UDS) registry. [10]



[1] Bodenheimer, T., & Sinsky, C. (2014). From triple to quadruple aim: care of the patient requires care of the provider. Annals of family medicine, 12(6), 573–576. doi:10.1370/afm.1713

[2] Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system, xxi. Washington, D.C.: National Academy Press; 2000.

[3] Jencks SF, Cuerdon T, Burwen DR, et al. Quality of medical care delivered to Medicare beneficiaries: a profile at state and national levels. J Am Med Assoc 2000;284:1670–1676.

[4] Institute of Medicine (U.S.). Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C.: National Academy Press; 2001.

[5] Berwick DM. A user's manual for the IOM's 'Quality Chasm' report. Health Aff (Millwood) 2002;21:80–90.

[6] US Food and Drug Administration. Guidance for industry. Patient-reported outcome measures: use in medical product development to support labeling claims. 2009; Accessed February 11, 2020.

[7] Scientific Advisory Committee of the Medical Outcomes Trust. Assessing health status and quality of life instruments: attributes and review criteria. Qual Life Res. 2002(11):193-205.

[8] Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol. Jul 2010;63(7):737-745.

[9] AHRQ Health Literacy Universal Precautions Toolkit. Content last reviewed July 2019. Agency for Healthcare Research and Quality, Rockville, MD. Access February 11, 2020.         

[10] Schmeler, M.R., Schein, R.M., Saptono, A., & Schiappa, V.J. Development and Implementation of a Wheelchair Outcomes Registry. Archives of Physical Medicine and Rehabilitation, 100(9), 1779-1781. doi:10.1016/j.apmr.2019.03.007


We want to acknowledge the Van G. Miller Group, US Rehab, and a special thank you to Tricia Down, FMA Quality Assurance Coordinator at U.S. Rehab.