National Outcomes Measurement System (NOMS): 2003

Since 1998, speech-language pathologists (SLPs) have had a tool to help them document the real-life impact of their interventions. This tool, the National Outcomes Measurement System, or NOMS, was developed by ASHA to help its members meet the need for outcomes data which they could use with a variety of clinical and non-clinical audiences.

In the early-to-mid 1990s, SLPs increasingly found themselves called upon to provide evidence of the impact made by their treatment efforts. Third-party payors in particular were demanding such evidence. ASHA responded by establishing a task force to develop a clearinghouse within ASHA for the aggregation and dissemination of outcomes data. The task force determined that no existing outcome measurement systems adequately captured the impact of SLP intervention. Some systems were too clinically-oriented to be understood by third-party payors, non-SLP administrators, and other non-clinical audiences. Previously existing tools had poor reliability and/or validity while others seemed inappropriate as communication and swallowing issues were only minimally addressed amid a morass of often marginally-related measures.

In 1997, ASHA created the National Center for Treatment Effectiveness in Communication Disorders (NCTECD), a staff unit charged with developing sources of data that ASHA members could use to address questions regarding the impact of their services. NCTECD's charge is to develop data sources for all ASHA members, not just SLPs. The recognition of unmet needs for outcomes data has been much more strongly felt among SLPs than audiologists. Although this is slowly changing, the result has been that virtually all the work done at NCTECD, to date, has focused on speech-language pathology.

Most of the tools developed by the NCTECD fall under the heading of NOMS. NOMS is the umbrella term for three separate, but related, nationwide data collection systems.

The first data collection system to be developed and launched was the Adult component of NOMS, as it was the arena of adult health care in which SLPs most acutely recognized an unmet need for outcomes data, Data collection for the Adult component began in late 1998. The database currently contains data on over 70,000 patient-stays.

Although the initial impetus for the development of NOMS was the need for data to satisfy health insurance corporations, school-based SLPs soon recognized this approach could be applied to the school setting.

In the spring of 1999, the second component was launched, called the Pre-Kindergarten component. This component tracks outcomes for children ages three to five years who receive SLP services in health care or school settings. This database contains data on approximately 6,000 interactions.

The third component, called the "K-6" component, was launched at the beginning of the 1999-2000 school year. The goal of this component is to measure the impact of SLP intervention upon the students' ability to fully participate in classroom activities.

All three NOMS components have similar structure. Upon patient or client admission to SLP services, the SLP submits (via the Internet or a "scannable" paper form) an Admission form which captures basic demographic and diagnostic data about the individual receiving services. The SLP scores the patient on one or more of a series of seven-point scales to measure the patient's level of functional communication. These scales, referred to as the Functional Communication Measures (FCMs) are disorder-specific. The SLP scores the patient on whichever FCM corresponds to the patient's treatment plan.