Why is the COPM an Outcome Measure?
In 1966, Donabedian1 proposed a model for evaluating the quality of health care. To this day it remains the dominant paradigm of assessment. He proposed that quality of care is measured in three ways – structure, process and outcomes - where an outcome refers to the effects of health care on the health status of clients and populations that are attributable to defined interventions.
At the initial COPM assessment, clients indicate their occupational problems and rate the importance of each problem. Then clients select up to five problems that seem most pressing or important, and then score their estimate of their current performance in that area and their satisfaction with that current performance. Based on these identified problems, the therapist and client define the treatment goals and then select interventions to meet those goals. Subsequently, after an agreed upon time of focused therapy, the therapist conducts a re-assessment. Now, clients rescore their performance and satisfaction without seeing the initial scores.
The therapist then compares the differences between the initial scores and the reassessment scores. Given that the focus of the therapeutic interventions is placed on the occupational problems and the clients’ perception of their occupational problems, any changes between the initial and final reassessment scores can be attributed to the interventions that were used in treatment. A difference of two or more points is considered a clinically important difference2.
Many therapists use individual COPM data to determine the effectiveness of the therapy for their client. As well, when grouped across clients, COPM data demonstrates the program outcomes. The COPM is an effective measure to determine client outcome, is simple to apply and enhances client centredness.
1Donabedian, A. (1988). The quality of care. How can it be assessed? JAMA, 260(12), 1743-8.
2 Law, M., Baptiste, S., Carswell, A., McColl, M.A., Polatajko, H., & Pollock, N. (2014). Canadian Occupational Performance Measure(5thed.). Ottawa, Canada: CAOT Publications ACE.
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