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This should be every PT's aim when it comes to delivering the highest quality customer service on the planet. There are no better examples than this.
John
The US Census announced today (pg 26-28 of pdf) the latest numbers on income, poverty and health insurance for 2006. For the 6th year in a row, the number of uninsured Americans rose. For 2006, the number was 15.8% of all Americans or 47 million were uninsured.
While this is a somber fact, I would like to look at it another way: a growing market. Whoever figures out how to provide inexpensive health care to this population has a steadily growing market on their hands. It could be good business. Again, I refer you to retail health clinics.
ERIC
Check out upcoming Evidence in Motion courses currently open for registration! Learn more about MyEIM and our new Articulate course format!
***Indicates course open for internal registration only. Contact facility POC listed on website.
Evidence-based Examination and Selected Interventions for Patients with Lumbopelvic Spine and Hip Disorders
Sep 15, 2007
Medford, NJ (USA)
Sep 29-30, 2007***
Evansville, IN (USA)
Nov 3-4, 2007***
Hawthorne, NY (USA)
Nov 17-18, 2007***
Greenville, SC (USA)
Mar 29-30, 2008
Portland, OR (USA)
Evidence-based Examination and Selected Interventions for Patients with Cervical Spine Disorders
Sep 15-16, 2007
Burlington, NC (USA)
Sep 15-16, 2007***
Houghton, MI (USA)
Sep 29, 2007***
Everett, WA (USA)
Oct 27-28, 2007***
Evansville, IN (USA)
Nov 3-4, 2007***
San Luis Obispo, CA (USA)
Evidence-based Examination and Selected Interventions for Patients with Upper Extremity Disorders
Oct 26-27, 2007***
Ft. Lauderdale, FL (USA)
Evidence-based Examination and Selected Interventions for Patients with Lower Extremity Disorders
Sep 8-9, 2007
Concord, NH (USA)
Nov 10-11, 2007
New York, NY (USA)
We encourage early registration to insure a seat. Extensive hands-on lab sessions are included. Visit us on the web at www.evidenceinmotion.com to get more details, learn about other 2007 course dates and locations. Register online today!
Feel free to email us at courses@evidenceinmotion.com if you have any questions or need additional information. Consider passing this post on as an email to your colleagues who might benefit from this information. Hope to see you at an Evidence in Motion course in 2007! We sincerely thank you for joining with us to translate evidence into practice.
The Evidence in Motion Team
As we've mentioned before, there's a lot happening at EIM these days, like last week's announcement of the Fit for Work partnership. If you've visited the Evidence in Motion home page lately, you may have noticed a significant new link in the main navigation: Residency/Fellowship.
EIM has significantly increased our role in clinical education, and created the EIM Orthopaedic Physical Therapy Residency and the EIM Fellowship in Orthopaedic Manual Physical Therapy. Our mission is to equip physical therapists to be become distinguished leaders in evidence-based orthopaedic and manual physical therapy practice.
The programs are currently under review to obtain APTA credentialing. Indeed, the programs were created in response to a call by the APTA for the development of post-professional clinical education programs such as residencies and fellowships in support of Vision 2020 and the development of skilled, autonomous practitioners.
About the Programs:
I urge you to visit the above link which provides an overview of both programs, including details about the curriculum and our clinical partners. In short, the EIM Orthopaedic Residency is designed to prepare therapists for board certification in Orthopaedics. The EIM Fellowship in Orthopaedic Manual Physical Therapy is designed for therapists who may already be ABPTS certified and provide them the clinical skills and didactic learning needed in the critical sub-specialty of orthopaedic manual physical therapy.
The EIM Orthopaedic Residency and Fellowship in Orthopaedic Manual Physical Therapy programs are an intensive combination of didactic and clinical education experiences using a combination of distance learning, on-line courses, weekend intensive hands-on courses, and clinical practice hours. EIM highly leverages distance learning and other technologies (online Grand Rounds, Author in the Room, discussions via MyPhysicalTherapySpace, etc.) to maximize the learning experience and collaboration with other EIM Residents/Fellows-in-Training throughout the country. Both programs boast faculty who not only are clinical experts, but are often the drivers of research supporting orthopaedic physical therapy practice.
Our Partners
EIM has has built a vast community of evidence-based practitioners, high quality employers, prospective employees, and is closely associated with many of the best academic programs and other key stakeholder groups around the country. It is in these relationships where the true value of the programs lie. Both the Residency and Fellowship are designed to take place within this network, providing therapists-in-training both the opportunity to learn in excellent settings and the flexibility required of a working professional.
Graduates of the residency/fellowship will be highly skilled autonomous practitioners who are critical thinkers, reflective, empathetic, and lifelong learners, representing the best clinicians in the physical therapy profession. They will be equipped with the skills necessary to teach, provide mentorship and train future EIM-Network Partner Residents/Fellows-in-Training.
We at EIM are excited to announce these programs and would like to extend our best wishes to our initial cohort of residents and fellows!
Visit us at www.evidenceinmotion.com or contact us at info@evidenceinmotion.com for additional details.
All the rage of late in the medical business world is about retail medical clinics (or more aptly named, "convenience health clinics"). For Wall Street Journal readers, you know what I'm talking about. You may also know that the American Medical Association has declared war on these clinics. You may read their declaration here.
So far, customer satisfaction for this clinics has been high, around 97%. Its not surprise then, that this business model is taking off, with clinics popping up in Walgreen's and Wal-Marts all over the country. It is obvious that the AMA's opposition to these clinics is simply a turf battle and not legitimately about patient care quality. It reminds me of physician's opposition to direct access to physical therapists, and the battle over referral for profit arrangements; both battles also fought under the guise of physician's altruism.
The all-seeing Seth Godin, had a nice post a while back on "Stuck Systems." Here is a quote from that post:
"So, the marketer faces a challenge similar to the disruption challenge that most marketers face--how do you take a system filled with an inefficient, annoying, time-consuming, wasteful and yes, even stupid task and make it better in a way that serves all sides?
If it were me, I'd focus on being cheap and fast and viral. And the more you break the system, the better your upside."
Healthcare is a stuck system. I don't think it can stay that way for long. In the end, consumer choice of convenient services will rule the day. It could be an incredibly ironic moment in the upcoming presidential election, where health policy is expected to play such a large role, that consumers have already chosen their "fix" for healthcare in the marketplace.
Physical Therapists must acknowledge they are part of a stuck system! Third-party payment, regulatory woes, and limited access characterize our jobs. The convenience model needs greater attention. We are continually growing the research evidence base to support this model for physical therapist practice. We might think about acting quickly, it could be embarrassing for a physical therapist to get beat in a race by a nurse practitioner!
ERIC
I am posting this on behalf of our good friend Dr. Haxby Abbott from the School of Physiotherapy at the University of Otago in New Zealand. This will be a great opportunity for someone. The full announcement is attached via .pdf and here is a link that Dr. Abbott posted on MyPhysicalTherapySpace.
Download otago_phd_flyer_07b.pdf
John
Dear Colleagues,
Dr Haxby Abbott, Senior Research Fellow for Clinical Research Development at the Centre for Physiotherapy Research, was recently awarded funding from the New Zealand Health Research Council for a 3-year research project investigating physiotherapy interventions for osteoarthritis, as well as a feasibility study for an economic analysis of the same intervention programme. This funding includes a number of scholarships for Masters and PhD students. We are now seeking high-quality candidates to take up these scholarships here at the University of Otago to work on this research programme (see attached flyer). We would be grateful if you could post this flyer on notice-boards and pass it on to anybody who may be interested.
Any questions or enquiries about the application process can be directed to Emma Tumilty.
Questions or enquiries regarding what the trial involves and any other queries can be directed to Dr Abbott.
With kind regards,
Emma Tumilty
Research & Postgraduate Administrator
Centre for Physiotherapy Research
University of Otago
P.O.Box 56
Dunedin, New Zealand 9054
Tel: +64 3 479 4053
Fax: +64 3 479 8414
Email: emma.tumilty@otago.ac.nz
J. Haxby Abbott, PhD, MScPT, FNZCP
Senior Research Fellow, Clinical Research Development
Centre for Physiotherapy Research
School of Physiotherapy
University of Otago
PO Box 56
Dunedin, New Zealand 9054
T: +64 (0)3 479-5133
M: +64 (0)27 289-0863
E: haxby.abbott@otago.ac.nz
W: http://physio.otago.ac.nz
W (clinics): http://physio.otago.ac.nz/clinics/clinics.asp
EIM is glad to announce having acquired a great company called Fit for Work. Fit for Work is an occupational health company that contracts directly with both large and small employers to provide occupational health and safety services (injury prevention, early intervention, ergonomic evaluation, functional capacity evaluation, OSHA compliance programs and safety training, etc.). Founded in 1998, founding partners Tom Tobin and Keith Adamson built their business on a non-traditional service model focused on injury prevention and early intervention. Fit for Work has assembled an outstanding team with a great reputation and credibility with their clients. Their track record speaks for itself, having demonstrated cost and injury reductions on the order of 60% for almost every one of their clients, including the likes of Frito Lay North America and H. E. Butt Grocery Company (H-E-B).
Some of you will be asking the obvious question..."How does this relate to EIM?" The answer is actually quite simple. The genesis of our merger is hinged on a shared belief that there exists a great opportunity to elevate health care delivery in the workplace and that the current model is in dire need of reform. As an example, the traditional Workers’ Compensation system (a space that many PT providers operate) is a high-volume business riddled with inefficiencies and focus on post OSHA recordable injury rehabilitation, which translates into major costs. However, employers are the most important health care payer in the United States and should be viewed as supply chain partners rather than primarily a source from which to extract rehabilitation revenue. The Fit for Work model is based on an underlying belief that putting the right worker in the right place in as safe a manner as possible will result in decreased costs, decreased injuries, increased profitability, and increased productivity (ie, early intervention = manageable costs). By focusing on prevention and early intervention, employers trust that Fit for Work is a committed partner whose interests are aligned with theirs. Fit for Work and EIM share a strategic vision of growing and developing the direct employer health care contracting business, so the combination makes great strategic sense.
EIM has developed strategic relationships with many high quality physical therapy providers around the country and is privileged to be associated with so many quality providers in the EIM community. As an example, one of our strategic partnerships is with Jeff Hathaway from ProActive Physical Therapy to develop Evidence@Work(TM) EBP guidelines. A major focus of our strategy going forward will be to develop a national network of providers interested in providing the same high quality occupational health services to employers under the direct to employer contracting model. By aligning the Fit for Work brand with high quality providers around the country, Fit for Work Partners can deliver the same high quality occupational health services to both large and small employers all over the country. Not unlike providers under the traditional Workers' Compensation system, commercial insurers are also motivated by profit maximization, which requires doing more procedures and increasing utilization wherever it can. We are optimistic regarding the future and think that direct employer contracting in occupational health care is just the first step.
More details will become available in the coming months, but if you're interested in learning more about becoming a Fit For Work/EIM Partner, send us an email to info@evidenceinmotion.com. We will add you to our list of prospective partners and pass along additional information as it becomes available.
To Tom, Keith, and rest of the outstanding members of the Fit for Work team, the EIM community looks forward to partnering with you to elevate health care in the U.S.
The EIM/FFW Team
I was in Davenport IA this past weekend where I had the privilege of teaching the EIM Lumbopelvic Spine and Hip Disorders course to a group of therapists at St. Ambrose University . While in the birthplace of Chiropractic, I had the opportunity to drive by the Mecca of Chiropractic, Palmer College of Chiropractic. The prominent bust statues immediately caught my eye, but even more so the inscription.
"The Foundation of Chiropractic"
While not visible on this picture, that is what the inscription reads directly below the statues. In a nutshell, this is why the practice of Chiropractic practice will continue its march to irrelevance and place as a curious oddity in modern health care unless it changes (which evidence shows us is unlikely): It holds firm to its foundation of the Palmer persona and unfounded theories that have been passed down. Make no mistake, this characterizes the vast majority of the Chiropractors not the reformed few individuals you can still find here and there (most have become PTs).
With regard to our own house (Physical Therapy), what is our Foundation? I propose it is encapsulated by the following:
1) Advancing the Evidence-based Practice approach
a. developing and maintaining practice guidelines
b. supporting practitioners' ability to genuinely apply these methods and skills
2) Facilitating Professional Development
a. increase the reach and influence of residency & fellowship programs
3) Fostering Research
a. "performing and disseminating research and acquiring, appraising, and applying evidence for orthopaedic physical therapy"
b. "translating evidence into practice"
4) Promoting and Empowering the Profession as an Autonomous Practitioner of Choice for NeuroMusculoskeletal Care.
EIM's mission is completely aligned with APTA's Vision 2020 from which the above tenets and other professional source documents flow. Let's make sure we don't substitute style for substance. We can hold both past and present pioneers of our profession in high regard and stand on their shoulders to reach out and shape our future without falling into the trap of "Guruism"; otherwise who knows, years from now there could be a lofty bust in front of some academic institution (or even Alexandria Drive) which is looked to as a Foundation. However, if the mind-set and passion I saw this weekend at St. Ambrose and the many therapists from Rock Valley PT are any indication, then our Foundation is strong and our future is bright indeed.
BTW, what's your Foundation for practice?
Rob
The APTA deserves a high-five on their press release this week. Why am I happy? A PR campaign about fall awareness and prevention is much more in line with the branding our profession deserves. It reaches to a wide base, it provides an objective and easy assessment for consumers to try, and it supports our mission to be seen as serious healthcare providers. But most of all, I'm glad to see a press release about a patient category I've actually SEEN IN THE CLINIC!
What's the next PR campaign going to be? Back pain and treatment classifications? Hip and Knee OA? Or will it be something like "Nintendo-Wii-algia" ?
I can only hope.
ERIC
This is a recent trial seeking to evaluate the cost-effectiveness of physical therapy and general practitioner care for patients with sciatica compared to general practitioner care alone. First, I would appluad the authors for incorporating a cost-effectiveness analysis. We need far more consideration of cost versus benefit in the reporting of clinical trials. However, it is completely unclear to me from the report what constituted physical therapy (and I reviewed the full text article). Physical therapy was succinctly described as this:
"The treatment consists of exercise therapy as well as giving information and advice about LRS {sciatica}. Passive methods such as massage and manipulation techniques, or applications such as ultrasound therapy or electrotherapy were not allowed. The treatment protocol was developed in a consensus meeting with participating physical therapists (n=61).
They acted as coaches and guided the patient in order to stimulate return to activity. Both GP and PT interventions were restricted to a maximum of 9 treatments or consultations in the first 6 weeks after randomization."
It is good to see that passive modalities such as ultrasound and electrotherapy were excluded (some of these patients, albeit likely a smaller number, may well have been excellent candidates for manipulation depending on their acuity and other factors). The larger issue is trying to figure out what constituted "exercise therapy". Did patients receive current best evidence for patients with sciatica or general exercise therapy that doesn't consider directional preference? Without more details, clinicians have absolutely no idea what to do with the patient sitting in front of them should they be interested in translating this evidence into practice. Although it's not entirely clear in this study given the few details, treatment in rehabilitation clincial trials is all too often left to the "therapist's discretion", which is typically code for saying that therapists did whatever they felt best. This invariably mitigates potential treatment effects and dilutes the the study's statistical power. Researchers should examine the efficacy of more controlled protocols first by constraining therapist’s treatment choices (which was done partially in this case...a good thing), then examine what happens in routine clinical practice when physical therapists actually apply standardized treatment regimens based on current best evidence to the correct patients. In other words, physical therapy should be tested under the same standardized conditions that apply to pharmaceutical trials. That is, you prescribe X mg of Drug X, three times a week…not give them some of Drug X as you see fit....which has been a recipe for disaster when it comes to understanding the effectiveness of the nebulous term "physical therapy".
It is always encouraging to see clinical benefits of physical therapy reported in clinical trials, and I applaud the authors for doing much right. However, my hunch is that the cost-effectiveness analysis might have been more favorable if sub-grouping was considered in the decision-making process. Perhaps one of the authors might be interested in responding. I would be very curious to know what "exercise therapy" was actually delivered and whether it was sufficiently standardized to permit replication.
John
