MyPhysicalTherapySpace.com - A part of the 1T - the "One Thing" you need for PT practice.

Manage What You Measure

Measurement is the cornerstone of evaluation. In Healthcare, objective metrics help us assess treatment protocols and relative outcomes.  From this process we establish standards that serve as guidelines to help us recognize shortfalls in a procedure and make necessary changes.  Measurement guides our decision-making and provides benchmarks for optimal outcomes. 

Performance measures give providers a way to assess themselves as well as their patients. In a recent article entitled The ABCs of Measurement, the National Quality Forum (NQF) discusses the use of performance measures in evaluating optimal care and how they can improve quality and safety for patients (1).  The NQF offers guidelines, derived from providers and patients, that health professionals should incorporate into their care regimens.  This allows for a standardized, yet comprehensive review of the system and incorporates every endpoint of care.  “Measures light the way, showing where systems are breaking down and where they are succeeding to help patients get and stay well” (1).

Further, measurement drives improvement, informs consumers and influences payment (1).  Measures drive improvement through review of processes and adjustment of care. One example of this can be seen in physical therapy practices, ongoing measurement of a patient’s strength, range of motion and functional ability allow a physical therapist to evaluate effectiveness of treatment being applied and make necessary adjustments to subsequent treatment. Measures educate consumers, allowing them to better understand their condition, assess the quality of care being provided make informed decisions.  Finally, measures also allow payors to accurately and fairly evaluate caregivers and patient progress.

What are the key components of measurement? Communication and monitoring. A continuous feedback loop where patients and providers can actively engage ensures improvement in quality of care. This also allows patients to report errors and potential mishaps in their care.  For example, North Shore-Long Island Jewish Hospital uses performance measures of patient care and public reporting of results (1).  A database has been created to track all patient feedback, which is then used to prioritize improvement initiatives.  Communication ensures that patients “get better and stay better.”  A rural hospital in northern California’s Humboldt County has significantly improved outcomes through new models of patient monitoring. The hospital discovered, through measurement, that patients needed “more follow up: more education, more explicit linking back to primary care, and more help managing their chronic conditions” (1). 

Clinics leverage technology to become better informed. The NQF endorses wider use of electronic health records (EHRs) suggesting that, “EHRs will also make measurement and performance data available on a real-time basis, making healthcare much more responsive to patient needs.”

So how do we apply health care measurement in physical therapy?  What tools do we have at our disposal to document patient performance and drive better care?  Best practices dictate that we start the rehabilitation process by gathering baseline data against a set of standardized objective scales i.e. strength, range of motion and balance. Ongoing tracking of these metrics keep therapists and patients focused on specific, measurable goals. Engaging the patient in this process will allow providers to constantly re-evaluate care and make necessary adjustments. Available technology like the FORCE TherEx platform facilitates a continuous feedback loop between patient and provider. The NQF has made it a priority to endorse the use of performance measures to improve the healthcare system and it is imperative that we apply these standards the arena of physical therapy; “Measures can best succeed when they are backed by all involved in healthcare, reported to the public, and used for continuous improvement.” 

In the wellness arena, measurement devices and applications like ‘fitbit’ and ‘runkeeper’ have demonstrated traction with consumers. It seems that people manage what they measure, in which case, including patients in monitoring their physical progress should improve their participation in rehab programs and their resultant outcomes.

Resources

1. Robert Wood Johnson Foundation (RWJF). 2010 . The ABCs of Measurement, National Quality Forum, www.qualityforum.org/Measuring_Performance/ABCs_of_Measurement.aspx.

Authored by Bronwyn Spira, PT. Bronwyn Spira is Founder and President of Force Therapeutics, a web-based comprehensive patient management solution for physical therapists. She owns a private practice in New York City where she treats orthopedic and sports injured patients. Bronwyn can be reached at bronwyn@forcetherapeutics.com. Force Therapeutics can be found at www.forcetherex.com.

Avoiding the Breach: Is our patient data really protected?

Electronic 
health 
records
 (EHRs) 
are 
the 
future
 of 
the
 provider‐patient
 relationship.

 As 
the
 storage,

retrieval
 and
 sharing 
of 
information 
via 
EHR 
accelerates, 
providers 
benefit
 from
 the 
most 
accurate
 and

up‐to‐date 
information 
available.

 The 
delivery 
of 
care 
is 
optimized 
through 
these
 systems
 giving

providers 
the 
information 
necessary 
to 
make 
the 
most 
effective 
clinical 
decisions
 for 
their 
patients.

The
 issue
 of 
patient 
security 
is 
an 
ongoing
 concern.
 Privacy 
of 
our 
medical
 data 
is 
one 
of 
the

cornerstones 
of 
our
 healthcare 
system. 

This 
code
 of 
confidentiality 
empowers 
patients 
to 
share
 critical

information 
with 
providers 
and, 
in
 turn, 
allows 
them
 to 
make 
the 
most 
appropriate 
diagnosis 
and 
plan

of
 care 
necessary. 

In 
a
 recent 
blog 
entitled Living 
on 
a 
Cloud, 
we 
discussed 
how
 physical
 therapists 
are

beginning 
to 
embrace 
‘cloud
 computing’ 
as 
the 
new 
standard
 for 
accessing 
patient 
information 
any
time

and
 anywhere
 without 
having
 to 
purchase 
a 
server, 
upload 
a 
program 
or 
even 
back
 up 
their 
information.


We 
emphasized 
that 
these 
services
 must 
provide
 Health 
Insurance
 Portability 
and
 Accountability 
Act

(HIPAA) 
compliant
 user 
logins 
to 
ensure
 patient‐therapist 
confidentiality 
and
 should 
be 
SSL
 encrypted
 to

the 
level 
required 
by 
CMS
 guidelines.

So, 
just 
as 
with 
our 
financial 
information 
we 
must 
ask 
the 
same
 questions 
concerning 
our 
patient 
data:


Is 
this 
data 
vulnerable 
to 
internet 
attacks 
and
 security 
breaches?
 
What 
precautions 
are 
providers 
taking

to 
avoid
 these 
issues?

So
 here 
are 
some
 facts 
on
 EHR
 security.
 A
 recent
 study
 conducted 
by 
the 
consulting 
firm,
 Software

Advice,
 found 
that
 security
 breaches 
of 
patient
 data 
through
 internet 
hacking 
only 
account 
for 
a 
small

percentage
 (6%) 
of 
HIPAA 
violations 
(2,
3). 

A 
majority 
(63%) 
actually 
came
 from
 physical
 theft 
and

unauthorized 
access
or 
disclosure 
(16%). 

Of 
EHR
 violations,
 all 
involved
 on‐premise 
violations 
as

opposed
 to 
‘cloud
 based’
 breaches. 

The 
author 
of 
the
 study
 points 
out 
that,
 “HIPAA
 violations 
aren’t

happening 
in 
the 
cloud, 
rather, 
they’re 
happening
 in 
the 
doctor’s 
office,
 hospital 
IT 
closets,
 cars,

subways, 
and 
homes.”

In
 order 
to 
continue
 the
 safety
 of 
patient
 data,
 providers 
need 
to 
take 
precautions 
to 
comply 
with 
HIPAA

Privacy, 
Security, 
and 
Breach
 Notification
 Rules 
(1).
 

These
 include:

• Ensuring
 that 
any 
disclosure 
of 
patient
 information 
comply
 with 
HIPAA
 Privacy
 Rule

• Ensure
 the
 service 
performs 
a 
HIPAA
 Security
 Rule
 risk
 analysis 
indentifying
 potential 
threats

and
 vulnerabilities 
to 
protected
 health
 information

• Ensure 
that
 service 
conforms
 to 
the 
HIPAA 
Breach 
Notification 
Rule 
which
 requires
 the
 reporting

of
 breaches 
of 
protected 
health
 information

It 
is 
clear 
that 
EHRs
 can 
enhance
 the 
quality 
of 
patient 
care 
and 
that 
taking 
the 
necessary
 precautions
 to

protect 
privacy 
is 
a 
crucial
 step
 to 
ensure
 that 
our 
health care 
system
 moves 
closer 
to 
a 
paperless

practice 
model.

Resources
1.

Dolan,
 B. 
2011. 
Mobile 
Health:
 How
 to 
Comply
 with 
HIPAA, 
mobihealthnews,

http://mobihealthnews.com/11272/mobile‐health‐how‐to‐comply‐with‐hipaa/.

2.

Koploy,
 M. 
2011. 
HHS
 Data 
Tells 
the
 True 
Story 
of 
HIPAA
 Violations 
in 
the 
Cloud,

http://www.softwareadvice.com/articles/medical/hipaa‐violations‐arent‐in‐the‐cloud‐
1062011/#ixzz1TYEUKe4G.


3.

Simmons,
 J. 
2011. 
Can
 'clouds' 
protect 
patient 
data
 from
 security 
breaches?, 
Fierce EMR,

http://www.fierceemr.com/story/can‐clouds‐protect‐patient‐data‐security‐breaches/2011‐06‐23.


This 
guest 
post
 was
 co‐authored
 by 
Bronwyn
 Spira, 
P.T., 
President
 of 
Force 
Therapeutics 
and 
Mark
Anthony 
Fields, 
Ph.D., 
M.P.H. 


Force 
Therapeutics
 can
 be 
found
 at 
www.forcetherapeutics.com,
www.facebook.com/forcetherapeutics, 
or 
www.twitter.com/ForceTherEx.

What's the Single Best Exercise?

Dear New York Times Magazine:

I am a huge fan of your magazine.  In fact, reading it is part of my Sunday ritual.  I was particularly excited a few weeks ago about your Health and Wellness 2011 edition.   I immediately went to Gretchen Reynolds' short  article entitled:  What's the Single Best Exercise? After reading it, I have a much better answer than the multinational experts you asked, including the MD, PhD dude.

A great point was made ...ask a dozen physiologists which exercise is the best and you'll get a dozen wildly divergent replies...  This reminded me that if you asked a bunch of morbidly obese folks what's their favorite snack, you would also likely get "wildly divergent replies" as well.    I thought about implementing the experts advice in one of our physical therapy clinics the next day.   Wonder if 68 year old Granny would have obliged the kinesiology experts advice to do the "old fashioned burpee"? I don't think the problem would be her lack of "enjoying it" or "sticking to it for long" and I would highly doubt that it would do the reported job of building muscles or endurance.  I wonder how high she would have been able to "leap" after she was instructed to  "pull your feet back in" after she dropped to the ground and got her "feet out behind".

It was impressive that you cited the meta-analysis of walking briskly for 30 minutes' impact in decreasing premature death by 20%.  Unfortunately, sedentary people don't read many meta-analyses.  In fact, without clear examination and appropriate heart monitoring the advise for an initial "brisk walk" might just get these folks the statistic that you don't want.

I am also confident that Dr. Phillips, the professor of kineseology at McMaster, is a hoot at parties where he tells folks to do "the squat" because of its simplicity.  Gibala's high-intensity interval training (H.I.T.) suggestion, particularly the sound adage that to be "effective H.I.T. must hurt" affirms my confidence in a  long, steady pipleline of  future patients in an orthopedic physical therapy clinic.  It is apparent that a lot of folks doing Insanity, plyometrics, and the newly revolutionized Jazzercise appear to be followers of those experts.

The real answer is of course no answer or the proverbial "it depends".   The best answer to what is the single best exercise question would be for the patient to access their personal physical therapist who can examine and provide a customized exercise prescription including appropriate monitoring, goals, and instruction in technique.

But, that would have been too short of an article.

larry@physicaltherapist.com

Any other answers to "What's the Single Best Exercise?"

 

 

 

 

 

EIM is excited to announce a new Executive Program in Private Practice Management with optional tDPT Cohort!

40 students from 20 different states kicked off their program in Louisville, Kentucky this month.  Four of this cohort's students are the second or third in their practice to participate in the Executive Program.  EIM's Executive Program enhances the business intelligence and savvy of owners/managers in private practice with practical applications to provide a competitive advantage in the marketplace.  Click here for program details. 

"In today's ever changing healthcare environment with declining reimbursement we found our practice after 9 years on the edge of disaster. Referrals had declined, we were locked into two low paying contracts and our office morale was at an all time low. Using the tools and techniques learned in the EPPM Executive Program has allowed us to essentially restructure our business; we have eliminated our low paying contracts, our marketing efforts have increased our referrals, our net revenues and profits have increased. We are back to numbers of visits we have not seen for some time. Our staff now takes an active role in providing input and direction of our practice and as active participants morale in the clinic has dramatically changed.  Our business is back on the right track and growing again." - Bob Bacci (EIM Executive Program with optional Transition DPT graduate)

To date, a total of 75 have completed the program and, including the new cohort, 72 are currently enrolled.  Interested in the program too?   Apply today for a head start on clinical courses beginning in July.  Email info@eimpt.com for more information.

Emergency Response Course offered by EIM!

Hello!

EIM’s Emergency Response Course for PTs, taught by me, Teresa Schuemann, starts on February 14, 2011.  This course is a pre-requisite for the EIM Sports PT Residency Program and Emergency Response Course participants will receive a Sports Residency application fee waiver.  However, all therapists are welcome to enroll in the Emergency Response Course. 

This course integrates the objectives set forth by the American Red Cross and the Department of Transportation for Emergency Response and is designed specifically for the physical therapist seeking to provide athletic venue coverage and respond appropriately to acute injury.  The class includes instruction and discussion of assessment, management and prevention of cardio-respiratory emergencies, musculoskeletal injury, environmental injuries and medical emergencies such as shock or diabetic reactions, brain injury and spinal injury.    An intensive laboratory weekend is included on March 26-27, 2011. The Emergency Response Course fulfills the requirements for a physical therapist to be eligible for Sports Physical Therapy Residency Programs and submission of application for the ABPTS- SCS examination.   

Successful completion of both written and practical examinations will be required for this course.  The final practical examination will include successful completion of the following: bleeding control and shock management, trauma victim assessment and management, airway insertion and suction, management of injuries to soft tissue and skeletal structures and management of head, neck and back injuries.  Following successful completion of the course, the participant will be awarded a First Responder Certification (good for 3 years) and a CPR/AED usage for the Professional Rescuer Certification (good for 2 years).

Keep in mind that Sports Section of the APTA members get a $100 discount (make sure to enter discount code “APTA” during checkout to receive this discount.)  And remember, the online portion starts on February 14, 2011 and the on-site portion of the course is on March 26-27, 2011, so register now!

I’ll be at the APTA Combined Sections Meeting and you are invited to an EIM “Meet and Greet” in the Magnolia Room at the Hilton Riverside Hotel in News Orleans on Thursday, February 10, 2011 at 7:30pm.  Make sure to stop by and I can answer any questions you have about the Emergency Response Course or the Sports PT Residency.

Thanks!  Teresa Schuemann

 

Hip hurt? Eat More Meat!

At least according to this recent study entitled “Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study” that was recently published in BMC Musculoskeletal Disorders. It turns out that regardless of what is happening to your cardiovascular system, there is emerging evidence for a beneficial effect of meat consumption on the musculoskeletal system.

These authors performed a prospective cohort study that included 35,331 Australians and examined the relationship between meat consumption and risk of primary hip and knee replacement for osteoarthritis as evidenced by total joint replacement of the same. They found that was a negative dose-response relationship between high levels of fresh red meat consumption and the risk of hip replacement (but not knee replacement but hey, we ardent carnivores will take what we can get).

Now we can not only feel good about having a glass of red wine, our morning coffee, and satisfying our chocolate craving, but we can also fire up the grill and offer up a toast to that mound of fresh red meat that many of us love to eat! Notice I said “feel good” because a high level of confidence that our health is necessarily better off from any of these things just isn’t there, but they do make life richer for many of us.

Isn’t it interesting what you can find in the literature? I think the only way one comes across these kind of headlines is to either: a. be so head-down buried into a certain topic that you pursue the nuances and intricacies of your particular niche topic; b. read a blog related to health issues like this one; or c. have a push-information system like Evidence Express that puts this kind of information along with other more relevant research findings directly and automatically in your mail-box on a regular basis.

Hope your weekend is good……keep your grill hot.

Rob

EIM and FOTO Meet and Greet at CSM!

You're invited!  Evidence In Motion and Focus On Therapeutic Outcomes are hosting a meet and greet at the  APTA Combined Sections Meeting in February 2011.  

 

Please join us in the Magnolia Room at the Hilton Riverside Hotel in News Orleans on Thursday, February 10, 2011 at 7:30pm for light appetizers, drinks & mingling. 

 Rob Wainner, Tim Flynn, Larry Benz, and George Burkley from EIM and Al Amato and Judy Holder from FOTO will be in attendance to answer questions you have about EIM and FOTO offerings.

Questions?  Email Brooke@physicaltherapist.com

Special thanks to the reception co-sponsor, Focus On Therapeutic Outcomes (FOTO)!   

FOTO is an outcomes data collection and reporting service that provides risk-adjusted, nationally benchmarked measures of treatment effectiveness, treatment efficiency, and patient satisfaction.  FOTO’s Functional Status Measures are also included in the Physician Quality Reporting System and FOTO is an approved Data Registry for that program.  FOTO is proud to partner with Evidence in Motion to provide functional outcomes for its Residency and Fellowship programs.  

Note: EIM will be recognizing all Residency, Fellowship & Executive Program 2010 graduates and faculty from 6:30-7:30.  Email Brooke@physicaltherapist.com for more details about this portion of the event.

Manipalooza 2011 Registration is Now Open!!

Make sure to register ASAP for Manipalooza 2011- spots are limited!  Manipalooza is a 4 day festival of hands on learning in spinal and extremity joint manipulation, mobilization with movement procedures, instrumented and non-instrumented soft tissue techniques & pain management strategies.  This year included updated content, speakers, music, and more!  You will learn the most cutting edge techniques from experts in the PT field.  It will be held at the University of Colorado on May 21-24, 2011.  Click here to view a video with more details about the event and to register.

Everyone who attended last year's Manipalooza had nothing but wonderful things to say:

"I have attended very few continuing education courses that I can say have changed the way I treat...  This course has changed the way I treat!"

“I first want to say what an amazing conference you guys put on.  I have to say in 9 years of being a PT and attending different courses this was the BEST one I have been to.  You guys know how to do it right.  I had so much fun and learned so much this course has and will continue to change how I practice as I continue to do whatever I can to help the people I work with...”

“Thank you to all of the EIM instructors who were so incredibly helpful at Manipalooza-it was worth every minute, I am using the skills I gained with my patients today, on my first day back. Manipalooza changed my life, my practice and ultimately, will improve my patient outcomes. EIM-Thank you, thank you, thank you!!”

"With all the different philosophies and theories behind manipulation (many of which seem to contradict each other), I had found the subject a little overwhelming and confusing.  For this reason, I never felt comfortable or confident enough to use these types of techniques in the clinic for fear that I might do the wrong technique, or do the patient harm.  I came to Manipaloosa hoping that the course would simplify things for me, and separate what the evidence shows, from what is just theory and speculation.  This course far exceeded my expectations!  From the simple, evidence based instruction, to the one on one attention during the labs, I now feel confident in my ability to use the very effective techniques I have learned in this course to better my patient care."

And the 3rd Annual Elevator Pitch Winners are....

   

1st Place: Amy Lee from Physical Therapy Central

 

2nd Place: Jonathan Weber & Denver Lancaster from Regis Univeristy

 

3rd Place: Kristen Martin from Texas State University

We had many great submissions this year and thank every PT and PT student who participated!
Thanks,
Larry

Sports Residency Webinar with Teresa Schuemann

 

• Where is the sports PT profession really going?

 

• Does it  matter if I get Sports Residency training?

 

• What exactly is a Sports Residency?

Join Teresa Schuemann, EIM Sports Residency Program Director, on December 13, 2010 at 7pm CT for  answers on how you can make an impact on the PT profession & jump start your career with a Sports Residency Program.

Click here to reserve your webinar seat now.  After registering you will receive a confirmation email with info about joining the webinar.

Questions? Contact EIM at info@eimpt.com