How Physical Therapists Can Thrive Under Health Care

Pow hvslcal 1heraplsLs Can
1hrlve under PealLh Care 8eform

AuausL 2021 2011
Crlando llorlda
1lm 8lchardson 1
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1he llorlda hvslcal 1heraplsLs ln rlvaLe racLlce (lL1) presenLs
uownloadable sllde show aL
hLLp//www8ulleLproof1com
1
2
1he llorlda hvslcal 1heraplsLs ln rlvaLe racLlce (lL1) presenLs
Armln Loaes 1
Chrls Mulvev 1
1lm 8lchardson 1
ulane ParLelv 1
Lrlc uoualass 1
8oberL uraaan 1
SLephen 1rlnque 1
1om Zeller 1
1rlcla 1rlnque 1
Can We uo 8eLLer?
47 mllllon unlnsured Amerlcans
Amerlca spends more Lhan anv oLher counLrv ln Lhe
worlds almosL 17 of Cross uomesLlc roducL (Cu) on
healLhcare
8uL Amerlca ranks #37 ln CuallLv and lalrness accordlna
Lo Lhe World PealLh CraanlzaLlon (WPC)
Cllck Lhe llnk for Lhe 2008 8S lronLllne documenLarv 5lck
AtoooJ 1be wotlJ
3
Can We uo 8eLLer?
4
Can We uo 8eLLer?
3
Can We uo 8eLLer?
6
WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
1he Shared Savlnas roaram ls deslaned Lo lmprove beneflclarv ouLcomes and
lncrease value of care bv
romoLlna accounLablllLv for Lhe care of |nd|v|dua| Medlcare feefor
servlce beneflclarles
8equlrlna coordlnaLed care for all servlces provlded to a popu|at|on of
peop|e under Medlcare leelorServlce
Lncouraalna lnvesLmenL ln lnfrasLrucLure and redeslaned care processes
|n order to reduce the percap|ta cost of hea|thcare
Lllalble provlders hosplLals and suppllers mav parLlclpaLe ln Lhe Shared Savlnas
roaram bv creaLlna or [olnlna an AccounLable Care CraanlzaLlon also called an
ACC 1he ACC ls expecLed Lo LranslLlon Lo populaLlonbased pavmenL
arranaemenLs
7
CraanlzaLlon (ACC)?
SecLlon 3022 of Lhe Affordable Care AcL LhaL was slaned lnLo law bv resldenL 8arack
Cbama on March 23 2010 requlres Lhe CenLers for Medlcare and Medlcald Servlces
(CMS) Lo esLabllsh a Shared Savlnas roaram Lo faclllLaLe coordlnaLlon and
cooperaLlon amona provlders Lo lmprove Lhe quallLv of care for Medlcare feefor
servlce beneflclarles and reduce unnecessarv cosLs
8
ACC CuallLv Measures
9
10
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13
CMS ls proposlna Lo deflne Lhe flrsL quallLv performance perlod as bealnnlna !anuarv
1 2012 and endlna uecember 31 2012
lor Lhe flrsL vear of Lhe Shared Savlnas roaram CMS proposes Lo seL Lhe quallLv
performance sLandard f be tepotloo level
16
CraanlzaLlon (ACC)?
1he hvslclan Croup racLlce (C) uemonsLraLlon was Lhe flrsL pavfor
performance lnlLlaLlve for phvslclans under Lhe Medlcare proaram
1 8llllnas Cllnlc 8llllnas MonLana
2 uarLmouLhPlLchcock Cllnlc 8edford new Pampshlre
3 1he LvereLL Cllnlc LvereLL WashlnaLon
4 lorsvLh Medlcal Croup WlnsLonSalem norLh Carollna
3 Celslnaer PealLh SvsLem uanvllle ennsvlvanla
6 Marshfleld Cllnlc Marshfleld Wlsconsln
7 Mlddlesex PealLh SvsLem MlddleLown ConnecLlcuL
8 ark nlcolleL PealLh Servlces SL Louls ark MlnnesoLa
9 SL !ohn's PealLh SvsLem Sprlnafleld Mlssourl
10 unlverslLv of Mlchlaan laculLv Croup racLlce Ann Arbor Mlchlaan
17
CraanlzaLlon (ACC)?
1here are Lhree prlmarv wavs for an ACC Lo achleve
savlnas on Lhe care of Lhe asslaned Medlcare populaLlon
1 8educlna emeraencv room vlslLs and hosplLal lnpaLlenL
admlsslons
2 8educlna Lhe provlslon of speclalLv care for Lhe
asslaned Medlcare paLlenL populaLlon
3 8educlna Lhe provlslon of lmaalna and oLher speclal
LesLs
18
CraanlzaLlon (ACC)?
9revent|ng Avo|dab|e nosp|ta| keadm|ss|ons
revenLable readmlsslons can occur because
of
nadequaLe dlscharae plannlna
nadequaLe posLdlscharae followup
Lack of coordlnaLlon beLween lnpaLlenL and
ouLpaLlenL healLhcare Leams
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CraanlzaLlon (ACC)?
SmlLh eL al reporLed on Lhe dlscharae recommendaLlons of 40 phvslcal
LheraplsLs LreaLlna 762 paLlenLs aL a larae acuLe care hosplLal SmlLh
wanLed Lo see how ofLen Lhe LheraplsLs' recommendaLlons were followed
1he LheraplsLs' dlscharae recommendaLlons were followed 83 of Lhe Llme
1here was a mlsmaLch ln 1 recommendaLlon and paLlenL dlscharae
locaLlon ln 124 of 743 cases
When Lhe LheraplsLs' recommendaLlons were nC1 followed Lhe paLlenLs
were 29 Llmes MC8L llkelv Lo be readmlLLed Lhan when Lhe
recommendaLlons were followed
1he hosplLal had an 18 30dav readmlsslon raLe whlch ls conslsLenL wlLh
Lhe llLeraLure
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CraanlzaLlon (ACC)?
pec|a||st Costs
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CraanlzaLlon (ACC)?
CveruLlllzaLlon of CA1 scans
uouble bllllna Lhe Medlcare proaram
mag|ng Costs
22
ntervent|on ke|mbursement kange of Lst|mated Charges
Lumbar splne radloaraphv $30
$204286 (ln neLwork)
$404363 (ouL of neLwork)
Lumbar splne compuLed
Lomoaraphv
$381 (wlLhouL conLrasL)
$439 (wlLh conLrasL)
Lumbar splne maaneLlc
resonance lmaalna
$713 (wlLhouL conLrasL)
$863 (wlLh conLrasL)
CraanlzaLlon (ACC)?
mag|ng Costs
23
CraanlzaLlon (ACC)?
24
CraanlzaLlon (ACC)?
23
CraanlzaLlon (ACC)?
8lsk 8eward
26
Pow Lo Manaae a aLlenL opulaLlon
27
9opu|at|on hea|th has been deflned as #be beflb oocomes of f otoop of loJlvlJofls
locloJloo be Jlstlboloo of socb oocomes wlblo be otoop
L ls an approach Lo healLh LhaL alms Lo lmprove Lhe healLh of an enLlre populaLlon
Cne ma[or sLep ln achlevlna Lhls alm ls Lo reduce healLh lnequlLles amona populaLlon aroups
opulaLlon healLh seeks Lo sLep bevond Lhe lndlvlduallevel focus of
malnsLream medlclne and publlc healLh bv addresslna a broad ranae of facLors LhaL lmpacL
healLh on a populaLlonlevel such as envlronmenL soclal sLrucLure resource dlsLrlbuLlon
eLc
An lmporLanL Lheme ln populaLlon healLh ls lmporLance of soclal deLermlnanLs of healLh and
Lhe relaLlvelv mlnor lmpacL LhaL medlclne and healLhcare have on lmprovlna healLh overall
lrom a populaLlon healLh perspecLlve healLh has been deflned noL slmplv as a sLaLe free
from dlsease buL as be cfpfcl of people o fJfp o tespooJ o ot cootol llfes
cbflleooes foJ cbfooes
28
|agnos|s
1he process Lhe cllnlclan uses Lo move proaresslvelv from a realon
of low cllnlcal cerLalnLv Lo a realon of hlah cllnlcal cerLalnLv
n low probablllLv condlLlons screenlna LesLs are used Lo aeneraLe
dlaanosLlc posslblllLles and Lo rule ouL" lmprobable condlLlons
n hlah probablllLv condlLlons dlaanosLlc LesLs are used Lo conflrm
or rule ln" llkelv condlLlons
8oLh LesLlna and LreaLmenL carrv rlsk
29
30
now Are 9hys|ca| 1herap|sts Mak|ng |agnoses?
Self8aLed and hvslcal CharacLerlsLlcs
1reaLmenL 8ased ClasslflcaLlon
aLholoalcal CondlLlons
svchoSoclal CondlLlons
31
e|f kated and 9hys|ca| Character|st|cs 9reva|ence
lalr" or oor" selfraLed healLh 44
Chronlc uepresslon ln AdulLs 67
Cenerallzed AnxleLv ln AdulLs 181
usual CalL Speed 042m/s 23
8apld CalL Speed 037m/s 23
1hree Chalr SquaLs 10sec 24
Anv alcohol use 62
3 medlcaLlons 33
32
Cu
SAu
33
1reatment 8ased C|ass|f|cat|on 9reva|ence
ManlpulaLlon for L8 Croup 33 43
SLablllzaLlon for L8 Croup 8 72
Lumbar 1racLlon for L8 Croup 9 24
ulrecLlonal reference for L8 Croup 18 43
1horaclc ManlpulaLlon for neck aln 34
1horaclc ManlpulaLlon for Arm aln 61
MoblllzaLlon for LaLeral Ankle Spraln 73
Plp !olnL MoblllzaLlon for AnLerlor knee aln 68
34
9atho|ogy 9reva|ence
Ankle lracLure followlna 1rauma 13
knee lracLure followlna 1rauma 6
ueep veln 1hrombosls ln posLsuralcal paLlenLs varles
Carpal 1unnel Svndrome ln paLlenL wlLh wrlsL paln/numbness 34
Splnal lracLure followlna 1rauma ln Clder eople 03 30
CommunlLv Acqulred neumonla (CA) 2 8
AcuLe SLroke ln ulzzv aLlenLs ln Lhe Lmeraencv SeLLlna 23
Plp !olnL MoblllzaLlon for AnLerlor knee aln 68
33
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
1emperaLure 10004
o
ulse 100bpm
Crackles/8ales on ausculLaLlon
uecreased breaLh sounds on ausculLaLlon
no asLhma
1he cllnlclan asslans one polnL for each of Lhe flndlnas
LhaL ls pteseo
C||n|ca| ec|s|on ku|es
36
revalence of neumonla ln rlmarv Care 2
now many var|ab|es are present?
0 presenL 2 llkelv
1 presenL 3 llkelv
2 presenL 11 llkelv
3 presenL 22 llkelv
4 presenL 33 llkelv
3 presenL 73 llkelv
37
revalence of neumonla ln Lhe Lmeraencv seLLlna 8
now many var|ab|es are present?
01 presenL 8 llkelv
23 presenL 27 llkelv
4 presenL 69 llkelv
3 presenL 100 llkelv
38
39
Luna Sounds normal
Luna Sounds Crackles/8ales
Luna Sounds Wheezlna
40
nd|v|dua| I|nd|ngs 9os|t|ve L|ke||hood
kat|o (+Lk%
-egat|ve L|ke||hood
kat|o (Lk%
uecreased 8reaLh Sounds 37 07
Wheezlna 38 066
8honchl 39 093
9neumon|a ec|s|on ku|e 9os|t|ve L|ke||hood
kat|o (+Lk%
-egat|ve L|ke||hood
kat|o (Lk%
0 or 1 flndlnas 03
2 or 3 flndlnas
4 or 3 flndlnas 82
compared wlLh
41
uerlve Sn Sp +L8 L8 wlLh a 2x2 Lable
need neumonla numbers
42
McGee's 8eds|de Lst|mates
L|ke||hood kat|o Lst|mated 9robab|||ty h|ft
01 43
02 30
03 23
04 20
03 13
1 no chanae
2 +13
3 +20
4 +23
3 +30
6 +33
7
8 +40
9
10 + 43
43
44
Pow hvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
Lxerclse ls aenerallv nC1 harmful ower Lralnlna
ncreased selfdlrecLed acLlvlLv ls essenLlal Lo
reduclna dlsablllLv
romoLe acLlvlLv walklna voaa runnlna llfLlna
reslsLance proarams Zumba llaLes aardenlna
aolf flshlna
43
8eLLer CuLcomes
PurL Parm IA8 8eference?
LmoLlonal/MenLal facLors mav drlve 3033 of
musculoskeleLal ouLcomes lear Avoldance
8ehavlors %lok o lfttfb lfwcee xetclse bft)
8ehavloral Lralnlna more lmporLanL Lhan
CoanlLlve Lralnlna
46
8eLLer CuLcomes
maae of dlsclalmer
47
8eLLer CuLcomes
AdequaLe phvslcal acLlvlLv ls llnked wlLh lmporLanL healLh
ouLcomes
8educed cardlovascular dlsease
1vpe 2 dlabeLes
Some cancers
luLure falls rlsk
CsLeoporoLlc fracLures
uepresslon
hvslcal funcLlon scores on sLandardlzed self reporL
measures
48
8ehav|or Change Assumpt|ons
LducaLlon
knowledae
8ehavlor Chanae
8eLLer CuLcomes
49
8eLLer CuLcomes
8ehavloral lnLervenLlons MC8L effecLlve Lhan
educaLlonal lnLervenLlons
Coal seLLlna/conLracLlna
SelfmonlLorlna (aln scales/luncLlonal Scales
ueuscher sLudv)
leedback
Consequences/rewards
Lxerclse prescrlpLlon
Cues
30
8eLLer CuLcomes
Goa|s
uo slnale lea sLandlna x 30sec Lhree Llmes per dav
Lo lmprove balance
Cues
llrsL Lhlna ln Lhe mornlna do slnale lea sLandlna x
30sec ln Lhe klLchen whlle Lhe coffee percolaLes
31
8eLLer CuLcomes
LducaLlonal/coanlLlve lnLervenLlons LLSS effecLlve aL
promoLlna phvslcal acLlvlLv
1araeLlna knowledae aLLlLudes or bellefs
Mass medla (vs lndlvlduallzed lnsLrucLlon)
1ralnLheLralner models (vs sLaff provldlna
lnLervenLlons dlrecLlv Lo paLlenLs)
dlosvncraLlc provlder lnLervenLlons (vs sLandardlzed
recommendaLlons)
32
8eLLer CuLcomes
#Med|ca| 1heater"
8eal LreaLmenL effecLs/ouLcomes due Lo some
aspecL of Lhe medlcal lnLervenLlon oLher Lhan Lhe
phvsloloalc effecL nC1 a placebo!
#A plfcebo ls f sobsfoce ot
ptoceJotebf ls objeclvel wlboo
speclflc fclvl fot be cooJlloo beloo
tefeJ
33
8eLLer CuLcomes
Jhat dr|ves outcomes |n add|t|on to the |ntended
treatment?
uress 1he whlLe coasL and sLeLhoscope
Lanauaae Medlcal [araon based ln LaLln
ulaanosls and LxpecLaLlon 1he effecL on funcLlonal sLaLus
over Llme of a dlaanosls of dlsc deaeneraLlon"
CosL More cosLlv medlcal LreaLmenLs have a hlaher cosL
and a hlaher percelved beneflL
Color 8lue plll vs 8ed plll sLudv bv 8lackwell
34
8eLLer CuLcomes
#Med|ca| 1heater"
AlbuLerol vs Sham AcupuncLure for AsLhma (2011)
8randed Analaeslcs for Peadache (1981)
8ed plll vs 8lue lll for Mood AlLeraLlon (1972)
nLernal Mammarv ArLerv LlaaLlon for ChesL aln
(1939 1960)
33
8eLLer CuLcomes
#Med|ca| 1heater"
36
8eLLer CuLcomes
#Med|ca| 1heater"
37
8eLLer CuLcomes
#Med|ca| 1heater"
38
8eLLer CuLcomes
#Med|ca| 1heater"
39
8eLLer CuLcomes
nea|th Coach|ng
PoLspoLs bv ALul Cawande Mu feaLurlna
!effrev 8renner Mu
new ?orker maaazlne arLlcle
lronLllne PoLspoLLers" vldeo
60
8eLLer CuLcomes
1he Slx Sources of nfluence
61
62
8eLLer CuLcomes
Pow Lo ersuade vour aLlenL
SLone eL al aLLempLed Lo chanae colleae sLudenL sexual
proLecLlon behavlor
LecLured Lhe sLudenLs #Dse cooJoms! dldn'L work
Pad colleae sLudenLs make an educaLlonal vldeo Lo Leach hlah
school sLudenLs abouL proLecLed sex
1echnlque worked
80 of Lhe colleae sLudenLs bouahL condoms lmmedlaLelv and
Lhe amounL of condoms purchased was areaLer Lhan a conLrol
aroup
1echnlque known as CoanlLlve ulssonance
63
8eLLer CuLcomes
CrlLlcal aLhwavs of Care
SLarbucks/AeLna Saves Monev mproves CuLcomes
64
8eLLer CuLcomes
CosLs and roducLlvlLv
Metr|c Med|an
Charae per vlslL $16426
avmenL per vlslL (SouLh 8ealon) $8318
avmenL per vlslL (naLlonal) $9477
number of paLlenL vlslLs per hour 286
avroll as a percenL of lncome (lncludes Cwner's replacemenL
cosL")
636
number of vlslLs per paLlenL (slnale vlslL paLlenLs exLracLed) 116
Cancel/noshow raLe 112
1lme Lo Cash 40 davs
aver Mlx Medlcare 227
roflL Maraln 142
63
ulsrupLlve nnovaLlon
#1be bosloess moJels of beflb fte ftozeo lo be bosplfl foJ be Jocots offlce 1be
pfb o flxloo be ssem ls o Jlstop bose moJels
ClavLon ChrlsLensen
1he nnovaLor's rescrlpLlon
1here are reallv Lhree buslness model under one roof ln Lhe hosplLal
1 reclslon medlclne LhaL can be koololzeJ 1he aoal ls Lo ldenLlfv areas where
auLomaLlon of repeLlLlve Lasks can lmprove care and save cosLs Lxample 1oLal knee
8eplacemenLs
2 nLulLlve medlclne LhaL requlres hlahlv Lralned speclallsLs uslna cosLlv dlaanosLlc LesLlna
machlnes Lo dlscover Lhe besL LreaLmenL approach Lxample Creaorv Pouse Mu
3 Lmplrlcal medlclne ls Lhe cosLlv Lrlalanderror realm of chronlc dlsease manaaemenL
ChrlsLensen predlcLs an lncrease ln paLlenL auLonomv selfdlaanosls and selfcare
cholces 1he rlse of soclal neLworks wlll feaLure promlnenLlv ln Lhls realm Lxample
CuLpaLlenL hvslcal 1herapv
66
SLrucLured uaLa
SLrucLured daLa ls anoLher wav of referrlna Lo daLa
LhaL ls enLered lnLo a speclflc fleld as opposed Lo free
LexL ln a charL noLe
60 of Lhe narraLlve noLe daLa ls losL Lo Lhe LM8
67
SLrucLured uaLa
68
SLrucLured uaLa
69
SLrucLured uaLa
70
SLrucLured uaLa
71
SLrucLured uaLa
72
SLrucLured uaLa
73
SLrucLured uaLa
74
SLrucLured uaLa
73
76
CACL 8ule for Alcohollsm Screenlna
An esLlmaLed 100 mllllon Amerlcans drlnk alcohol
10 of Lhose who drlnk have alcohol problems LhaL adverselv affecL Lhelr
llves and Lhelr famllles llves
1he morLallLv raLe of Lhose who drlnk 6 or more drlnks per dav ls 30 Lhan
maLched conLrols
Alcohol ls a ma[or facLor ln sulcldes homlcldes vlolenL crlmes and moLor
vehlcle accldenLs
hvslclans are abouL Lo recoanlze wlLhouL declslon alds onlv abouL half of
Lhe problem drlnkers Lhev encounLer
hvslclans are even LLSS llkelv Lo ldenLlfv wlLhouL declslon alds alcohol
problems ln women and elderlv people
ueclslon 8ules
77
1 Pave vou ever felL vou ouahL Lo cut down on vour drlnklna?"
2 Pave people annoyed vou bv crlLlclzlna vour drlnklna?"
3 Pave vou ever felL bad or gu||ty abouL vour drlnklna?"
4 Pave vou ever had a drlnk (eye opener) flrsL Lhlna ln Lhe mornlna Lo sLeadv vour nerves
or aeL rld of a hanaover?"
ueclslon 8ules
78
ueclslon 8ules
CAGL ku|e for creen|ng 9at|ents for A|coho| Abuse
now many #yes" responses? 9robab|||ty h|ft L|ke||hood kat|o
0 presenL 43 013
1 presenL no chanae 13
2 presenL + 23 43
3 presenL + 30 13
ueclslon 8ules
79
n-1 to |agnose troke |n Acute Vest|bu|ar yndrome (verLlao nvsLaamus nausea head
moLlon lnLolerance unsLeadv aalL)
normal PorlzonLal nead mpulse 1esL
-vsLaamus ln dlfferenL aaze poslLlons
1esL of Skew wlLh prlsm crossover LesL of ocular allanmenL
9reva|ence of troke 23 of dlzzv paLlenLs ln Lhe emeraencv seLLlna are experlenclna a
sLroke
Pn1S ls neadmpulse -vsLaamus 1esLofkew
ueclslon 8ules
80
n-1 ec|s|on ku|e for |zzy 9at|ents
now many var|ab|es are present? 9robab|||ty h|ft L|ke||hood kat|o
0 presenL sLroke dlaanosls unllkelv nA
1 presenL +30 chance of a sLroke +L8 23
ueclslon 8ules
uv1 rlsk and prevalence ls lncreaslna
uv1 and ulmonarv Lmbollsm (L) ls #be mos
commoo pteveofble cfose of bosplfl Jefb lo be
DoleJ 5fes
2 mllllon Amerlcans develop uv1s everv vear and
200000 dle of Lhe assoclaLed L
Lach vear over 23000 people ln Lnaland dle from
venous Lhromboembollsm developed ln hosplLal
Screenlna for ueep veln 1hrombosls
81
ueclslon 8ules
9at|ent afety
nd|cator
ear
-umber of
Lvents
1ota|
Cases
Lva|uated
kate
per
1000
Assoc|ated
Morta||ty
change |n
kate (2005
2007%
osLoperaLlve
pulmonarv embollsm
or deep veln
Lhrombosls
2003 43436 3421093 12697 4166
1431
2006 46640 3360843 13877 3942
2007 46764 3216372 14338 3661
2003
2007
136840 9998310 13686 11769
82
ueclslon 8ules
9at|ent Group V1 nc|dence (%
Medical patients 10-26
Major gynecological, urological, or general surgery 1540
Neurosurgery 1540
Stroke 11-75
Hip or knee surgery 40-60
Major trauma 40-80
Spinal cord injury 60-80
Critical care patients 15-80
83
AcLlve cancer?
8edrldden recenLlv 3 davs or ma[or suraerv wlLhln four weeks?
Calf swelllna 3cm compared Lo Lhe oLher lea?
CollaLeral (nonvarlcose) superflclal velns presenL?
LnLlre lea swollen?
Locallzed Lenderness alona Lhe deep venous svsLem?
lLLlna edema areaLer ln Lhe svmpLomaLlc lea?
aralvsls paresls or recenL plasLer lmmoblllzaLlon of Lhe lower exLremlLv
revlouslv documenLed uv1?
AlLernaLlve dlaanosls Lo uv1 as llkelv or more llkelv?
84
ueclslon 8ules
Screenlna for ueep veln 1hrombosls (uv1)
83
-umber of 9os|t|ve I|nd|ngs k|sk C|ass|f|cat|on L|ke||hood of V1
1 pL Low rlsk 3
12 pLs Medlum 8lsk 17
2 pLs Plah rlsk 73
ueclslon 8ules
Screenlna for ueep veln 1hrombosls (uv1)
1esL CuesLlon #o oo belleve bf oo sboolJ oo Jo fo
fclvlles bf mfke oot pflo wotse?
kesponse L|ke||hood rat|o 9robab|||ty h|ft
aLlenL answers ?es" 3488 + 30
aLlenL answers no" 018 30
n one sLudv of 80 paLlenLs Ceorae esLlmaLes Lhe populaLlon
prevalence of elevaLed fear avoldance behavlors Lo be 373
86
Screenlna for lear Avoldance 8ellefs
ueclslon 8ules
1he laraesL slnale modlflable facLor affecLlna worker and
our paLlenLs' ouLcomes mav be Lhe psvchosoclal facLor
As sLaLed bv Waddell
#feft of pflo foJ wbf we Jo fboo l mf be mote
Jlsfblloo bfo pflo lself
87
ueclslon 8ules
88
ueclslon 8ules
89
ueclslon 8ules
90
Screenlna for uepresslon
revalence of acuLe depresslon ls 23 ln Amerlcans
uepressed paLlenLs 3x more llkelv Lo be nonadherenL
wlLh Lhelr medlcal LreaLmenL
Cf Lhe world's Len leadlna causes of dlsablllLv flve are
psvchlaLrlc/addlcLlve condlLlons
WlLh approprlaLe LreaLmenL 80 of people wlLh
depresslon wlll recover fullv
91
Ask vour paLlenL Lhese quesLlons
#otloo be pfs moob bfve oo ofeo beeo bobeteJ b feelloo Jowo
JeptesseJ ot bopeless?
Anu
#otloo be pfs moob bfve oo ofeo beeo bobeteJ b llle loetes ot
plefsote lo Joloo bloos?
ueclslon 8ules
92
ueclslon 8ules
-umber of #yes" responses 9robab|||ty h|ft
0 20
1 + 20
2 + 30
revalence of acuLe depresslon ls 23 ln Amerlcans
revalence of chronlc depresslon ls 67 ln Amerlcans
ueclslon 8ules
9hys|c|an Cua||ty keport|ng ystem
1 PealLh nformaLlon 1echnoloav AdopLlon/use of LlecLronlc Medlcal 8ecords (#124)
2 ulabeLes MelllLus ulabeLlc looL and Ankle Care erlpheral neuropaLhv neuroloalcal
LvaluaLlon (#126)
3 ulabeLlc MelllLus ulabeLlc looL and Ankle Care ulcer revenLlon LvaluaLlon of
looLwear revenLlve Care and Screenlna (#127)
4 8odv Mass ndex (8M) Screenlna and lollowup (#128)
3 uocumenLaLlon and verlflcaLlon of CurrenL MedlcaLlons ln Lhe Medlcal 8ecord (#130)
6 aln AssessmenL rlor Lo nlLlaLlon of aLlenL 1reaLmenL (#131)
7 lalls lan of Care (measure #134)
8 lalls 8lsk AssessmenL (#133)
93
1be AffotJfble cfte Ac mfkes f oombet of cbfooes o be lbslclfo Oofll kepotloo 5sem locloJloo
fobotlzloo loceolve pfmeos btooob 2014 foJ teooltloo f peofl beolooloo lo 2015 fot ptofessloofls wbo
Jo oo sflsffcotll tepot
ueclslon 8ules
94
9hys|c|an Cua||ty keport|ng ystem
n addlLlon phvslcal LheraplsLs are ellalble Lo reporL on a measures aroup relaLed Lo back
paln f a phvslcal LheraplsL elecLs Lo parLlclpaLe based on Lhls measures aroup he or she
musL perform all Lhe measures ln Lhls aroup 1he back paln measures lnclude
8ack aln nlLlal vlslL (measure #148)
8ack aln hvslcal Lxam (measure #149)
8ack aln Advlce for normal AcLlvlLles (measure #130)
8ack aln Advlce AaalnsL 8ed 8esL (measure #131)
#5evetfl of be ptoposeJ AcO oofll mefsotes flloo wlb bose oseJ lo obet cM5
oofll ptootfms socb fs be lbslclfo Oofll kepotloo 5sem
ueclslon 8ules
CLLawa 8ules for Ankle lracLure lollowlna 1rauma
93
ueclslon 8ules
CLLawa 8ules for knee lracLure lollowlna 1rauma
96
ueclslon 8ules
Screenlna for Splnal lracLure
97
Pow hvslcal 1heraplsLs Can uo 8eLLer
C||n|ca| ec|s|on upport 1oo|s
Move awav from asklna permlsslon" from Lhe phvslclan Lo maklna
recommendaLlons" Lo Lhe phvslclan
knowlna when noL Lo LreaL ls as lmporLanL as knowlna when Lo LreaL
MalnLaln a llsL of healLh professlons Lo refer paLlenLs Lo when lndlcaLed
MalnLaln a hlah lndex of susplclon" for paLholoav
CollecL basellne daLa CreaLe svsLems ush down daLa collecLlon Lo
everv person ln Lhe cllnlc
SLandardlze vour LxamlnaLlon Screen low Anu hlah rlsk populaLlons
llnd paLLerns
lollowup
98
Pow hvslcal 1heraplsLs Can uo 8eLLer
9opu|at|on nea|th
Address populaLlon healLh Lhrouah behavlor and acLlve exerclse proarams Some
posslblllLles mlahL lnclude
Smoklna cessaLlon
Alcohol/urua screenlna
AdulL welahL loss
Chlldhood obeslLv
SLress reducLlon
?oaa
llaLes
AcupuncLure
Massaae Lherapv
Lxerclse booL camps
Croup supporL proarams (ea depresslon)
Lncouraae paLlenLs Lo flnd a prlmarv care provlder
99
1hank ?ou
100

How Physical Therapists Can Thrive Under Health Care

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How Physical Therapists Can Thrive Under Health Care

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