PATIENT MANAGEMENT

AND CLINICAL DECISION

MAKING
LECTURE 2
DR. AROOSHA ABRAR
CLINICAL DECISION MAKING

 DEFINITON
 Clinical decision making refers to a dynamic, complex process of reasoning and
analytical (critical) thinking that involves making judgments and determinations in the
context of patient care
 An important aspect of this process is selection, implementation, and modification
of therapeutic exercise interventions based on the unique needs of each patient or
client
 There are a few requirements for skilled clinical decision making during Patient
Management
 Knowledge of about the problem(s)
 Prior clinical experience with the same or similar problems
 Ability to integrate new and prior knowledge
 Ability to obtain, analyze, and apply evidence from the literature
 An understanding of the patient’s values and goals etc
EVIDENCE BASED PRACTICE

 Physical therapists who wish to provide high-quality patient care must make
informed clinical decisions based on sound clinical reasoning and knowledge
of the practice of physical therapy.
 Evidence-based practice is “the conscientious, explicit, and judicious use of
current best evidence in making decisions about the care of an individual
patient”
 Evidence-based practice also must involve combining knowledge of evidence
from well designed research studies with the expertise of the clinician and
the values, goals, and circumstances of the patient
PROCESS OF EVIDENCE BASED PRACTICE

 The process of evidence-based practice involves the following steps

 Identify a patient problem and convert it into a specific question
 Search the literature and collect clinically relevant, scientific studies that contain
evidence related to the question.
 Critically analyze the evidence found during the literature search and make
reflective judgments about the quality of the research and the applicability of the
information to the identified patient problem.
 Integrate the appraisal of the evidence with clinical expertise and experience and
the patient’s unique circumstances and values to make decisions.
 Incorporate the findings and decisions into patient management.
 Assess the outcomes of interventions and ask another question if necessary
PATIENT MANAGEMENT MODEL

 The process of patient management has five basic components

 A comprehensive examination
 Evaluation of data collected
 Determination of a diagnosis based on impairments, functional limitations, and
disability
 Establishment of a prognosis and plan of care based on patient-oriented goals
 Implementation of appropriate interventions
EXAMINATION

 Examination is the systematic process by which a therapist obtains

information about a patient’s problem and his or her reasons for seeking
physical therapy services.

 HISTORY (overview of current and past information about the condition)

 SYSTEM REVIEW (A brief but relevant screening of the body systems, known as a
systemic review)
 TEST AND MEASURES (to gain in depth knowledge of the condition to reach
diagnosis)
EVALUATION

 Evaluation is a process characterized by the interpretation of collected data.

 Measure the extent to which relationship occur between impairment and
functional limitation
DIAGNOSIS

 The term diagnosis can be used in two ways; it refers to either a process or a
category (label) within a classification system.
 The diagnosis is an essential element of patient management because it
directs the physical therapy prognosis (including the plan of care) and
interventions.
 DIAGNOSTIC PROCESS
 DIAGNOSTIC CATEGORY
PROGNOSIS AND PLAN OF CARE

 A prognosis is a prediction of a patient’s optimal level of function expected as

the result of a course of treatment and the anticipated length of time needed
to reach specified functional outcomes.
 The plan of care is an integral component of the prognosis
 Who , will do what, under what condition and when
INTERVENTION

 Intervention refers to any purposeful interaction a therapist has that directly

relates to a patient’s care.
 Implementation of plan of care
 Co ordination
 Communication
 Documentation
 Procedural interventions
 Patient related instructions
OUTCOMES

 Outcomes are results

 Functional outcomes
 Measuring impact of intervention (scales)
THANK YOU