care planning: better health begins here... april 2013
TRANSCRIPT
Overview Importance of care planning What we trying to achieve? Implementation steps of care plans - Is it happening?
Care planning Schedule management Barriers to implementation
Measure of Success Follow up strategies and expectations
Care Planning
Objective:
To provide the best possible care by: Utilizing all options available to client Become the provider of choice Create the ultimate customer
experience
Tools: The Assessment
1. First Impression:• Phone call• First visit• Introduction
2. Thorough Assessment (history, special tests, etc.)
3. Communication of Findings:• Diagnosis• Proper education• Confidence regarding managing the injury
THIS WILL RESULT IN A PLAN!
The Science Behind Care Plans
Take away message (clinicians)
Not only a business model
Best practice treatment model optimum care, not rationed care
Long et al., 2004
Objective: To evaluate the usefulness of a range of factors to predict outcome.
Interventions: Subjects from a randomized controlled trial, matched or unmatched ROM ex’s to the directional preference.
6 visits in 2 weeks.
Results: Subjects with DP who received matched treatment had a 7.8 times greater likelihood of a good outcome.
The comparative prognostic value of directional preference and centralization.
Guzman et al., 2001
Objective: To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with CLBP. Conclusions: Intensive multidisciplinary rehabilitation (>100 hrs) with functional restoration reduces pain and improves function in CLBP.
Multidisciplinary rehabilitation for CLBP: systematic review
Coppack et al., 2012
Objective: To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome.
Interventions:1. Goal setting experimental 2. Therapist-led exercise therapy 3. Non-therapist led exercise therapy
Results: 1. Adherence & Self-efficacy scores - higher in the goal setting group.
2. 3-week treatment outcome did not differ significantly.
Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a RCT
Tools: Care Plans
• Provided to the client at the end of the assessment.
• Complete treatment plan outlined for both client and therapists.
• Schedule is:• front end loaded • entirely booked in advance• printed off and provided to the
client.
Communication• of Care Plans to Client• of Care Plans to Admin/team
The Schedule• First two weeks of treatment
Physician Communication• Request for Medical Information (RMI)
Tools: RMI
• Completed following assessment of client
• Sent to the MD
• Remember signatures
Execution: Care Plans
What are targets for generation of the RMI?
What are the targets for Care Plan utilization?
How are we doing?
• Barriers• Solutions
1st week3-5 visits
Ax*RMI
24 hr recheck* Care Plan
Visit 5Kin Func test
Week 2-48-12 Visits
PT & Kin
Visit 10 Func test
* Report to GP
Week 5-83-5 visits
PT & Kin
Visit 15 Func test
Week 9+
PT & Kin as required
Discharge plan & report
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Pain Control
Recovery of Movement
Recovery of Function
Care Planning & Schedule Management
Functional Testing
What should it include?
When is it occurring?
How does it drive care planning?
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Process: Ongoing Care Planning
Gym Referrals
• Communication tool for updating the Care Plan to therapists being added to the treatment team.
Clinic Manager tool - Weekly Team Meeting
Include:
1. Are quantifiable goals set?2. Are plans ESTABLISHED?3. Are plans being done?4. Is there progression of the treatment?
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How to ensure success?
Process: Goal Setting
Goal Setting
Initial goal setting happens at the assessment
Goals should be reviewed each week during “Team Meeting”
Ensures treatment progression and scheduling adjustments
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Execution: Care Plans
Clinic Manager tools:
• Schedule Management
• What should the schedule look like for a typical sponsored intake?
• Introduce functional testing
• Testing frequency• Sharing with stakeholders
• Goal Setting
• From intake to discharge
Inactivity list/active client listing
Weekly Clinician Review
Monitor Care Plan completion Plan for ongoing tx planning Transition of client to additional
services Track reporting timelines Track extension requests Discharge planning
Weekly Administration Review
Which clients needs revised schedules What require transition to additional services Track reporting timelines Track extension requests Discharge planning Phase/case closure
Recap: Key Success Factors
Consistent commitment to:• Care Plans• Weekly Team Meetings• Managing performance
Urgency Target for 100 days
• Bridge from Level 1 course to clinic • 100% compliance
– Care Plans– Goal setting– Functional testing– GP / RMI communication
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