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Requested plzzzzz….. Listen carefully Be silent Attention Important Any questions

THE PHYSICAL THERAPIST ASPATIENT/CLIENT MANAGER

ALAM ZEBROLL-NO: 09

Although the term patient/client management is relatively new, this is probably the best established and most recognizable role of the physical therapist (PT).

Patient/client management for the PT has

changed over the years in five areas: Knowledge and skill used in the processes of

evaluation and diagnosis, prognosis, and discharge planning.

Referral relationships with physicians. Technological advances in the tools available for

examination and intervention. Interpersonal relationships with patients. Outcomes of care.

The physical therapist integrates the five elements of patient/client management :

examination, evaluation, diagnosis, prognosis, Intervention in a manner designed to optimize outcomes. (The Interactive Guide to Physical Therapist

Practice with Catalog of Tests and Measures (2002)

examination

evaluation

diagnosis

prognosis

Intervention

EVALUATION AND DIAGNOSIS:

Evaluation: is the process of making clinical judgments,

based on examination data, to create a problem list for each patient.

This list may include problems Require referral of the patient to other

professionals. Fall within the scope of practice of physical

therapy

This decision making process may also be considered clinical problem solving, diagnosing, or clinical reasoning.

The end product of evaluation is a diagnosis, which is the term for problems that have been categorized into defined clusters, syndromes.

PHYSICAL THERAPY DIAGNOSIS: Rose suggested that using the term is important

to distinguish the PT’s findings from diagnoses made by other health care practitioners.

Sahrmann defined the term diagnosis as simply the primary dysfunction toward which the PT directs treatment. and this has helped Decreases the fears of the medical community that PTs

intend to diagnose disease, infringe on the practice of others perform clinical services outside their scope of expertise.

Rose further explained that, by naming and classifying clusters of symptoms, signs, and demographic data, the clinician increases the probability that the best results previously obtained will be replicated or surpassed.

Physical therapy diagnoses help identify the role of physical therapy and its scope of practice.

Nevertheless, some have opposed the idea of PTs using the term diagnosis, expressing concerns about PTs’ prerogative to diagnose in the first place and the extent of their involvement in the process.

PROGNOSIS:

Prognosis is the determination of : The predicted optimal level of improvement in

function, The time needed to reach that level, The levels of improvement that may be reached

at various intervals during the course of physical therapy.

The prognosis is documented in the physical therapy plan of care, which includes the following :

Specific short- and long-term goals for identified problems.

The duration and frequency of specific interventions selected to meet goals.

The expected outcome. The optimal level of improvement expected.

The HOAC II model specifies the types of goals as long term or short term.

Long- and short-term goals represent the same kind of phenomenon (meaningful change for the patient), the only difference is the time required to achieve them.

Defining goals in this way is an attempt to reduce confusion created by PTs who use short-term goals to reflect the impairments to be addressed so that long-term functional goals can be met.

Patient function must therefore be addressed throughout a plan of care in short and long-term goals that represent meaningful accomplishments. PTs can check whether a goal is meaningful or not.

For the patient’s current problems, PTs decide which interventions will achieve the short- and long-term goals.

Jette determined that this decision-making process is influenced by a variety of factors in addition to the patient’s current health status.

Factors that contribute to treatment decisions : The PT’s educational level, The payment source, The self-interests of the PT, The size of the PT’s caseload

DISCHARGE AND DISCONTINUATION PROCESSES:

Discharge: Ending physical therapy services provided during

a single episode of care because the expected goals and outcomes of treatment have been achieved.

Documentation requirements may need to be met regarding the conclusion of physical therapy services.

Note: Discharge does not occur with a transfer: that is, when the patient is moved from one site to another site in the same setting or across settings during a single episode of care.

Discharge is based on the physical therapist’s analysis of the achievement of expected goals and outcomes.

The physical therapist plans for :DischargeFollow-upReferral

Discontinuation: Ending physical therapy services provided during a

single episode of care because of the following circumstances:

1. The patient, caregiver, or legal guardian declines to continue intervention.

2. The patient is unable to continue to progress toward expected goals and outcomes because of :

Medical complications Psychosocial complications Financial orinsurance resources have been expended.

3. The physical therapist determines that the patient will no longer benefit from physical therapy.

Discharge Planning: Hospitals must have in effect a discharge planning

process that applies to all patients, and the discharge planning evaluation must include an evaluation of the likelihood of a patient needing post hospital services and of the availability of the services.

In addition the patient and family members must be counseled to prepare them for post-hospital care.

Physical therapy practice acts may also address the PT’s legal responsibility for discharge planning.

The way in which PTs make discharge decisions is important.

Jette, Grover, and Keck studied occupational therapists and PTs in acute care settings to explore this decision-making process.

Transfer or Referral: The hospital must transfer or refer patients, along

with necessary medical information, to appropriate facilities, agencies, or outpatient services as needed for follow-up or ancillary care..

OUTCOMES: According to the Guide, PTs ask themselves early

in the patient management process. “What outcome is likely, given the diagnosis?”

After listing the likely outcomes for each diagnosis, they may reexamine the actual outcomes to determine whether the predicted outcomes are reasonable and then modify them as necessary.

At the end of an episode of care, the PT analyzes through organizational review processes, the overall impact of the interventions on :

the patient’s disorders, impairments, functional limitations, disabilities, health status,satisfaction with care, risk prevention

The more PTs assume responsibility for practicing without referrals, the more accountable they will become for the outcomes of the care they provide.

At the end………

Special thanksMam Sajida Mazhar

Faryal Javed