using foto data and peer review to optimize patient care julie collins, ma, otr/l april 6, 2014
TRANSCRIPT
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Using FOTO Data and Peer Review to
Optimize Patient Care
Julie Collins, MA, OTR/L
April 6, 2014
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Not-for-profit, faith-based health systemWest Ohio Conference of United Methodist Church
Our Organization
+ 17,000 associates
+ 2,800 physicians
+ 3,000 volunteers
+ 19 hospitals(member and affiliated)
+ 30+ ambulatory sites
+ 94,000 inpatient admissions
+ 393,000 ED visits
+ 1.8 million outpatient visits
OhioHealth SystemOhioHealth System
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OhioHealth Physical Rehabilitation OhioHealth Physical Rehabilitation
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OhioHealth Outpatient RehabilitationOhioHealth Outpatient Rehabilitation
+20+ ambulatory sites
+15 Sub-specialties
+150+ Occupational, Physical, Speech Therapists, and Athletic Trainers
+200,000+ Visits in 2013
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OhioHealth Outpatient Rehabilitation
OhioHealth Outpatient Rehabilitation
Outpatient Rehab Quality Management Committee (ORQMC)
Committee Membership– Director(s)– Manager(s)– Supervisor(s)– Sub-committee Chairperson– Specialty Therapists > 5 years per APTA
Guidelines: Peer Review Training BOD G03-05-15-30
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Clinical Quality Peer ReviewClinical Quality Peer Review
What it IS:– A process to :
Improve rehabilitation’s overall quality of care Identify clinical practice improvement
opportunities Integrate evidence based care
What it is NOT:– A historical chart review process of regulatory
requirements
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ORQMC Committee GoalsORQMC Committee Goals
Improve patient outcomes by pursuing and maintaining excellence in therapist performance
Create a positive culture toward OP peer review
Promote efficient resource use by assessing treatment justification, medical necessity,
intervention effectiveness, and treatment duration
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ORQMC Committee GoalsORQMC Committee Goals
Positively assist in providing therapists timely and specific feedback
Promote efficient resource utilization(therapists, admin, quality, office support)
Support therapist educational goals, professional growth, and competence
Maximize value to patients, payer sources, and regulatory agencies
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Committee ResponsibilitiesCommittee Responsibilities
OP Rehab Quality
Management
Committee
Identify outlying
charts and review
Communicate and track
improvement for system and individual therapists
Identify opportunities for improvement and
develop plan
Disseminate results to
management and clinicians
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OhioHealth Outpatient Rehabilitation Peer Review Program
Assigned manager by the Quality Management Group runs a report weekly
indicating patient visit number for all
outpatient locations and
specialties
The assigned manager will
review the report for cases over the recommended visit
number
Is the case above the recommended
visit number?
Yes
No
No Further peer review required on charts below the recommended visit
below
The manager sends the
appropriate cases to the subcommitte
chairperson
The subcommittee chairperson will
delegate the appropriate cases
to the qualified subcommittee
member
The committee member will
perform the chart review on the
appropriate peer review form within 30 days of receipt
Is the number of visits justified?
Yes
No
The peer review form will be sent to
the individual’s manager
The peer review form will be sent to
the individual’s manager
The peer review form will be shared with the individual
The peer review form will be sent
back to the Quality Management Team
The form will be stored in a designated area
Post-Peer review
The individual’s manager will
review the peer review form
The manager will meet with the
individual one-on-one
Is further action indicated?
Yes
No
The peer review form will be sent back to the Quality Management
Team
The form will be stored in a designated area
Implementation of the appropriate
action (mentoring, coursework, other defined actions)
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Clinical Quality ReviewClinical Quality Review
Pilot review performed utilizing information on outpatients with lumbar spine involvement
– Most opportunity for improvement
– Most frequent diagnosis
– Greatest potential for patient improvement
– Robust evidence based practice literature
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Care Type
Body Part
Count Avg Visits
Standard Deviation
Usual Min
Usual Max
Orthopedic
Lumbar Spine
45162 11.04 8.1255 -5.21111 27.2911
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Clinical Quality ReviewClinical Quality Review
FOTO Benchmark Data– Lumbar Visit Average: 11– 1 Standard Deviation: >/= 19 visits– 2 Standard Deviations: >/= 27 visits
OhioHealth Rehabilitation Review Criteria– All charts with >/=19 visits reviewed– Identified 7 charts from >500 patients
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Lumbar Peer Review ResultsLumbar Peer Review Results
Admission Diagnosis # Visits
Actual# Visits
Predicted
>1 Standard Deviation
>2 Standard Deviations
724.4-LUMBOSACRAL NEURITIS NOS
52 No FOTO X
722.10-LUMBAR DISC DISPLACEMENT
23 18 X
724.2-LUMBAGO 23 12 X
724.2-LUMBAGO 19 10 X
724.4-LUMBOSACRAL NEURITIS NOS
25 18 X
724.2-LUMBAGO 21 12 X
847.2-SPRAIN LUMBAR REGION
19 11 X
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Clinical Quality Data Review QuestionsClinical Quality Data Review Questions
– Improvement Opportunities: Review process Individual therapist impact Rehabilitation Services system impact
– Application to: Physician referral practice Payer sources Other rehab sub-specialties
– Patient satisfaction impact
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Committee ResponsibilitiesCommittee Responsibilities
OP Rehab Quality
Management
Committee
Identify outlying
charts and review
Communicate and track
improvement for system and individual therapists
Identify opportunities for improvement and
develop plan
Disseminate results to
management and clinicians
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The Advisory BoardThe Advisory Board
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System Improvement OpportunitySystem Improvement Opportunity
Acuity FOTO (12 Mo)
OhioHealth (12 Mo)
Acute (0-21 days) 20 % 15 %
Subacute (22-90 days)
28 % 33 %
Chronic (>90 days) 52 % 52 %
FOTO database >5% referrals in “Acute” phase compared to OhioHealth
Plan physician education for earlier physical therapy referral
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System Improvement OpportunitySystem Improvement Opportunity
Compared with delayed physical therapy, early physical therapy timing was associated with decreased:– Risk of advanced imaging– Physician visits– Likelihood of surgery– Likelihood of injections and opioid
medications– Total medical costs ($2,736 lower)
Overall lower risk of subsequent medical service usage among patients who received PT early after and episode of acute low back pain
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ORQMC Subcommittee Peer Review RecommendationsORQMC Subcommittee Peer Review Recommendations
Continue to review individual patient charts >1 SD
Identify patients with best utilization
Randomly review patient charts
Goal to increase review to 10 per quarter
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QUESTIONS ????QUESTIONS ????
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ReferencesReferences
APTA Guidelines: Peer Review Training BOD G03-05-15-30 Campbell SM, Braspenning J, Hutchinson A, Marshall M.
Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care. 2002; 11:358-364.
Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine. 2012;37(25):2114-21.
Gellhorn AC, Chan L, Martin B, Friedly J. Management patterns in acute low back pain: the role of physical therapy. Spine. 2012;37(9):775-82.
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References ContinuedReferences Continued
Jansen MJ, Hendriks EJ, Oostendorp RAB, Dekker J, De Bie RA. Quality indicators indicate good adherence to the clinical practice guideline on “Osteoarthritis of the hip and knee” and few prognostic factors influence outcome indicators: a prospective cohort study. European Journal of Physical and Rehabilitation Medicine. 2010; 46(3); 337-345.
Jette DU, Jewell DV. Use of Quality Indicators in Physical Therapist Practice: An Observational Study. Phys Ther. 2012; 92(4): pages unknown. Published online January 6, 2012.
Jette DU, Halbert J, Iverson C, Miceli E, Shah P. Use of Standardized Outcome Measures in Physical Therapist Practice: Perceptions and Applications. Phys Ther. 2009; 89:125-135.
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References ContinuedReferences Continued
Miller PA, Nayer M, Eva KW. Psychometric Properties of a Peer-Assessment Program to Assess Continuing Competence in Physical Therapy. Phys Ther. 2010; 90(7): 1026-1038.
Rollan T-M, Hocking C, Jones M. Physiotherapists’ Participation in Peer Review in New Zealand: Implications for the Profession. Phys Ther. Res. Int. 2010; 15:118-122.