Physical therapists need to define success, then measure and report it.
By Eric Cardin, PT
Advances in technology are all around us. The evolution of telecommunications, computers, and medicine continues at an exponential pace. Medical technological advances in the past 20 years have brought radical change to surgery and postoperative care and have saved and prolonged lives. However, what about physical therapy? How does a profession rooted in the basic human connection of communication and personal contact benefit from the frenetic pace of technological change? Should it? Can it?
Measuring success is a complicated task. First it must be defined, then measured and repeated. Understanding the “outcome” of physical therapy is as varied as the patients we serve. Two patients with the same diagnosis could and will have varied paths to “success.” On one table is a patient with a total knee replacement with excellent motion—but continued complaints of pain and poor function. The next client has what would be considered poor motion but feels they are “doing great!” How will these patients fare in a “pay for performance” environment? How do we measure, report, and define their success or failure? Can success be defined? Can technology hold the key to an effective (i.e., cost effective/efficient) method of saying, “This patient had a good/great/bad outcome?” The response pain from surgery or injury as well the emotional, spiritual, and physical changes related to disease and recovery are too variable to neatly fit into a standardized set of questions. It requires a distinct combination of measures and judgment. Taking clinical judgment, which evolves quickly in the mind, and combining it in real time with the patient in front of you and documenting and educating in the frenzied pace of physical therapy is a daunting task. Measuring outcomes is essential and the time is coming fast, if it is not already here, when we will prove what we have done has worked above the obligatory batch of thank-yous and fresh-baked chocolate chip cookies. (If you are not getting cookies you might be doing it wrong.)
Private practice physical therapists need to lead the way. We must define how we measure success and use and/or develop the methods and technologies necessary to measure success. The American Physical Therapy Association’s (APTA’s) Evaluation Database to Guide Effectiveness (EDGE) initiative has been in place for close to a decade; Dr. Rebecca Craik called for the need to classify our patients, standardize our interventions, and effectively measure outcomes in 2005.1 Are we doing it? Are we identifying our patients, treating them with generally accepted interventions (backed by evidence) and documenting the outcome? Physical therapists have been aggressive and competent adopters of Physician Quality Reporting System (PQRS) and therefore capable of collecting and reporting information. However, what about that information? Does collecting information on body mass index (BMI) or medications accurately measure the quality of care? If we have shown that we can collect and report information, the next logical step is to define what is pertinent to our practice. We must define success and continue to demonstrate that physical therapy is a highly valuable and essential part of recovery from injury, illness, and surgery. Successful (and happy) clients are an important tool. We must harness their satisfaction and use it to our advantage. Each day thousands if not hundreds of thousands of “physical therapy evangelists” are discharged into the world. We can use them to help us define success.
The answer may lie in technology. Activity trackers, worn on the wrist or belt, can provide useful information. Smartphones can track movement and patients can log activity in a digital diary. Video can be an effective tool for objectively defining a patient’s start and end point. Tablets can streamline the data collection process and electronic medical records (EMRs) can integrate standardized tests. Innovations continue in gadgets that accurately measure motion and movement and help us to quantify our observations. We must stand atop this heap of information and decide what is relevant and define what success is and how it is measured. We cannot wait for “the doctor said I’m doing great!” or the “insurance says I am functional.”
Last month 450 different humans walked into my practice. They were tall, short, fit, overweight, young, old, English speaking, non-English-speaking—the list goes on as they were as diverse as the country we live in. Effectively collecting, documenting, and interpreting information about their current, past, and potential function is essential. Doing it while continuing to provide quality care while generating adequate revenue to provide that care and run the business is a monumental task. The patients we serve, and the injuries that limit them, are diverse as are the resources the patients bring to the recovery process. Perhaps the app or the software or the hardware we need has not been invented or it is evolving right now. Evolving payment structures and increasing patient-cost sharing is moving us toward an environment where results matter more than ever. Technology investments already strain our budgets in an era where so many things chip away at revenue. We need to define success, measure it, and report it. Therapists are making dramatic steps toward success every day but unless we collaborate (via technology) and innovate—it will be defined for us.
1. Craik RL. Thirty-Sixth Mary McMillan Lecture: Never satisfied. Phys Ther. 85:1224-37, 2005.
Eric Cardin, PT, is the executive director of South County Physical Therapy, Inc. He can be reached at firstname.lastname@example.org.