Data and Peer Review to Optimize Patient Care Julie Collins MA OTRL April 6 2014 Notforprofit faithbased health system West Ohio Conference of United Methodist Church Our Organization ID: 489211
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Using FOTO Data and Peer Review to Optimize Patient Care
Julie Collins, MA, OTR/L
April 6, 2014Slide2
Not-for-profit, faith-based
health
systemWest Ohio Conference of United Methodist ChurchOur Organization17,000 associates2,800 physicians3,000 volunteers19 hospitals(member and affiliated)
30+ ambulatory sites94,000 inpatient admissions393,000 ED visits 1.8 million outpatient visits
OhioHealth System
2Slide3
OhioHealth Physical Rehabilitation Slide4
OhioHealth Outpatient Rehabilitation
20+ ambulatory sites
15 Sub-specialties150+ Occupational, Physical, Speech Therapists, and Athletic Trainers200,000+ Visits in 2013Slide5
OhioHealth Outpatient Rehabilitation
Outpatient
Rehab Quality Management Committee (ORQMC) Committee MembershipDirector(s)Manager(s)Supervisor(s)Sub-committee ChairpersonSpecialty Therapists > 5 years per APTA Guidelines: Peer Review Training BOD G03-05-15-30Slide6
Clinical Quality Peer Review
What it
IS:A process to :Improve rehabilitation’s overall quality of careIdentify clinical practice improvement opportunitiesIntegrate evidence based care
What it is NOT:A historical chart review process of regulatory requirementsSlide7
ORQMC Committee Goals
Improve patient outcomes by pursuing and maintaining excellence in therapist performance
Create a positive culture toward OP peer reviewPromote efficient resource use by assessing treatment justification, medical necessity, intervention effectiveness, and treatment durationSlide8
ORQMC 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 competenceMaximize value to patients, payer sources, and regulatory agenciesSlide9
Committee ResponsibilitiesSlide10Slide11
Clinical Quality Review
Pilot review performed utilizing information on outpatients with
lumbar spine involvementMost opportunity for improvementMost frequent diagnosisGreatest potential for patient improvementRobust evidence based practice literatureSlide12
Care Type
Body Part
CountAvg Visits
Standard DeviationUsual MinUsual MaxOrthopedicLumbar Spine4516211.048.1255-5.2111127.2911Slide13
Clinical Quality Review
FOTO
Benchmark DataLumbar Visit Average: 111 Standard Deviation: >/= 19 visits2 Standard Deviations: >/= 27 visitsOhioHealth Rehabilitation Review CriteriaAll charts with >/=19 visits reviewedIdentified 7 charts from >500 patientsSlide14
Lumbar Peer Review Results
Admission
Diagnosis# Visits Actual# Visits Predicted>1 Standard Deviation>2 Standard Deviations724.4-LUMBOSACRAL NEURITIS NOS52
No FOTOX722.10-LUMBAR DISC DISPLACEMENT2318X724.2-LUMBAGO2312X724.2-LUMBAGO
1910
X724.4-LUMBOSACRAL NEURITIS NOS2518X724.2-LUMBAGO2112X847.2-SPRAIN LUMBAR REGION1911XSlide15
Clinical Quality Data Review Questions
Improvement Opportunities:
Review processIndividual therapist impactRehabilitation Services system impactApplication to: Physician referral practicePayer sources
Other rehab sub-specialtiesPatient satisfaction impact15Slide16
Committee ResponsibilitiesSlide17
The Advisory BoardSlide18
System 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 OhioHealthPlan physician education for earlier physical therapy referral Slide19
System Improvement Opportunity
Compared with delayed physical therapy, early
physical therapy timing was associated with decreased:Risk of advanced imagingPhysician visitsLikelihood of surgeryLikelihood of injections and opioid medicationsTotal 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 painSlide20
ORQMC Subcommittee Peer Review Recommendations
Continue
to review individual patient charts >1 SDIdentify patients with best utilizationRandomly review patient chartsGoal to increase review to 10 per quarterSlide21
QUESTIONS ????
No easy answersSlide22
References
APTA Guidelines: Peer Review Training BOD G03-05-15-
30Campbell 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.Slide23
References 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.Slide24
References 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.