Carry on my wayward son…

“Carry on my wayward son For there’ll be peace when you are done Lay your weary head to rest Don’t you cry no more…”                                                                                                                                              Kansas

As I wade through the current literature regarding the use of patient outcome measures in the practice of Physical Therapy, the above lyrics to a classic rock hit by Kansas come to mind.  I feel quite wayward about my use of outcome measures in the clinic when I read articles or presentations by researchers in our profession.  They do not believe outcome measures are worth my patient’s time, much less worth my time as a clinician.  I disagree. A simple solution I have found to avoid taking up valuable appointment time and/or overlapping patients is telling the patients as they are being scheduled to arrive 20minutes prior to their appointment.  Is it 100% fool proof?  Absolutely not.  However, the great majority of our patients comply with our request and rarely is it an issue.  Also, minimizing my time as a clinician in scoring the outcome measures also has a simple solution…practice.  I score the outcome measures we use in less than 30seconds now. You become very quick and efficient with enough practice.

Let’s discuss the merits of measuring outcomes.  The bottom line is that any vocation or business benefits from measuring impact- it is the foundation of any successful endeavor. A baseline is established and progress toward goals and objectives is monitored and tracked determining whether positive progress occurs. Any deviation to progress is identified and necessary adjustments are made to get back on track.  This is true in business, fund-raising, strategic planning initiatives and the like. Should healthcare delivery be any different? I do not believe so. In fact, healthcare accreditation bodies require constant monitoring of care, identification of issues and concerns and documenting their resolution and constant evaluation to ensure improvement. The primary reason I utilize outcome measures in my clinic is communication and engagement with the ultimate goal of improved patient care.  Communication between the patient and I engages the patient directly in their plan of care.  Communication among my colleagues and I is enhanced through active discussion about progress and challenges in the clinic.  Communication with clinic administrators has improved, as I am able to provide them with measurable information. In my experience (13+ years) and in my practice setting/patient population, I use the outcome measures to demonstrate whether or not there is any improvement in a patient’s pain and function.  The improvement may not hold up to the rigors of statistical analysis but I am not conducting research. I am individually monitoring patient care and improvement and matching them to effective treatment modalities. Applied consistently and ethically, outcome measures are both a subjective and objective way to show the patient and myself whether he/she is improving with the current treatment approach.  It plays an integral role in my clinical reasoning and in answering the question “am I on the right track” with this patient?

As a clinic supervisor, I can use the results of patient outcome measures to communicate strengths and weaknesses in clinical skills with my staff.  Outcome measures may also be used to complement or supplement performance evaluations, construct staff development goals and determine CME requirements.

I also use the results of patient outcome measures on a monthly basis to communicate to clinic administrators our effectiveness as practitioners and also to prove our worth as medical providers.  Productivity is a hot topic in most every PT practice.  Why wouldn’t it be?  It determines the bottom line.  You can bet the bottom line is constantly monitored with its own version of outcome measures. However, measuring productivity doesn’t always consider quality or effectiveness of care.  Patient outcome measures aren’t perfect.  What is perfect in the healthcare field?  That’s right…nothing.  Outcome measures are a useful tool that if used properly, ethically and consistently, can prove to the patient sitting in front of you, clinic administrators or any other stakeholders and you yourself as a clinician that you are indeed on the right track with your practice.

So now I’m going to carry on my wayward ways and continue to utilize patient outcome measures in my practice regardless of the non-believers.  At night I will lay my head to rest, not cry anymore and hope there’ll be peace to come.

– Dr. T

Dr. Jennifer C. Turner is board certified in orthopaedic physical therapy and a Fellow in the American Academy of Orthopaedic Manual Physical Therapists.  She is a commissioned officer in the U.S. Public Health Service, holding the rank of LCDR. Her views in this blog are her own and do not necessarily reflect those of the USPHS or her employer.

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