2. Registry Basics: PEDS Addition
Karen Chesbrough, MPH
Director, PT Outcomes Registry
Hi everyone –
Thanks for letting me join you today. As you might have heard, the Registry has been identified as one of APTA’s top priorities for And we talk a lot about it at staff meetings and other events. And there is some expectation that everyone here at APTA should be able to have some baseline knowledge about the Registry – but we have discovered that isn’t necessarily the case.
So today, I hope to shed some light about what the Registry IS, why it is IMPORTANT, and what it DOES.
I also will provide you at the end with some important points that we hope you take away from this presentation, allowing you to be more confident about your knowledge of the Registry.
So let’s jump in.

3. What is a Clinical Data Registry? Collects and Records Information
*What is a Clinical Registry? National Quality Registry Network.
A clinical registry is an IT system that collects and records information about the health status of patients and the health care they receive over varying periods of time in a big computer server.
It is essentially a “database”.

4. Why Have a Clinical Data Registry?
Improve the quality and safety of the care
Compare the effectiveness of different treatments and/or evaluate different approaches
Monitor safety
Why would a group/person/company/government want to have a Clinical Data Registry?
Clinical registries provide information to health professionals to improve the quality and safety of the care they provide to their patients. For example, the use of evidence-based practice guidelines can be evaluated by asking questions like, how many patients are receiving recommended treatment(s)?
Information from clinical registries can be used to compare the effectiveness of different treatments for the same disease or condition. And/or to evaluate different approaches to a procedure.
Registries can be used to monitor the safety of implanted devices. (Up to a few years ago, this has been the general use of registries – to monitor safety of devices such as materials used in joint replacements or drugs being prescribed.

5. Why Have a Clinical Data Registry? cont …
Support health care education, accreditation and certification
Drive quality payment initiatives
Inform patients
*What is a Clinical Registry? National Quality Registry Network.
These are a couple of other uses of registries in the modern era …
4. The data gathered can be used to support health care education, accreditation, and certification.
5. And finally, registry data has been increasingly used to ensure that payment is adjusted based on the quality of care provided and to give patients the information they need to make better informed choices regarding their healthcare.

6. Impact of Registries Improve survival in lung cancer and colon cancer
Improve compliance with guidelines for diabetes care
Improve the success of smoking cessation counseling
Reduce use of antibiotics in ulcer treatment
Reduce post-surgical infections
Increase control of cholesterol levels

7. Physical Therapy Outcomes Registry
Track performance of care delivery and documentation patterns
Assess adherence
to CPGs
Fulfill quality reporting requirements
Support quality improvement initiatives
Practice
Quality
Drive health
services research
initiatives
Demonstrate value of physical therapist services
Research
Payment
Inform payment
contract negotiations
Guide payment policy
So with that baseline of what a registry theoretically is and does, let’s talk about our Registry, the Physical Therapy Outcomes Registry
It too is an organized data collection system that allows therapists to evaluate patient function and other measures for PT patients.
Data from the Registry will support the profession in four major areas:
Practice: captures patterns in care as well as performance, provides the ability to examine documentation patterns – what is and what is not getting documented, and the opportunity to assess the adherence to clinical practice guidelines - eventually developing predictive analysis to be able to influence clinical decision making.
Quality: This where policy and healthcare reform have landed. There is more emphasis on pay-for-performance as well as increased transparency and accountability. The Registry assists with this. Captured data can measure outcomes and enable providers to perform quality improvement initiatives.
Payment: Use Registry data for contract negotiations; justification of services, and APTA can use the data to advocate for payment policies.
Research: Finally, the Registry will provide a comprehensive database that can be used to support Health Services Research. This data set the stage for studies that demonstrate the value of physical therapist services.
All this provides the needed information to support APTA’s advocacy efforts to establish fair valuation for physical therapist services.

8. What Data is Collected in the Registry?
Facility
Location
Name
Site type
Provider
Provider Name
NPI Number
Demographic information
School, graduation year
Specialization
Patient/ Episode
Diagnosis
Health history information (BMI, tobacco, surgical history)
Pain intensity
Physical function (global/ condition/ body region specific)
Billing information
Patient satisfaction
So what types of information are we targeting to collect?
Facility
Provider
Patient/Episode

9. How is the Registry Data Used?
Data is transformed into meaningful, intuitive, and actionable feedback, focused on what is happening with the care a physical therapist provides and his/her patient population and the Registry’s as well.
Essentially – making the black box … transparent. It is data from the profession, for the profession.
Think back to our earlier slides on how data from a Registry can be used. We talked about Registries being used for improving quality and safety of care, comparing effectiveness of different interventions, monitoring safety, supporting education, accreditation, certification, informing patients.

10. Practice Performance
Registry data can be aggregated at different levels.
It can be looked at on the provider level, at the clinic or site level if their organization has multiple clinic locations, and/or as an organizational “whole” against other organizations in the Registry.

11. Identifying Variations in Practice
So here with our first way that Registry data can be used:
Registry data can be used to examine identified variations in practice.
On this chart, an administrator can get a snapshot comparison of how their sites are doing. Same condition – different number of visits across the sites. What’s accounting for the difference? Why are some sites requiring double the amounts of patient visits than others? With the Reports tool offered in the Registry, the administrator can plug in different variables to examine specifics.
This allows administrators to take a closer look at what’s going on within their spaces. Why the variations between the sites? Drill down to specifics within the sites, and determine if resources need to be redistributed, mentoring programs established, and/or what type of in-service education workshops should be provided.

12. Quality Measure Benchmarking
Another way Registry data can be used is within the Quality space. (Are you thinking about that diagram presented earlier yet? With the four areas of Practice, Quality, Payment, and Research?)
Registry data can be used to benchmark the quality of care delivered.
This slide shows the old PQRS measures initially used in the Registry.
A couple different ways this data can be used. As with the first example, the data is aggregated at the provider level, the site level, and then the organization level (if applicable).
The provider has his or her own log-in and dashboard. They can see where they stand as far as hitting the performance benchmarks of their peers in the Registry. This gives them the opportunity to identify areas for improvement (which we will specifically address in a bit).
The administrator has the ability to examine how their providers are doing as far as measure performance against each other, how their sites are doing against each other, and how their organization is performing as a whole against others.
Again, providing information which can then be appropriately acted upon.
Next …

13. Determining Clinical Practice Patterns
Ensure utilization of guidelines
Quality measures that focus on clinical activities included in the CPGs (must do’s or must avoid)
Analyze outcomes for population
Determine how adherence to CPG impacts patient outcomes
Inform CPG changes
In addition to scientific publications, clinical data will help to evolves future CPGs
Registry data can be used to determine Clinical Practice Patterns.
Clinical Practice Guidelines should provide a roadmap for a lot of what happens at the clinic level. But how do you know if clinicians are following them or using them? How do you know if the CPGs are effective?
Data collected in the Registry can be used to test CPGs effectiveness as well as examining if clinicians are following them. If the CPGs have proven to be effective, and your clinicians are not following them, this is an opportunity to redirect.
If the data shows that the CPGs are not effective, it offers the opportunity to re-examine/re-design interventions at the aggregate level of population health, to achieve the highest outcomes at a lower cost, if possible.
Are you thinking about that diagram presented at the start of the presentation, the four areas that will be driven by Registry data?
Here are some of the questions we are interested in learning answers to in regards to Clinical Practice Patterns …
Were interventions consistent with CPGs?
Were interventions matched to treatment classification?
Did matched treatment result in better outcomes then unmatched treatment?
Would a built in decision support system help with adherence to CPG & lead to better outcomes?
Does Registry data provide support for CPGs or suggest that changes for the CPGs are necessary?

14. Performance Improvement and Feedback
Audit your process and performance
Make changes to your process as needed
Implement relevant CPGs, data collection
Define and begin treating population
Plan Do
Check
Act
Finally, and we have been alluding to this throughout ..
Data from the Registry can be used in Performance Improvement and Feedback.
Using the data in the Registry, performance improvement activities can be identified and implemented at both the clinician level and site/organization level. APTA will also be able to see where education efforts could be directed.
Creating a feedback loop as far as performance in relation to collected data should also be an important practice. Clinicians should know and understand how they are doing as an individual clinician and as a whole. By being able to see performance, they are able to take steps to either improve or share their knowledge and collaborate in areas needing assistance. In fact, data transparency has been shown to increase performance.
Think about it, who wants to be at the bottom if everyone is seeing the ranking? Thinking about both clinicians and organizations?

15. Take Away What is the Registry?
The Registry is an electronic mechanism that collects and records information about physical therapist services and deposits it into a database.
What will the Registry do?
Data will provide the answers to questions that can characterize the practice of physical therapy and the physical therapist herself/himself.
That data will then, in turn, be used to drive physical therapist practice, quality, payment, and research.
It is data from the profession, for the profession.
We want all staff members at APTA to be able to speak about the Registry with a confident, baseline understanding.
Please remember one of these points and be able to deliver it if you are ever asked what you know about the Registry.

16. Take Away How can the Registry be used by physical therapists?
Identify variations in practice.
Benchmark quality performance.
Determine clinical practice patterns.
Provide performance improvement information and feedback.
What does all this mean to the profession?
The tools will be in place to create the best practice environment and provide the best care to patients.
Patients will have the ability to be data-driven consumers in selecting healthcare options.