1. Using FOTO Data and Peer Review to Optimize Patient Care Julie Collins, MA, OTR/L April 6, 2014

2. 2 Not-for-profit, faith-based health system West 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 System 2

3. 3 OhioHealth Physical Rehabilitation

4. 4 OhioHealth Outpatient Rehabilitation + 20+ ambulatory sites + 15 Sub-specialties + 150+ Occupational, Physical, Speech Therapists, and Athletic Trainers + 200,000+ Visits in 2013

5. 5 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

6. 6 Clinical 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

7. 7 ORQMC 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

8. 8 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 competence Maximize value to patients, payer sources, and regulatory agencies

9. 9 Committee 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

10. 10

11. 11 Clinical 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

12. 12 Care TypeBody PartCountAvg VisitsStandard Deviation Usual MinUsual Max OrthopedicLumbar Spine 4516211.048.1255-5.2111127.2911

13. 13 Clinical 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

14. 14 Lumbar Peer Review Results Admission Diagnosis # Visits Actual # Visits Predicted >1 Standard Deviation >2 Standard Deviations 724.4- LUMBOSACRAL NEURITIS NOS 52 No FOTOX 722.10- LUMBAR DISC DISPLACEMENT 2318X 724.2-LUMBAGO 2312X 724.2-LUMBAGO 1910X 724.4- LUMBOSACRAL NEURITIS NOS 2518X 724.2-LUMBAGO 2112X 847.2-SPRAIN LUMBAR REGION 1911X

15. 15 Clinical 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 15

16. 16 Committee 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

17. 17 The Advisory Board

18. 18 System Improvement Opportunity AcuityFOTO (12 Mo)OhioHealth (12 Mo) Acute (0-21 days)20 %15 % Subacute (22-90 days)28 %33 % Chronic (>90 days)52 % FOTO database >5% referrals in “Acute” phase compared to OhioHealth Plan physician education for earlier physical therapy referral

19. 19 System 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

20. 20 ORQMC 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

21. 21 QUESTIONS ????

22. 22 References  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.

23. 23 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.

24. 24 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.