Summary of Major Differences Between Guide2 and Guide3

Transcription

1 Patient/Client Management Model Summary of Major Differences Between Guide2 and Guide3 The concept of patient/client management model is consistent with the original model approved by the HOD in June 1995: The American Physical Therapy Association endorses a physical therapist patient/client management model which includes: examination, evaluation, diagnosis, prognosis, intervention, and outcome. HOD P (Position) The physical therapist integrates the 5 elements of patient/client management examination, evaluation, diagnosis, prognosis, and intervention in a manner designed to optimize outcomes The management model consists of examination, evaluation, diagnosis, prognosis, intervention, and outcomes. Examination (history, tests and measures), diagnosis, and prognosis are all part of evaluation. Management starts at the beginning of the evaluation, even as information is gathered prior to meeting with a patient/client and continues throughout the defined episode of physical therapist care. This includes coordination, collaboration, communication, and documentation to ensure optimal management of services provided. Guide2 depicted patient/client management model as a linear model. Guide3 depicts a model that is a continuous process of evaluation, measurement, and interventions.

2 Foundational Concepts Disablement model of health identified as a key concept. The terminology selected for the Guide framework was based on the disablement terms developed initially by Nagi (pathology/pathophysiology, impairment, functional limitation, disability) and incorporated the broadest possible interpretation of those terms. Evidence based practice not identified as a key concept. Stated: Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Stated: Critical inquiry is the process of applying the principles of scientific methods to read and interpret ; participate in, plan, and conduct research; evaluate outcomes data; and assess new concepts and technologies. Referenced: evidencebased practice in relation to Hooked on Evidence. Stated: Whenever possible, physical therapists should use measurements whose reliability and validity have been documented in the peer-reviewed literature. Quality and effectiveness of services not identified as a key concept. States: Coordination, communication, and documentation are administrative and supportive processes that are intended to ensure that patients/clients receive appropriate, comprehensive, efficient, effective, and high-quality care from admission through discharge. Professional values not identified as a key concept; however: Physical therapists are the only professionals who provide physical therapy interventions. Biopsychosocial model of health a foundational concept. This model reflects the dynamic interactions among health conditions, functioning, environment, and personal factors that influence an individual s health and well-being, including that a person s health status is determined by the interplay of the person s status in the biological, psychological, and social domains. The International Classification of Functioning, Disability and Health (ICF) provides a means not only to describe the states of illness and disability, but to classify the components and magnitude of level of health. Evidence-based practice a foundational concept. Physical therapist practice incorporates all components of evidence-based practice (EBP), integrating best available research evidence, clinical expertise, and patient/client values and circumstances into decisions regarding services for patients/clients practice management, and health policy. Quality and effectiveness of services a foundational concept. Quality assessment is continuous and systematic and includes: Assessment of the structure of physical therapist services Assessment of processes of care, such as adherence to well-documented practice policies or clinical decision rules Measurement of outcomes of care through data collection and analysis. Professional values a foundational concept. Physical therapists demonstrate professional values in their interactions with patients/clients and colleagues. Physical therapist practice is predicated on certain behaviors that are expected of all physical therapists and that are integral to all practice settings. Identified as core values: accountability, altruism, compassion/caring, excellence, integrity, professional duty, social responsibility.

3 Collaboration not identified as a key concept. Included: Interact and practice in collaboration with a variety of professionals. The collaboration may be with physicians, dentists, nurses, educators, social workers, occupational therapists, speech-language pathologists, audiologists, and any other personnel involved with the patient/client. Physical therapists acknowledge the need to educate and inform other professionals, government agencies, third-party payers, and other health care consumers about the cost-efficient and clinically effective services that physical therapists provide. Person-centered focus a key concept. Physical therapist practice addresses the needs of both patients and clients through a continuum of service across all delivery settings by identifying health improvement opportunities, providing interventions for existing and emerging problems, preventing or reducing the risk of additional complications, and promoting wellness and fitness to enhance human performance as it relates to movement and health. Collaboration a foundational concept. Through the execution of the patient/client management model, the physical therapist determines the need for physical therapy and other services and develops the plan of care in collaboration with the patient/client, caregivers, and other health care professionals involved in the care. Person-centered focus a foundational concept. As integral members of a collaborative, multidisciplinary health care team, physical therapists aim to provide patient/client centered care.

4 Review of Systems/Systems Review Review of systems - not included or defined The history includes a review of systems, which consists of a series of questions or checklists that relate to general health and the functioning of specific body systems. The review of systems begins during the initial interview with the patient/client and is usually completed during the examination as physical findings and patient/client responses to questions prompt additional and more specific questions. The review of systems has multiple intended purposes: To identify symptoms originating from other body systems that may mimic those that can arise from the musculoskeletal, neuromuscular, cardiovascular/pulmonary and integumentary systems, and, therefore, provide alternative explanations for the symptoms reported by the patient. To enhance the recognition and understanding of various symptoms to help identify malfunction in a specific body system resulting from (1) an undiagnosed disease or condition, (2) a worsening of a recognized condition, or (3) an adverse reaction to a medication or other medical treatment, thereby indicating a need for referral or follow-up. Review of systems is more consistent with language used in health care community. Reflects physical therapist s role as entry point into the health care system. Systems review a brief or limited examination of (1) the anatomical and physiological status of the cardiovascular/pulmonary, integumentary, musculoskeletal, and neuromuscular systems and (2) the communication ability, affect, cognition, language, and learning style of the patient. The physical therapist especially notes how each of these last 5 components affects the ability to initiate, sustain, and modify purposeful movement for performance of an action, task, or activity that is pertinent to function. The systems review includes the following: For the cardiovascular/pulmonary system, the assessment of heart rate, respiratory rate, blood pressure, and edema For the integumentary system, the assessment of pliability (texture), presence of scar formation, skin color, and skin integrity Systems review not defined. Concept is included in Tests and measures: The physical therapist examination includes, at a minimum screening or initial testing of the status of the musculoskeletal, neuromuscular, cardiovascular/pulmonary, and integumentary systems. Vital signs should be collected on each patient/client as the minimum examination of the cardiovascular/pulmonary system.

5 For the musculoskeletal system, the assessment of gross symmetry, gross range of motion, gross strength, height, and weight For the neuromuscular system, a general assessment of gross coordinated movement (eg, balance, gait, locomotion, transfers, and transitions) and motor function (motor control and motor learning) For communication ability, affect, cognition, language, and learning style, the assessment of the ability to make needs known; consciousness; orientation (person, place, and time); expected emotional/behavioral responses; and learning preferences (eg, learning barriers, education needs) The systems review also assists the physical therapist in identifying possible problems that require consultation with or referral to another provider. Outcome Status, Outcome Measures, Goals Outcome status not defined; does define Expected outcomes the intended results of patient/client management, which indicate the changes in impairments, functional limitations, and disabilities and the changes in health, wellness, and fitness needs that are expected as the result of implementing the plan of care. The expected outcomes in the plan should be measurable and time limited. Outcome measures not defined. Does include: As the patient/client reaches the termination of physical therapy services and the end of the episode of care, the physical therapist measures the global outcomes of the physical therapy services by characterizing or quantifying the impact of the physical therapy interventions Goals - The intended results of patient/client management. Goals indicate changes in impairment, functional limitations, and disabilities and changes in health, wellness, and fitness needs that are expected as a result of implementing the plan of care. Goals should be measurable and time limited. (If required, goals may be expressed as short-term and long-term goals.) Outcome status is the impact of care on patient/client health over time. Outcome measures quantify the changes in impairments in body function and structure, activity limitations, and participation restrictions, and the changes in health, wellness, and fitness that are expected Goals reflect the intended results of management and indicate the changes in impairments in body function and structure, activity limitations, and participation restrictions and the changes in health, wellness, and fitness that are expected as the result of implementing the plan of care. Goals should be measurable, functionally driven, and time limited.

6 Episode of Physical Therapist Care An episode of physical therapy care consists of all physical therapy services that are (1) provided by a physical therapist, (2) provided in an unbroken sequence, and (3) related to the physical therapy interventions for a given condition or problem or related to a request from the patient/client, family, or other provider. A defined number or identified range of number of visits will be established for an episode of care. A visit consists of all physical therapy services provided in a 24-hour period. The episode of care may include transfers between sites within or across settings or reclassification of the patient/client from one preferred practice pattern to another. Reclassification may alter the expected range of number of visits and therefore may shorten or lengthen the episode of care. If reclassification involves a condition, problem, or request that is not related to the initial episode of care, a new episode of care may be initiated. An episode of physical therapy maintenance is a series of occasional clinical, educational, and administrative services related to maintenance of current function. No defined number or range of number of visits is established for this type of episode. An episode of physical therapy prevention is a series of occasional clinical, educational, and administrative services related to prevention, to the promotion of health, wellness, and fitness, and to the preservation of optimal function. Prevention services; programs that promote health, wellness, and fitness; and programs for maintenance of function are a vital part of the practice of physical therapy. No defined number or range of number of visits is established for this type of episode. An episode of care is defined as a period of time in which a problem or condition is diagnosed, treated, and managed. The episode of care should include all services provided to a patient/client within a specific period of time across a continuum of care. It may be continuous, or it may consist of a series of intervals marked by 1 or more brief separations from care; it also may identify the sequence of care (e.g., inpatient to outpatient) provided in various settings. An episode of care is distinct from an episode of disease or illness; therefore, for chronic conditions, the duration of an episode of physical therapy care usually is set at 1 calendar year. For acute conditions, the period typically begins when the condition is first examined and ends when treatment for the condition is completed.