How do you know if what you are doing is working? You don’t want to waste your time, or your patients’ time and money.
Physiotherapy is supposed to add value to the healthcare system, not be a drain on it. Value can be defined as improving our patient’s quality of life and function (i.e., effectiveness) while minimizing treatment costs and healthcare visits (i.e., efficiency).1
After decades of collecting outcomes during routine clinical practice, I would like to share with you my clinical thoughts on ways to achieve efficient and effective patient outcomes.
Being effective is important
Decades of discussion have gone into what makes a physiotherapist “effective.” Some believe further education, while others (like myself) have found research suggesting that years of clinical experience, continuing education courses, and specialty certification(s) may not be as important as traditionally thought.
To me, being effective means adding value to patient care. That means being able to measure what you’ve done so that you can use that information and learn from it.
My focal area of clinical interest lies in managing patients with cervical and lumbar impairments from a biopsychosocially-informed perspective. In that realm, I share an unrelenting passion for collecting data and multi-domain outcomes. I do this by using psychometrically sound measures during every day clinical practice to guide patient management.
What you need to know about being effective
So, being effective means being able to measure what you’ve done so that you can use that information to learn from it. The functional status scores from patient self-report outcome measures that physiotherapists typically collect during routine care are observational data.
Common challenges associated with being effective
Differences in outcomes between your patients and other providers may be due to the fact that your patients received superior treatment. It may also be simply due to the differences in the characteristics of the patients you are managing.
The majority of physiotherapists do not have the capability to apply sophisticated risk adjusted analytical methods to strengthen the validity and interpretation of their patient outcomes. We chose FOTO to manage and risk adjust our outcomes; this allows us to compare apples to apples.
Another challenge our research group learned from using observational data for improvement was that it takes time to understand how to integrate patient self-report data into daily practice. Analyses of providers’ performance using FOTO data between 2010- 2014 taught us that it takes about one to three years of practice to enhance your outcome performance skills.
The point is: don’t be discouraged when you first start to systematically incorporate patient outcome data into your practice.
Potential consequences of not using effectiveness in your practice
The short version of not using objective patient self-report data in your practice is that you won’t be as an effective physiotherapist as you could be.
That applies to both choosing what observational data to collect and how you analyze it.
Three things you can do right now to make your clinical practice more effective and efficient
- Understand how to integrate these data to guide your patient management. I don’t believe this concept is emphasized enough at university or postgraduate educational levels. Can you remember an instance when a clinical instructor shared their patient self-report outcome data to support the value of interventions being touted as evidence-based?
- Choose efficient measures. When getting started, using efficient measures means a reduced time for patients to complete and physiotherapists to score. Saving time during fast-paced and often hectic outpatient environments is a strong clinical advantage for collecting data at the patient’s bedside.
- Make a plan to incorporate observational data into your practice today. Start with small steps and within a few weeks, you’ll start to have valuable data to improve your patient care.
- Porter ME. (2010) What is Value in Health Care? N Engl J Med, 363 (26), 2477-2481. DOI: 10.1056/NEJMp1415160.