Download Not-for-profit, faith-based health system West Ohio Conference of

Using FOTO Data and
Peer Review to Optimize
Patient Care
Julie Collins, MA, OTR/L
April 6, 2014
OhioHealth System
Not-for-profit, faith-based health system
West Ohio Conference of United Methodist Church
Our Organization
+ 17,000 associates
+ 30+ ambulatory sites
+ 2,800 physicians
+ 94,000 inpatient admissions
+ 3,000 volunteers
+ 393,000 ED visits
+ 19 hospitals
+ 1.8 million outpatient visits
(member and affiliated)
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OhioHealth Physical Rehabilitation
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OhioHealth Outpatient Rehabilitation
+ 20+ ambulatory sites
+ 15 Sub-specialties
+ 150+ Occupational,
Physical, Speech
Therapists, and
Athletic Trainers
+ 200,000+ Visits in 2013
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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
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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
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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
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ORQMC Committee Goals
Positively assist in providing therapists timely and
specific feedback
Support therapist educational goals, professional
growth, and competence
Promote efficient resource utilization
(therapists, admin, quality, office support)
Maximize value to patients, payer sources, and
regulatory agencies
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Committee Responsibilities
Identify
outlying charts
and review
OP Rehab
Quality
Management
Committee
Communicate and
track improvement
for system and
individual
therapists
Identify
opportunities for
improvement and
develop plan
Disseminate results
to management
and clinicians
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OhioHealth Outpatient Rehabilitation Peer Review Program
Assigned manager
by the Quality
Management
Group runs a
report weekly
indicating patient
visit number for all
outpatient
locations and
specialties
Yes
The assigned
manager will
review the report
for cases over the
recommended visit
number
The manager
sends the
appropriate cases
to the subcommitte
chairperson
Is the case above
the recommended
visit number?
The subcommittee
chairperson will
delegate the
appropriate cases
to the qualified
subcommittee
member
No
No Further peer review required on
charts below the recommended visit
below
The committee
member will
perform the chart
review on the
appropriate peer
review form within
30 days of receipt
Yes
The peer review
form will be sent to
the individual’s
manager
Is the number of visits
justified?
The peer review
form will be shared
with the individual
The peer review
form will be sent
back to the Quality
Management Team
The form will be stored in a
designated area
No
The peer review
form will be sent to
the individual’s
manager
Post-Peer review
Yes
The individual’s
manager will
review the peer
review form
The manager will
meet with the
individual one-onone
Is further action
indicated?
Implementation of
the appropriate
action (mentoring,
coursework, other
defined actions)
The peer review form
will be sent back to the
Quality Management
Team
The form will be stored in a
designated area
No
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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
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Care Type
Body Part
Count
Avg Visits
Standard
Deviation
Usual Min
Usual Max
Orthopedic
Lumbar
Spine
45162
11.04
8.1255
-5.21111
27.2911
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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
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Lumbar Peer Review Results
Admission
Diagnosis
724.4LUMBOSACRAL
NEURITIS NOS
722.10LUMBAR DISC
DISPLACEMENT
724.2-LUMBAGO
724.2-LUMBAGO
724.4LUMBOSACRAL
NEURITIS NOS
724.2-LUMBAGO
847.2-SPRAIN
LUMBAR REGION
>1 Standard
Deviation
# Visits Actual
# Visits
Predicted
52
No FOTO
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18
X
23
12
X
19
10
X
25
18
X
21
12
X
19
11
X
>2 Standard
Deviations
X
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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
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Committee Responsibilities
Identify
outlying charts
and review
OP Rehab
Quality
Management
Committee
Communicate and
track improvement
for system and
individual
therapists
Identify
opportunities for
improvement and
develop plan
Disseminate results
to management
and clinicians
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The Advisory Board
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System Improvement Opportunity
FOTO database >5% referrals in “Acute” phase
compared to OhioHealth
Plan physician education for earlier physical
therapy referral
Acuity
FOTO (12 Mo)
OhioHealth (12 Mo)
Acute (0-21 days)
20 %
15 %
Subacute (22-90 days)
28 %
33 %
Chronic (>90 days)
52 %
52 %
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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
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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
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QUESTIONS ????
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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.
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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.
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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.
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