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Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report

Emily Karlen, Becky McCathie
DOI: 10.2522/ptj.20150035 Published 1 December 2015
Emily Karlen
E. Karlen, MPT, Orthopedic Service Line, Fairview Health Services, 2450 Riverside Ave S, COB-410, Minneapolis, MN 55454 (USA).
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Becky McCathie
B. McCathie, MEd, ATC, Orthopedic Service Line, Fairview Health Services.
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Abstract

Background and Purpose The current state of health care demands higher-value care. Due to many barriers, clinicians routinely do not implement evidence-based care even though it is known to improve quality and reduce cost of care. The purpose of this case report is to describe a theory-based, multitactic implementation of a quality improvement process aimed to deliver higher-value physical therapy for patients with low back pain.

Case Description Patients were treated from January 2010 through December 2014 in 1 of 32 outpatient physical therapy clinics within an academic health care system. Data were examined from 47,755 patients (mean age=50.3 years) entering outpatient physical therapy for management of nonspecific low back pain, with or without radicular pain. Development and implementation tactics were constructed from adult learning and change management theory to enhance adherence to best practice care among 130 physical therapists. A quality improvement team implemented 4 tactics: establish care delivery expectations, facilitate peer-led clinical and operational teams, foster a learning environment focused on meeting a population's needs, and continuously collect and analyze outcomes data. Physical therapy utilization and change in functional disability were measured to assess relative cost and quality of care. Secondarily, charge data assessed change in physical therapists' application of evidence-based care.

Outcomes Implementation of a quality improvement process was measured by year-over-year improved clinical outcomes, decreased utilization, and increased adherence to evidence-based physical therapy, which was associated with higher-value care.

Discussion When adult learning and change management theory are combined in quality improvement efforts, common barriers to implementing evidence-based care can be overcome, creating an environment supportive of delivering higher-value physical therapy for patients with low back pain.

Footnotes

  • Both authors provided concept/idea/project design, writing, data analysis, and project management. Ms McCathie provided data collection.

  • Received January 20, 2015.
  • Accepted September 9, 2015.
  • © 2015 American Physical Therapy Association
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Vol 95 Issue 12 Table of Contents
Physical Therapy: 95 (12)

Issue highlights

  • Physical Activity and Sedentary Behavior in Children With Cerebral Palsy
  • Whole-Body Vibration in Stroke
  • Implementing Quality Improvement for Higher-Value Low Back Pain Care
  • Role of Health Services Research
  • Risk Adjustment for Lumbar Dysfunction
  • Out-of-Pocket Spending for Ambulatory Services: National Panel Survey
  • Physical Therapy for Medicaid Enrollees
  • Association of Rehabilitation Intensity and Risk of Hospital Readmission
  • CMS G-Code Functional Limitation Severity Modifiers
  • Refinements of Medicare Outpatient Therapy
  • Self-Reported Disability in Older Adults
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Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report
Emily Karlen, Becky McCathie
Physical Therapy Dec 2015, 95 (12) 1712-1721; DOI: 10.2522/ptj.20150035

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Implementation of a Quality Improvement Process Aimed to Deliver Higher-Value Physical Therapy for Patients With Low Back Pain: Case Report
Emily Karlen, Becky McCathie
Physical Therapy Dec 2015, 95 (12) 1712-1721; DOI: 10.2522/ptj.20150035
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  • Article
    • Abstract
    • Setting
    • Development of Quality Improvement Process
    • Application of the Quality Improvement Process
    • Outcomes
    • Discussion
    • Appendix 1.
    • Appendix 2.
    • Appendix 3.
    • Footnotes
    • References
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Cited By...

Subjects

  • Health Services Research
  • Health Policy & Administration
    • Health Policy & Administration: Other
  • Special Series and Special Issues
    • Health Services Research Special Series
  • Musculoskeletal System/Orthopedic
    • Injuries and Conditions: Low Back
  • Physical Therapist Practice
    • Evidence-Based Practice
  • Education
    • Education: Other
  • Case Reports

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