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Improving the Human Experience Through Collaborative Care
CombinedSectionsMeeting2015
February 4‐7, 2015
Indianapolis, IN
www.aptahpa.org HPA The Catalyst is the Section on Health Policy & Administration
of the American Physical Therapy Association
Speaker(s): Friend "Mark" Amundson, PT, DPT, DSc, MA, SCS, ATC, CSCS
Session Type: Educational Sessions
Session Level: Multiple Level
This information is the property of the author(s) and should not be copied or otherwise used without the
express written permission of the author(s).
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Improving the Human Experience Through Collaborative Care
F. “Mark” AmundsonPT, DPT, DSc, MA, SCS, ATC, CSCS
Disclosure
No relevant financial relationship exists
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Learning Objectives
• Distinguish between the four basic functional levels of the health care continuum as they relate to physical activity.
• Choose the most appropriate health care professionals to collaborate with based upon the functional level of the patient/client.
• Coordinate care of a patient/client along the health care continuum.
• Develop a plan of care for a patient/client that includes functional level terminology.
Transforming society by optimizing movement to
improve the human experience
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Guiding Principles
IdentityQuality
CollaborationValue
InnovationConsumer-centricity
Access/EquityAdvocacy
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Right CareRight TimeRight Place
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Right Level
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Who is the BEST member of the
Health Team to be working with the Patient/Client at that LEVEL?
Best Practice?
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A guide to ease the delivery of safe, effective, and efficient collaborative health care along the health care
continuum.
In a Blink
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What is Health?
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“Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity”
WHO (World Health Organization)
International Classification of
Disease
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“Health is a dynamic state of well being characterized by a physical, mental and social potential, which satisfies the demands of a life, commensurate with age, culture, and personal responsibility. If the potential is insufficient to satisfy these demands the state is disease.”
Meikirch Model, Bircher and Wehkamp 2011
International Classification of
Functioning, Disability, and
Health
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Physical Therapy …..clinical applications in the restoration, maintenance, and promotion of
optimal physical functionGuide
Right Level
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Physical Therapists are health care professionals who help individuals
maintain, restore, and improve movement activity, and functioning,
thereby enabling optimal performance and enhancing health,
well being, and quality of life.Guide
Right Level
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Physical therapist’s services prevent, minimize, or eliminate impairments of body function and structure, activity
limitations, and participation restrictions.
Guide
Right Level
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Physical therapists collaborate with other health care professionals to
address individual needs and provide efficient and effective care across the
continuum of health care settings.Guide
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Our Health Status is DYNAMIC, ever
changing; on a CONTINUUM
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ContinuumA continuous sequence in which adjacent elements are not perceptibly different from each other, although the extremes are quite distinct. (Oxford)
Worst – poor – fair – good - Ultimate
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The health of patients/clients is somewhere along
the health care continuum between
Worst and Ultimate
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Collaboration
A working together “The act of working together with one or more people in order to achieve something (positive)”
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Collaborative Involving people of groups working
together to produce something (positive)
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One2Four developed as a Guide for the delivery of collaborative health care
along the health care continuum
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One2Four based on LEVELS along the
health care continuum
Level: a relative rank on a scale
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LevelsLevel Description
One Total dependence to assisted ADL
Two Assisted to independent in ADL , home, andcommunity
Three Independence in community to moderate intensity fitness to sports activities
Four Moderate to high intensity fitness to sports activities 27
Health Care Providers
One2Four Providers along the Continuum
Level 1: ICU to inpatient rehabilitation
–Physician, nurse, physical therapist
Level 2: Inpatient to outpatient rehabilitation
–Physician, physical therapist, nurse (*Not conclusive list of providers but used as an example)
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Health Care ProvidersLevel 3: Outpatient rehabilitation to fitness program
–Physical therapist, athletic trainer, fitness specialist
Level 4: Fitness program to sports performance
–Sports physical therapist, athletic trainer, fitness specialist
(*Not conclusive list of providers but used as an example)
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LevelFunctional
Characteristics Professionals
One Total Dependence to Assistance for Basic ADL
Physician(s), Nurse, Physical Therapist (PT)
Two Assistance ADL to Independence in Community
Physician, PT, Nurse, Athletic Trainer (AT)
Three General Fitness PT, AT, Sports Performance (SP)
Four Sports Performance Sports PT, AT, SP
Health Care Collaborative Team
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One Two Three Four
Level of Function
ADL Dependenceto Assistance
ADL Assistanceto Independence
CommunityIndependence
to Fitness
Sports Performance
Exercise Intensity
Passive to Low
Low to Moderate
Moderate ≥ High
Moderate ≤ HIGH
Primary planes
of motion
Unidirectional Unidirectional to Assistive
Multidirectional
Unidirectional ≥ Multidirectional
Unidirectional ≤ Multidirectional
Functional Progression
ICD- 10 = injury or illness
ICF = level of function and disability
One2Four = level appropriate intervention
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Applications
Real evidence based medicine has the care of the individual patient as its top priority, asking “what is the
best course of action for this patient, in these circumstances, at
this point in their illness or condition”
BMJ 2014
Right Right Level
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Right Level
Right Care
Right Time
Right Place
Always Patient
Advocate
Determine Patient Level
Level Specific
HCP
Level Specific
TX
Positive Outcome
Right Right Level
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