Using FOTO Data and Peer Review to

Optimize Patient Care

Julie Collins, MA, OTR/L

April 6, 2014

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Not-for-profit, faith-based health systemWest Ohio Conference of United Methodist Church

Our Organization

+ 17,000 associates

+ 2,800 physicians

+ 3,000 volunteers

+ 19 hospitals(member and affiliated)

+ 30+ ambulatory sites

+ 94,000 inpatient admissions

+ 393,000 ED visits

+ 1.8 million outpatient visits

OhioHealth SystemOhioHealth System

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OhioHealth Physical Rehabilitation OhioHealth Physical Rehabilitation

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OhioHealth Outpatient RehabilitationOhioHealth 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

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 ReviewClinical 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 GoalsORQMC 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 GoalsORQMC Committee Goals

Positively assist in providing therapists timely and specific feedback

Promote efficient resource utilization(therapists, admin, quality, office support)

Support therapist educational goals, professional growth, and competence

Maximize value to patients, payer sources, and regulatory agencies

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Committee ResponsibilitiesCommittee Responsibilities

OP Rehab Quality

Management

Committee

Identify outlying

charts and review

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

The assigned manager will

review the report for cases over the recommended visit

number

Is the case above the recommended

visit number?

Yes

No

No Further peer review required on charts below the recommended visit

below

The manager sends the

appropriate cases to the subcommitte

chairperson

The subcommittee chairperson will

delegate the appropriate cases

to the qualified subcommittee

member

The committee member will

perform the chart review on the

appropriate peer review form within 30 days of receipt

Is the number of visits justified?

Yes

No

The peer review form will be sent to

the individual’s manager

The peer review form will be sent to

the individual’s manager

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

Post-Peer review

The individual’s manager will

review the peer review form

The manager will meet with the

individual one-on-one

Is further action indicated?

Yes

No

The peer review form will be sent back to the Quality Management

Team

The form will be stored in a designated area

Implementation of the appropriate

action (mentoring, coursework, other defined actions)

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Clinical Quality ReviewClinical 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 ReviewClinical 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 ResultsLumbar Peer Review Results

Admission Diagnosis # Visits

Actual# Visits

Predicted

>1 Standard Deviation

>2 Standard Deviations

724.4-LUMBOSACRAL NEURITIS NOS

52 No FOTO X

722.10-LUMBAR DISC DISPLACEMENT

23 18 X

724.2-LUMBAGO 23 12 X

724.2-LUMBAGO 19 10 X

724.4-LUMBOSACRAL NEURITIS NOS

25 18 X

724.2-LUMBAGO 21 12 X

847.2-SPRAIN LUMBAR REGION

19 11 X

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Clinical Quality Data Review QuestionsClinical 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 ResponsibilitiesCommittee Responsibilities

OP Rehab Quality

Management

Committee

Identify outlying

charts and review

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 BoardThe Advisory Board

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System Improvement OpportunitySystem Improvement Opportunity

Acuity FOTO (12 Mo)

OhioHealth (12 Mo)

Acute (0-21 days) 20 % 15 %

Subacute (22-90 days)

28 % 33 %

Chronic (>90 days) 52 % 52 %

FOTO database >5% referrals in “Acute” phase compared to OhioHealth

Plan physician education for earlier physical therapy referral

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System Improvement OpportunitySystem 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 RecommendationsORQMC 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 ????QUESTIONS ????

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ReferencesReferences

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 ContinuedReferences 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 ContinuedReferences 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.