Defining Potential Overutilization of Physical Therapy Consults on Hospital Medicine Services

Appropriate use of inpatient physical therapy services is important for preventing hospital-associated disability (HAD). We assessed potential overutilization of physical therapy consults on hospital medicine services using the Activity Measure-Post Acute Care (AM-PAC) score. Our sample included 3592 unique admissions (mean age, 66 years; 48% women) at a large academic medical center. Based on an AM-PAC cutoff of >43.63 (raw score, 18) in patients who were discharged to home, 38% of physical therapy consults were considered “potential overutilization.” Combined with age <65 years, 18% of consults remained “potential overutilization.” After adjustment for age, sex, and length of stay, patients admitted with high mobility scores were 5.38 times more likely to be discharged to home (95% CI, 4.36-2.89) compared with those with low mobility scores. Being more judicious with physical therapy consults and reserving skilled therapy for at-risk patients could help prevent HAD while also having a positive impact on healthcare systems.

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Collaborative Comanagement Between Neurohospitalists and Internal Medicine Hospitalists Decreases Provider Costs and Enhances Satisfaction With Neurology Care at an Academic Medical Center

The Neurohospitalist ◽

10.1177/1941874417735173 ◽

2017 ◽

Vol 8 (2) ◽

pp. 74-81

Author(s):

James G. Greene

Keyword(s):

Positive Impact ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Medicine ◽

Professional Services ◽

Care Model ◽

Future Health ◽

Medical Centers ◽

Academic Medical ◽

Potential Benefits

Background and Purpose: The majority of academic medical centers are moving to a neurohospitalist model of care for hospital neurology coverage. Potential benefits over a more traditional academic model of patient care include greater expertise in acute neurologic disease, increased efficiency, and improved availability to patients, providers, and learners. Despite these perceived advantages, switching to a neurohospitalist model can come at substantial financial cost, so finding ways to maximize the positive impact of a limited number of neurohospitalists is very important to the future health of academic neurology departments. Over the past 7 years, we have implemented a model for inpatient neurological care based on an intimate collaborative relationship between the neurology and hospital medicine services at our main academic hospital. Our goal was to optimize the value of care by decreasing cost while improving quality. Methods: Cost and revenue associated with professional services was evaluated on a yearly basis. As part of ongoing quality improvement efforts, yearly surveys were administered to referring providers during the transition to a collaborative care model in which NHs and medicine hospitalists comanage neurology inpatients. Results: Net operating loss was dramatically decreased upon transition to the new care model. Concomitantly, there was a robust positive impact on perception of overall quality, timeliness, and communication skills of neurology services. Conclusions: Collaborative comanagement is an effective strategy to improve overall satisfaction with neurology services at a tertiary academic medical center while maintaining financial viability.

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A decade of building massage therapy services at an academic medical center as part of a healing enhancement program

Complementary Therapies in Clinical Practice ◽

10.1016/j.ctcp.2014.12.001 ◽

2015 ◽

Vol 21 (1) ◽

pp. 52-56 ◽

Cited By ~ 8

Author(s):

Nancy J. Rodgers ◽

Susanne M. Cutshall ◽

Liza J. Dion ◽

Nikol E. Dreyer ◽

Jennifer L. Hauschulz ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Massage Therapy ◽

Academic Medical ◽

Therapy Services

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Pursuit and Implementation of Hospital-Based Outpatient Direct Access to Physical Therapy Services: An Administrative Case Report

Physical Therapy ◽

10.2522/ptj.20080244 ◽

2010 ◽

Vol 90 (1) ◽

pp. 100-109 ◽

Cited By ~ 15

Author(s):

William G. Boissonnault ◽

Mary Beth Badke ◽

Jane Megan Powers

Keyword(s):

Case Report ◽

Physical Therapy ◽

Medical Center ◽

Academic Medical Center ◽

Plain Film ◽

Scope Of Practice ◽

Direct Access ◽

Pilot Program ◽

Practice Model ◽

Academic Medical

Background and Purpose Despite legislative approval of direct access to physical therapy, other regulatory barriers and internal institutional policies often must be overcome before this practice model can be fully adopted. Few institutional initiatives have been published describing strategies designed to change policies restricting direct patient access. This case report describes steps and strategies associated with successful implementation of a direct access physical therapy model at a large academic medical center. Case Description The process of obtaining institutional medical board and hospital authority board approval and implementing a pilot program is described. Program details, including therapist qualifications and scope of practice, the required internal training program, and program outcome assessment, are provided. The therapist scope of practice includes the ability to refer patients directly to a radiologist for plain film radiography. Early pilot program findings, including challenges faced and subsequent actions, are described. Outcomes Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics. Discussion Autonomy is described, in part, as self-determined professional judgment and action. This case report describes such an effort at a large academic medical center. The interdependent, collaborative relationship among physical therapists, physicians, and hospital administrators has resulted in the implementation of a patient-centered practice model based on the premise of patient choice.

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