Patient-Client Management Model

Physical Therapists
health care professionals who help individuals maintain, restore, improve movement, activity, functioning, thereby enabling optimal performance and enhancing health, well-being, quality of life
PT services
according to ICF, prevent, minimize, or eliminate impairments of body function and structure, activity limitations and participant restrictions
Restrictions
can be musculoskeletal, neuromuscular, cardio/pulm, integumentary or negative effects attributable to unique personal and environmental factors as they relate to human performance
Primary Care PT
front line in multiple settings; the provision of integrated, accessible health care services by clinicians who are accountable for addressing health care needs, partnership with patients, family communities contexts
Secondary Care PT
referred to PT by another provider
Tertiary Care PT
specialized technology based settings (ex. lung transplant unit)
Primary Prevention
identify risk factors and implement services for susceptible populations
Secondary Prevention
prevent or slow the progression of disability due to sequelae of existing conditions
Tertiary Prevention
reduce degree of disability from chronic conditions
Consultation
getting professional opinion or advice
Critical Inquiry
planning, conducting, analyzing, applying, disseminating research, evaluating efficacy of new and established technology
Professional PT Roles
consultation, education, critical inquiry, administration
Physical Therapy
provided by PT or PTA under supervision
PTAs
under direction and supervision of PTs; only individuals who assist pts
Factors to Consider in Delegation
education, experience, responsibilities, organizational structure, applicable state law
Patients
individuals with a disease who are recipients of PT exam, eval, diagnosis, prognosis, and intervention
Clients
recipients of a PT’s consultation, intervention, professional advice, prevention services or services promoting health, wellness, fitness (for fee, private pay)
Constructs of Current PT Practice
ICF and Biopsychosocial Model, evidence-based practice, professional values, quality assessment
Components of Evidence Based Practice
best available evidence, clinical expertise, patient/client values and circumstances
Professional (Core) Values
accountability, altruism, compassion/caring, excellence, integrity, professional duty, social responsibility
Quality Assessment
PTs measure the quality of their services by assessing structure, process, and outcome using different approaches; continuous and systemic and includes assessment of services, assessment of process of care, measurement of outcomes
Interprofessional Collaborative Practice
practice in collaboration with other health care professionals and members of health care team to meet patients’/clients’ needs
Education of PTs
as of 2016 DPT will be required
Specializations
ABPTS: cv/pulm, clinical electrophysiology, geriatrics, neurology, ortho, peds, sports, women’s health
Scope of Practice
1) Examining 2) Alleviating 3) Preventing 4) Engaging in consultation
Elements of Patient/Client Management Model
exam, eval, diagnosis, prognosis, intervention, outcome
Components of Examination
History,Systems Review, Tests and Measures
History
systematic data gathering related to why consumer is seeking services
Systems Review
brief physical exam, “hands on”, anatomic/physiologic status of CP, integumentary, neuromusculoskeletal, cognition, learning style; determines impaired or unimpaired
Tests and Measures
general diagnostic hypotheses; means of gathering data about individual to rule in or out causes of impairment; part of initial exam; **26 categories
Review of Systems
seek information about all major body systems to determine whether there are symptoms that suggest the need for referral for additional medical evaluation: cv/pulm, endocrine, ears, eyes, nose, throat, GI, genitourinary, reproductive, hematologic, lymphatic, integ, neuro **ex. going in for a shoulder dislocation and getting an eye exam
Reasons for Tests and Measures
1) confirm or reject a hypothesis about the factors that contribute to making the individual’s current level of function less than optimal and 2) support the physical therapist’s clinical judgments about the diagnosis, prognosis, POC
Evaluation
interpret response to tests/measures, integrate tests and measure data with other information from history, determine diagnosis, determine prognosis, determine POC
Diagnosis
use of labels that identify impact of a condition on function at the level of the system (movement system) and at the level of the whole person
Prognosis
determination of predicted optimal level of improvement in function and amount of time needed to reach that level; can include prediction of levels of improvement that may be reached throughout therapy
Plan of Care
statements specifying goals, predicted level of optimal improvement, specific interventions to be used, proposed duration and frequency of the interventions required to reach the goals and outcomes
Goals
intended impact on functioning as result of POC; measurable, functionally driven, time limited; short term v. long term
Episode of Care
after person meets goals and is done seeing PT; can be multiple
Intervention
based on exam data, eval, diagnosis, prognosis, goals, individual factors
Intervention Examples
patient instruction, airway clearing techniques, assistive technology, biophysical agents, functional training in self-care and domestic, work, community, social, civic life, integumentary repair, manual therapy, motor function training, therapeutic exercise
Outcomes
actual results of POC and indicate impact on functioning; at end of episode of care
Global Outcomes
characterizing or quantifying impact of PT interventions in different domains
Coordination
working together of all parties involved with the individual
Communication
exchange of information
Documentation
entry into individual’s health record, consultation reports, progress notes, etc. that identifies the care or services provided and individual’s response to intervention