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Improving and Proving Care with Clinicial Outcome Data

Care influences outcomes, outcomes influence care. It's this simple equation that makes clinical data collection and analysis a best practice for private practice owners.

The consistent pursuit of clinical outcome data can be invaluable. In the case of Integrated Musculoskeletal Care, it's been essential to building its multi-state practice.

"Our organization uses the clinical outcome data to quality assure and in real-time change clinical process behaviors toward an improved outcome," IMC President and Chief Clinical Officer J. Mark Miller says. "When you can consistently achieve quality outcomes, you can then use that data as a marketing tool."

IMC works primarily via direct contracts with large, self-insured employers with workforces that range anywhere from 250 to 25,000. Not only does the clinical outcome data help net employers as new clients, IMC also uses it to improve upon practice behaviors and educate employees internally.

"Clinicians don't know what they don't know," Miller says. "If you look at the biggest problems that currently exist in health care, there's a lot of misinformation: It's poor assessments, misdiagnoses, the over-utilization of imaging. Imaging lacks sensitivity, so imaging results actually drive unnecessary care and referring clinicians just don't recognize it.

"Patient education is set around letting them become aware that there's a problem in the current health care delivery system for their condition, letting them know what those problems are and letting them know a good solution," Miller says. "We're walking them down a pathway for better understanding of the problem, a better understanding of how they're probably going to get caught within that problematic system and how they can avoid that."

These educational efforts include internal print, digital and display pieces that explain causes and solutions behind different kinds of pain. Health fairs, lunch and learns, and employee intranet are just a few ways they inform using the results they are constantly collecting using proprietary software.

"Clinical outcomes data allows us to explain to patients that the last 100; 1,000; 10,000 patients seen in clinics with presentations similar to theirs experienced good to excellent results," IMC CEO Chad Gray says as an example. "You're basically using data to create awareness, reduce fear and anxiety, validate the program and its results, and also help them have some perception of value around the investment they're making in that care."

Their data has shown that false positives and escalation of care can be avoided when the problem is addressed with a movement as opposed to an anti-inflammatory solution. The data also shows that the McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT) that IMC uses exclusively is an extremely effective foundation to approach patient care.

The evidence-based MDT system begins with a thorough mechanical evaluation to establish a "cause-and-effect" relationship between historical pain behavior as well as the response to repeated test movements, positions and activities.

A systematic progression of applied mechanical forces utilizes pain and mechanical responses (motion and function) to classify the disorder. Clinicians then develop a plan of care that empowers patients to treat themselves when possible.

Clinical data should be a priority no matter the method of physical therapy or size of the practice.

"At least start measuring clinical outcome data utilizing what science says are the best metrics to measure," Miller says. "Even if they don't use it for quality assurance, they can use it to be able to make statements on brochures, to make statements when sitting in front of possible referral sources.

"To make those statements, you need clinical data," he says.

That can be as simple as intake and discharge assessments using the standard indexes and dropping the results in a spreadsheet. A few hundred outcomes create a good base.

"We also use that information to motivate and drive productivity and behavior in our clinicians," Gray says. "It creates transparency about how good a job they're doing both clinically and how good a job they're doing to be better stewards of health care resources from a financial perspective."

Every week, reports of pain and function data as well as treatment results are printed and posted in their respective practices. And every week, clinicians consult with IMC clinical leadership to meet challenges.

"It provides some transparency as to where you are as a clinician and where you need to focus your efforts to improve your clinical practice," Gray says.

Care influences outcomes, outcomes influence care and clinical data proves it.

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