Preparing Students for a Changing Health Care Environment: Integrating Evidence-Based Practice and Performance Improvement
Purpose
The purpose of this educational session is to describe the didactic and clinical training that prepares DPT graduates to function as effective, value-based clinicians.
Methods and/or Description of Project
In his 2012 Mary McMillan Lecture, Alan Jette stated “Physical therapists must become equipped with the skills necessary to function within an effective health care system to identify what works, for what conditions, under what circumstances and at what costs.” Furthermore, payment and reimbursement for physical therapist services is shifting from volume-based to value-based methodologies, where value is defined as the ratio of the benefits to the costs of care. To function successfully in today’s health care environment, physical therapists must be able to implement the principles of evidence-based practice, have an interest in and use of process of care and clinical outcomes data, and have the skills to recognize and develop solutions for problems uncovered by the data (i.e., a quality improvement approach). More importantly the new graduate must be prepared with these skills as they leave the entry-level program. Previous anecdotal reports have indicated that it can take up to two years for practice sites to bring new graduates “up to speed” to be fully functioning members of the healthcare team. While this extended amount of time was tolerated in the past, the current environment can no longer afford such delays in practicing in a value-based manner.
To train our students in the application evidence-based practice principles, and to have them understand the importance and use of data to improve their performance, we have integrated the essential skills of evidence-based practice and quality improvement throughout the entire DPT curriculum. Through a series of courses students learn and apply the principles of evidence-based practice, outcome measurement and data collection, organization, analysis and interpretation. The series begins with principles of research methodology and design and then progresses with sequential courses that introduce evidence-based practice concepts, appraisal of intervention studies, diagnostic and prognostic studies, quality improvement and outcomes management, outcome measures and database development. Integration of lecture and discussion, including small-group forums, are part of the teaching strategies used to enhance the students’ understanding of the impact of using best evidence to guide clinical practice.
This knowledge is translated into clinical practice through a performance improvement project that is conducted during the year-long clinical internship. Prior to the start of the clinical internship, students use the best available evidence to create clinical practice guidelines for classifying and treating the types of patients they are expected to manage in their assigned clinical placement. The students learn to integrate this information with their clinical expertise, while accounting for the unique needs of the patient. Patient-centered outcomes and process of care data are gathered on all patients for a 3 month period. The students then summarize and analyze the data, critically appraising their performance by reflecting on adherence to practice guidelines and the achievement of meaningful clinical outcomes. From this, they establish and implement a performance improvement plan. Data are collected for an additional 3 months to determine the effectiveness of the performance improvement plan.
Completion of the performance improvement project during the yearlong internship allows us to evaluate how well the DPT students implement evidence-based practice standards in real-life clinical environments, including adherence to best care principles, compliance with data collection, and outcome changes that can be benchmarked to known standards of practice. The students also have a yearlong opportunity to identify areas for personal and professional skill development.
Two recent graduates of the program will provide their perspectives by providing a brief summary of the performance improvement project that they conducted during their yearlong internship. They will also discuss how this training has influenced their career and their distinct areas of practice.
In reflecting on our experiences, we recognize the challenges of translating this quality improvement approach from the educational environment to clinical practice. It is critical that all stakeholders have a clear understanding of the usefulness and relevance of the data. Moreover, it needs to be clear that this process is not research, rather it is an important part of today’s clinical practice and should be seamlessly integrated into routine operations. Additionally, the systems and technology to foster routine collection and analysis of clinical data are lacking. As a result we are embarking on the creation of an application to facilitate the ease with which the student can track their patient outcomes and critically evaluate their performance. This should allow the student to maximize their learning and understanding of the quality improvement approach, rather than being burdened with the details of setting up the data collection system. This initiative aligns with the recent launch of the APTA Physical Therapy Outcomes Registry.
Results/Outcomes
Over the past 12 years we have trained 575 DPT students to apply evidence based practice principles, and to collect and analyze data in order to improve clinical performance and provide value-based care. As part of the process, students typically collect and analyze data on over 2000 patients per year. Each student writes two papers summarizing and critically appraising their own clinical performance. In addition students participate in group presentations midway through and at the end of their year-long internship. The final presentation is part of the capstone experience and includes invited distinguished guest discussants.
Conclusions/Relevance to the conference theme: The Pursuit of Excellence in Physical Therapy Education
Adoption of this educational model will provide the DPT graduate with the skills necessary to assess and improve their clinical performance. Ultimately this has the potential to transform the profession and prepare the physical therapist to deliver optimal value in today’s evolving and challenging healthcare environment.
References
Jette, AM. 43rd Mary McMillan Lecture. Face into the storm. Phys Ther. 2012 Sep;92(9):1221-9.
American Physical Therapy Association. 2016 Strategic Plan. Available at http://www.apta.org/StrategicPlan/
Course Objectives
1-Provide the rationale for collecting and using process of care and outcomes data to improve clinical performance;
2-Describe curricular considerations necessary to prepare future clinicians;
3-Provide the perspective of recent graduates on how the process of data collection and use informs their clinical practice;
4-Provide considerations for implementation as part of routine clinical education and practice.
Instructional Methods
Lecture and discussion with question and answer period.
Tentative Outline/Schedule
Rationale for the Collection and Use of Data for Performance Improvement - 15 minutes.
Curricular Considerations Necessary to Prepare Future Clinicians - 20 minutes.
Perspective of Recent Graduates on How the Process of Data Collection and Use Informs their Clinical Practice - 20 minutes.
Considerations for the Implementation of Performance Improvement Processes as Part of Clinical Education and Practice - 15 minutes.
Discussion /Question & Answer - 20 minutes.