Evidence-based practice, technology and rehabilatation

•

2 likes•2,041 views

Dr. Chris Stout

Invited presentation on innovative models of technology and big data to rehabilitation medicine and case management.

Health & Medicine Education

Evidence-Based
Approach to
Comp and
Rehab:
New Tools and
Actionable Approaches
Chris E. Stout, PsyD
Department of Research and Data Analytics, ATI
College of Medicine, University of Illinois, Chicago

Please note that this is a March 2014 presentation.
While you can see most of what was displayed, you cannot
hear what I said, and I wish you could.
You may reach me via http://about.me/DrChrisStout
if I may be of help to you in your work.
Cheers,
Chris

OFFICIAL DISCLAIMER:
Cool stuff we’ll not be covering

It’s nice to work with workers’ comp
outcomes because…

Outcomes are VERY Quantified
– RTW at the same job description and PDL
or not?
– How many days passed before RTW?
– Nice, clean, and tidy!

Surgeon’s Perspective on a
Good Outcome
•
•
•
•
•

No anesthesia issues
No surprises during or after
No complications
Good wound healing
No post-op infection

But how does the story end?
Is the patient back at work?
Quickly?
At the same PDL as prior to injury?
With the same job classification?

Evidence is predicated on
clinical outcomes

So, evidence-based practice ROCKs!

Right…?

Half of what is taught in medical school will be
wrong in 10 years’ time, the problem is we
don’t know which half.
Sydney Burwell, MD, former Dean,
Harvard Medical School

It took an
average of 17
years for new
knowledge
generated by
RCTs to be
incorporated
into practice.
–IOM

Not a problem of too little,

but too much

Just for Coronary Heart Disease…

• 3600 statistical articles are published
on average each year
• Do you know how long it would
take you to keep up…?

If you read 1 article/15 minutes
You would have to read >10
articles
For 2 hours/day
7 days/week

Forever…

Onset
Location
Duration

Character
Aggravating/Alleviating
Relieving factors
Timing & severity

Got an image?
Onset
Location
Duration

Character
Aggravating/Alleviating
Relieving factors
Timing & severity

• 75% hit rate for NEJM’s
weekly puzzler via
cut-and-paste
• 96% if fill in the fields

There are a number of resources
available

EvidenceUpdates
• A joint collaboration of
BMJ Group and the
Health Information
Research Unit at
McMaster University
• Best new evidence
tailored to your interests.
• 2-step process shrinks
~50,000 articles/year
(from >140 clinical
journals) down to the
most important 1 - 2
articles per month
= "noise reduction" of
over 99.9%.

And, wouldn’t it be cool if surgeons could
have their latest post-op protocol available
to their rehab-referrals?

They already do (and for free).

And I have been doing some
experimenting….

I was always frustrated with the
disconnect of getting evidence-based
practice in real-time to the clinician
while with the patient

PRN Tx
Guideline
Consult (brought to
you by your EMR)

As a nice side-effect of
building this we found…

And now for something
completely different…

>15,000 prior-managed bills were loaded and rerun
against the ODG Treatment UR Advisor for each ICD9CPT combination on frequency, number of visits,
recommendations from ODG Treatment, and the "Bill
Review Payment (or ODG Approval) Flags" divided
into Green, Yellow, Red…

Green, OK to auto-pay up to ODG Codes for
Automated Approval max number of visits;
Yellow, OK to auto-pay up to 25th %tile
number of visits
Red, need to review

Evidence-based practice is sort of
like MoneyBall

Please be in touch
Chris.Stout@ATIPT.com
or visit DrChrisStout.com and get
these slides (and a lot more)

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Don Berwick’s ‘Triple Aims of Healthcare’ emphasises the pursuit of improved patient experience as top priority for healthcare systems. However, leaders are challenged with having a clear ‘process’ for improving patient experience. Data collection is often fragmented, person-dependent, inconsistently applied and not reported in real-time. Results take 3 to 18 months before being communicated back to the wards, resulting in a lack of accountability, transparency and meaningful change. Results obtained in the NSW Bureau of Health Information surveys led Western Sydney Local Health District to improve its strategy around measurement of patient experience. Facilitating the collection of timely and granular feedback was needed. Implementation of a new patient survey system (MES Experience) in August 2016 provided a combination of real-time data collection and the unique 6E Framework (experience, emotions, engagement, execution, excellence and evolution) which is now guiding and driving quality improvements and meaningful change for consumers.

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59 minutes ago Luke Powell Initial post - Luke Powell COLLAPSE Top of Form Introduction As nurses, we are guided by evidence-based practice to ensure that the care we deliver is safe and appropriate for our patients. During nursing school, we are encouraged to seek out scientific research to support why we do what we do and are taught to continue to do so even after we leave the classroom. We make decisions based from sources including coursework, our textbooks, and clinical experience (Polit & Beck, 2017). However, I have caught myself asking “what does the research say?” especially when completing cares. In particular, do sequential compression devices (SCD) actually contribute to the prevention of deep venous thrombosis (DVT). Nursing research is conducted to answer questions or solve problems (Polit & Beck, 2017). As I have began to ask my coworkers as to why we use SCDs, the answer is always that this is what we have always done. According to Polit and Beck (2017), this is described as unit culture, and these interventions are based on tradition rather than sound evidence. PICOT Question Many of the patients that I see in the intensive care unit (ICU) can expect to be there for at least three days. Most are too sick to be able to get out of bed and move around the room. This inactivity can potentially put them at risk for developing a DVT. To help prevent this from happening, knee high SCDs are utilized. However, the organization that I work for does not have the evidence they found listed anywhere to support the use of SCDs. In fact, when looking at unit council notes from years ago, the same question was brought up and it was noted that there is no evidence to support their use in the ICU. When conducting research for evidence-based practice (EBP), it is important to create a clinical question that can be answered with research evidence (Polit & Beck, 2017). My PICOT question is “In patients admitted to the ICU, does the utilization of SCDs reduce the risk of DVTs as compared to the use of low dose subcutaneous heparin during a three day admission?” My background questions include: what is a DVT, and what is its pathophysiology? Using PICOT, I can turn this research question into search terms that help to prevent my search from being too broad (Walden Student Center for Success, 2012). Adoption of Evidence-Based Practices Overall, I do believe that my organization is willing to change processes or procedures, if the evidence is there to support such a change. The only problem that I can identify with making those changes is that they must be presented to a committee who reviews our current policies and procedures every two years. Unless there is a strong need to make changes, it could take some time before the specific policy or procedure is up for review. As for my coworkers, we are constantly reevaluating and questioning why we do what we do. It is not that we are trying to find faults within our organization rather that we are try.

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