clinical decision making

1. .

2. Requested plzzzzz…..
 Listen carefully
 Be silent
 Attention
 Important
 Any questions

3. THE PHYSICAL THERAPIST AS
PATIENT/CLIENT MANAGER
ALAM ZEB
ROLL-NO: 09

4. Although the term patient/client management is relatively
new, this is probably the best established and most
recognizable role of the physical therapist (PT).
Patient/client management for the PT has changed
over the years in five areas:
 Knowledge and skill used in the processes of evaluation
and diagnosis, prognosis, and discharge planning.
 Referral relationships with physicians.
 Technological advances in the tools available for
examination and intervention.
 Interpersonal relationships with patients.
 Outcomes of care.

5. The physical therapist integrates the five elements of
patient/client management :
 examination,
 evaluation,
 diagnosis,
 prognosis,
 Intervention
in a manner designed to optimize outcomes.
(The Interactive Guide to Physical Therapist Practice
with Catalog of Tests and Measures (2002)

6. examination
evaluation
diagnosisprognosis
Intervention

7. EVALUATION AND DIAGNOSIS:
Evaluation:
is the process of making clinical judgments, based on
examination data, to create a problem list for each
patient.
This list may include problems
 Require referral of the patient to other professionals.
 Fall within the scope of practice of physical therapy

8.  This decision making process may also be considered
clinical problem solving, diagnosing, or clinical reasoning.
 The end product of evaluation is a diagnosis, which is
the term for problems that have been categorized into
defined clusters, syndromes.

9. PHYSICAL THERAPY DIAGNOSIS:
 Rose suggested that using the term is important to
distinguish the PT’s findings from diagnoses made by
other health care practitioners.
 Sahrmann defined the term diagnosis as simply the
primary dysfunction toward which the PT directs
treatment. and this has helped
 Decreases the fears of the medical community that PTs intend to
diagnose disease,
 infringe on the practice of others
 perform clinical services outside their scope of expertise.

10.  Rose further explained that, by naming and classifying
clusters of symptoms, signs, and demographic data, the
clinician increases the probability that the best results
previously obtained will be replicated or surpassed.
 Physical therapy diagnoses help identify the role of
physical therapy and its scope of practice.
 Nevertheless, some have opposed the idea of PTs using
the term diagnosis, expressing concerns about PTs’
prerogative to diagnose in the first place and the extent of
their involvement in the process.

11. PROGNOSIS:
Prognosis is the determination of :
 The predicted optimal level of improvement in function,
 The time needed to reach that level,
 The levels of improvement that may be reached at
various intervals during the course of physical therapy.

12. The prognosis is documented in the physical therapy plan
of care, which includes the following :
 Specific short- and long-term goals for identified
problems.
 The duration and frequency of specific interventions
selected to meet goals.
 The expected outcome.
 The optimal level of improvement expected.

13. The HOAC II model specifies the types of goals as long
term or short term.
 Long- and short-term goals represent the same kind of
phenomenon (meaningful change for the patient), the
only difference is the time required to achieve them.
 Defining goals in this way is an attempt to reduce
confusion created by PTs who use short-term goals to
reflect the impairments to be addressed so that long-term
functional goals can be met.
 Patient function must therefore be addressed throughout
a plan of care in short and long-term goals that represent
meaningful accomplishments. PTs can check whether a
goal is meaningful or not.

14.  For the patient’s current problems, PTs decide which
interventions will achieve the short- and long-term goals.
 Jette determined that this decision-making process is
influenced by a variety of factors in addition to the
patient’s current health status.
 Factors that contribute to treatment decisions :
 The PT’s educational level,
 The payment source,
 The self-interests of the PT,
 The size of the PT’s caseload

15. DISCHARGE AND DISCONTINUATION
PROCESSES:
Discharge:
 Ending physical therapy services provided during a single
episode of care because the expected goals and
outcomes of treatment have been achieved.
 Documentation requirements may need to be met
regarding the conclusion of physical therapy services.
Note: Discharge does not occur with a transfer: that is,
when the patient is moved from one site to another site in
the same setting or across settings during a single
episode of care.

16.  Discharge is based on the physical therapist’s analysis
of the achievement of expected goals and outcomes.
The physical therapist plans for :
Discharge
Follow-up
Referral

17. Discontinuation:
Ending physical therapy services provided during a single
episode of care because of the following circumstances:
1. The patient, caregiver, or legal guardian declines to
continue intervention.
2. The patient is unable to continue to progress toward
expected goals and outcomes because of :
 Medical complications
 Psychosocial complications
 Financial orinsurance resources have been expended.
3. The physical therapist determines that the patient will no
longer benefit from physical therapy.

18. Discharge Planning:
 Hospitals must have in effect a discharge planning
process that applies to all patients, and the discharge
planning evaluation must include an evaluation of the
likelihood of a patient needing post hospital services and
of the availability of the services.
 In addition the patient and family members must be
counseled to prepare them for post-hospital care.
 Physical therapy practice acts may also address the PT’s
legal responsibility for discharge planning.

19.  The way in which PTs make discharge decisions is
important.
 Jette, Grover, and Keck studied occupational therapists
and PTs in acute care settings to explore this decision-
making process.

20. Transfer or Referral:
 The hospital must transfer or refer patients, along with
necessary medical information, to appropriate facilities,
agencies, or outpatient services as needed for follow-up
or ancillary care..

21. OUTCOMES:
According to the Guide, PTs ask themselves early in
the patient management process.
“What outcome is likely, given the diagnosis?”
 After listing the likely outcomes for each diagnosis,
they may reexamine the actual outcomes to
determine whether the predicted outcomes are
reasonable and then modify them as necessary.

22.  At the end of an episode of care, the PT analyzes through
organizational review processes, the overall impact of the
interventions on :
 the patient’s disorders,
 impairments,
 functional limitations,
 disabilities,
 health status,
 satisfaction with care,
 risk prevention
 The more PTs assume responsibility for practicing without
referrals, the more accountable they will become for the
outcomes of the care they provide.

23. At the end………
Special thanks
Mam Sajida Mazhar
Faryal Javed