care planning: better health begins here... april 2013

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Thomson Structure A Case for Change

Care Planning:

Better health begins here ...

April 20131OverviewImportance of care planningWhat we trying to achieve?Implementation steps of care plans - Is it happening?Care planningSchedule managementBarriers to implementationMeasure of SuccessFollow up strategies and expectations

Short Discussion: Why is Care planning important?

Differentiation from competitorClearly outlines treatment plan for client and treatment teamCare plan sheet is a tool. Care Planning is everything

File Management:I would suggest that the objective of File management to be (see following slide). File management is the process or one strategy to ensure that we provide the best possible care by utilizing all options available to our clients and becoming the provider of choice for our clients.

What sets us apart from our competitors? What is it that we are commended for in accreditation, external reviews, audits and external boards our processes, and our systems. This File Management process when executed is the fail safe to ensure that we dont neglect a single file which is a Client.

So you can say this isnt a file management system or process. This is a client management system. This isnt a file management strategy, this is a piece in creating a customer experience.

2Care PlanningObjective:

To provide the best possible care by:Utilizing all options available to clientBecome the provider of choiceCreate the ultimate customer experienceFile management, or client management, is the how to ensuring we create the ultimate customer experience. Today we are going to review some of the components of our system that inform the how in creating the customer experience that include: the tools and processes we have implemented and need to continue to implement in order to create the best experience. We will share some of the successes we have had to date and the overall outcomes we have achieved as a result of the implementation and more importantly the execution of these processes.3Execution OutcomeCreating a Customer ExperienceAssessment & PlanningCare PlanningIt is our experience that the foundation of Client Management is Assessment and Planning . With a comprehensive assessment and individualized planning of each clients injury, when we execute these plans effectively we achieve the outcomes we strive for customer satisfaction, customer engagement, effectiveness of service delivery (RTW, RADL, reduced pain, increased mobility).

4Tools: The AssessmentFirst Impression:Phone callFirst visitIntroductionThorough Assessment (history, special tests, etc.)Communication of Findings:DiagnosisProper educationConfidence regarding managing the injuryTHIS WILL RESULT IN A PLAN!The Assessment

We want to ensure that we have clear communication to managers and physios that the assessment process results in a PLAN

Talking Points:

Assessment has 3 critical elements

Determine expectationsHistory, ROM, Strength, Special Tests, etcCommunication of Findings

Ultimately this results in a PLAN to exceed expectations.

5The Science Behind Care PlansTake away message (clinicians)

Not only a business model

Best practice treatment model optimum care, not rationed careMessaging for clinicians as opposed to managers and admins6The importance of the 24 hour recheckLong et al., 2004Objective: To evaluate the usefulness of a range of factors to predict outcome.

Interventions: Subjects from a randomized controlled trial, matched or unmatched ROM exs to the directional preference.

6 visits in 2 weeks.

Results: Subjects with DP who received matched treatment had a 7.8 times greater likelihood of a good outcome.

The comparative prognostic value of directional preference and centralization. External research support for 24 -48 hours between visits.8The importance of the daily intervention for the off-work patientGuzman et al., 2001Objective: To assess the effect of multidisciplinary biopsychosocial rehabilitation on clinically relevant outcomes in patients with CLBP. Conclusions: Intensive multidisciplinary rehabilitation (>100 hrs) with functional restoration reduces pain and improves function in CLBP.

Multidisciplinary rehabilitation for CLBP: systematic reviewOff work 3-5x per week10The importance of goal settingCoppack et al., 2012Objective: To examine the effects of a goal setting intervention on self-efficacy, treatment efficacy, adherence and treatment outcome.

Interventions:1. Goal setting experimental 2. Therapist-led exercise therapy 3. Non-therapist led exercise therapy

Results: 1. Adherence & Self-efficacy scores - higher in the goal setting group. 2. 3-week treatment outcome did not differ significantly.

Use of a goal setting intervention to increase adherence to low back pain rehabilitation: a RCT Care plans setting the course for treatmentTools: Care Plans Provided to the client at the end of the assessment.

Complete treatment plan outlined for both client and therapists.

Schedule is: front end loaded entirely booked in advance printed off and provided to the client.

CCP reaffirms that we know what is going on, we have seen it before, and we know how to treat it. And this is how we do it Establishes confidence in the patient.

Confidence is much more likely to get you compliance.

What is Front End Loading? Sidney Crosby example.14

Communicationof Care Plans to Clientof Care Plans to Admin/teamThe ScheduleFirst two weeks of treatmentPhysician CommunicationRequest for Medical Information (RMI)Christina: Communication

Care Plan to Client:-As discussed in previous slide, clients will set goals with their physiotherapist (with CCP). -A treatment plan will be created with the expertise of the physio, but together with the client to plan accordingly with any barriers (example; funding, work schedule, transportation).-Homework will be discussed and explained to the client. This would most likely include pain control techniques (REIL, neck retractions), ice/heat-All this is written in the customized care plan. A written copy for both client and physio shows that the therapist has a plan and will be able to take care of the client! Also acts as a written agreement between therapist and client on the treatment plan (no surprises throughout treatment).-The Care Plan can also change and be updated throughout treatment with the client as often as needed!

Clare Plan to Admin/Team:-Carbon copy (or photocopy) of CCP helps admin know when and how often to book a client. -Helps future treatment team know of client goals and upcoming treatment plan-Although CCP is a plan on paper for the team, file review meeting should also be scheduled to discuss client treatment plans on a weekly basis.

Cam takes over with the schedule and RMIs

Front loading to minimize duration of WCB claims and closure within protocols for Auto cases.

RMI: TOOL for involving the GP as part of the team.

15Tools: RMI Completed following assessment of client

Sent to the MD

Remember signatures


Assessment report + a question.Primarily used for Rehab clients +\- $30 fee for completion and return to CBI.Private practice fee at discretion of clinic manager (caseload building tool)16Is this available witout the $30 fee statement?Execution: Care PlansWhat are targets for generation of the RMI?

What are the targets for Care Plan utilization?

How are we doing?



1718Pain ControlRecovery of MovementRecovery of FunctionCare Planning & Schedule ManagementFront end load Admins you can help guide/drive this process.Transition from PT heavy to Kin heavyWeekly review of short term and program goals

Continued follow up & continued scheduling

Ontario MIG model of care18Functional Testing What should it include?

When is it occurring?

How does it drive care planning?


Functional Testing d/c leads to another 2-5 visits to complete appropriate recovery

Frequency of testing visit 5, 10 and discharge planning

Functional testing can assist with ongoing goal setting 19 Process: Ongoing Care Planning

Gym Referrals

Communication tool for updating the Care Plan to therapists being added to the treatment team.

Christina to speak about process at Edm NW.

Gym Referrals:

-Helps communicate to the kins. -Special notes or specific instructions to be written, since the physio is trusting the kins with their clients.

Similar specific Massage Therapy Referrals are also completed for the MTs.

Treatment team can communicate later in the week using file reviews and team meeting forms. (NEXT SLIDE)20Clinic Manager tool - Weekly Team MeetingInclude:

Are quantifiable goals set?Are plans ESTABLISHED?Are plans being done?Is there progression of the treatment?21How to ensure success?The hardest part in the entire process is ensuring that this process is maintained and followed through properly. This requires consistent follow up.

The single most important thing you can do is review files with your team on a weekly basis. Each file should have a treatment plan established, a Care Plan on file. If there is no care planfocus on establishing care plans for ALL clients (Specifically Sponsored).

If there is a plan on file ensure that the plans are complete and have been executed on ie., scheduled kin functional testing is scheduled, and completed; work with admin team regarding schedule management opportunities. If not focus on this section.

If there is a plan established and