Care Planning:

Better health begins here ...

April 2013

Overview Importance of care planning What we trying to achieve? Implementation steps of care plans - Is it happening?

Care planning Schedule management Barriers to implementation

Measure of Success Follow up strategies and expectations

Care Planning

Objective:

To provide the best possible care by: Utilizing all options available to client Become the provider of choice Create the ultimate customer

experience

Execution

Outcome

Creating a Customer Experience

Assessment & Planning

Care Planning

Tools: The Assessment

1. First Impression:• Phone call• First visit• Introduction

2. Thorough Assessment (history, special tests, etc.)

3. Communication of Findings:• Diagnosis• Proper education• Confidence regarding managing the injury

THIS WILL RESULT IN A PLAN!

The Science Behind Care Plans

Take away message (clinicians)

Not only a business model

Best practice treatment model optimum care, not rationed care

The importance of the 24 hour recheck

Long et al., 2004

 Objective: To evaluate the usefulness of a range of factors to predict outcome. 

Interventions: Subjects from a randomized controlled trial, matched or unmatched ROM ex’s 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.

The importance of the daily intervention for the off-work patient

Guzman et al., 2001

Objective: 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 review

The importance of goal setting

Coppack et al., 2012

Objective: 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 treatment

Tools: 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.

Communication• of Care Plans to Client• of Care Plans to Admin/team

The Schedule• First two weeks of treatment

Physician Communication• Request for Medical Information (RMI)

Tools: RMI

• Completed following assessment of client

• Sent to the MD

• Remember signatures

Execution: Care Plans

What are targets for generation of the RMI?

What are the targets for Care Plan utilization?

How are we doing?

• Barriers• Solutions

1st week3-5 visits

Ax*RMI

24 hr recheck* Care Plan

Visit 5Kin Func test

Week 2-48-12 Visits

PT & Kin

Visit 10 Func test

* Report to GP

Week 5-83-5 visits

PT & Kin

Visit 15 Func test

Week 9+

PT & Kin as required

Discharge plan & report

18

Pain Control

Recovery of Movement

Recovery of Function

Care Planning & Schedule Management

Functional Testing

What should it include?

When is it occurring?

How does it drive care planning?

19

Process: Ongoing Care Planning

Gym Referrals

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

Clinic Manager tool - Weekly Team Meeting

Include:

1. Are quantifiable goals set?2. Are plans ESTABLISHED?3. Are plans being done?4. Is there progression of the treatment?

21

How to ensure success?

Process: Goal Setting

Goal Setting

Initial goal setting happens at the assessment

Goals should be reviewed each week during “Team Meeting”

Ensures treatment progression and scheduling adjustments

22

Execution: Care Plans

Clinic Manager tools:

• Schedule Management

• What should the schedule look like for a typical sponsored intake?

• Introduce functional testing

• Testing frequency• Sharing with stakeholders

• Goal Setting

• From intake to discharge

Inactivity list/active client listing

Weekly Clinician Review

Monitor Care Plan completion Plan for ongoing tx planning Transition of client to additional

services Track reporting timelines Track extension requests Discharge planning

Weekly Administration Review

Which clients needs revised schedules What require transition to additional services Track reporting timelines Track extension requests Discharge planning Phase/case closure

Recap: Key Success Factors

Consistent commitment to:• Care Plans• Weekly Team Meetings• Managing performance

Urgency Target for 100 days

• Bridge from Level 1 course to clinic • 100% compliance

– Care Plans– Goal setting– Functional testing– GP / RMI communication

25

Results: 100 Day Plans

100 days from now what should we see?

In clinic implementation/bridge course 100% Request for Medical Input 100% Care Planning

100% review of Care Plans

26