Making Health Care Better - Can We Do It?

Making Health Care Better - Can We Do It?

I just finished reading an article that every person working in healthcare should take the time to read.

http://www.nytimes.com/2009/11/08/magazine/08Healthcare-t.html?_r=1

Now I’ll really try hard not to make this a discussion about the frustrating differences between the Canadian and US health care systems, not to mention the opinions of Health Care Reform in the US under the new Obama government (Goooooooo-BAMA!), however.....This article brings to the forefront the main issues that I’ve been struggling with in 11 years of practise in the US and 1 short year back into the Canadian system. How do we motivate health care professional to get their patients better and better based on evidence-based practice?

I started to write this blog post with a global approach in mind, and discovered it will come in parts. Fair warning, just sayin....

So I’ve decided for my first venture into this topic to focus on how to make health care providers (I’ll use physical therapists as my example, for obvious reasons) be accountable for their patient outcomes, while also forcing the patient to be accountable for their role in their care. And how knowledge management and decision support platforms are an essential part of where healthcare needs to go in the near future. Health care simply doesn’t have the choice not do to something at this point.

We know that most patients get better faster, and get better ‘better’ if they understand the expectations of themselves and their care provider, and that they trust the clinical decision making skills of their provider. And as my colleague always reminds me, ‘Garbage in, garbage out...’. Remember that this holds true for the human brain in the same way as a computer. How do we promote and support thorough and directed assessments in private practice physical therapy in Canada?

A strong physical therapy diagnosis is the key starting point to developing an appropriate plan of care, clear expectations, and clinically and functionally based short and long term goals. If we don’t do an appropriate assessment in the first place, the succeeding items are subpar...Garbage in, garbage out...
What if we had a clinical decision support system in which we can put our assessment data in and out comes expert clinical reasoning....we do, it’s called Mavenlive....The problem is that it requires a very significant paradigm shift in the way we approach patient care, especially in the way of PT diagnosis, and setting functional, appropriate goals. We have a responsibility to our profession to improve patient outcomes.

The US has been on this for years based on reimbursement – a big issue there is that patient outcomes are driven by reimbursement and not driven by getting the patient better – one of the major problems with the US health care system is that treatments and tests are based in money, money, money, and not on what is best for the patient. Whatever happened to the PATIENT???...argh, I digress, let me get back to the topic of the Canadian approach to best practice guidelines and evidence based practice...where was I?? Oh yes, the US has been focused on best practice guidelines for years, documentation requirements are ridiculous and a big chunk of time is spent in a treating PT’s daily work flow....and this is because if they don’t get patients better is a shorter amount of time, reimbursement and insurance contracts become an issue....it’s not that far behind in Canada. But here, our documentation is ridiculous on the other end of the spectrum. Right, we need to sign our name legibly, but what about goal setting? A thorough evaluation that is documented....we see 20-30 patients a day, how do we remember what we did with them, how they felt, etc if we don’t document it in some sort of required format? What would we do if we got called to court and had to comment on the pt’s presentation that day, and why we decided on Treatment A ie Feeling good, Rx AA (read: As Above) might not help you here....cross your fingers!!! Our profession, particularly Private Practice, would be significantly better off if we approached patient care with more accountability and evidence based practice.

No one wants to take the time though...ugh, it’s more paperwork...actually I think it’s just more time we have to invest in the care of that patient, and since every patient is a dollar amount, it creates a HUGE conflict of interest. We still have a big responsibility to not put in garbage but it’s a step to making clinicians accountable for their outcomes.
Soooooo, how do we do that????

Not all experts are created equally – shared clinical reasoning is the best way to grow. As the above article quotes ‘...well done quality improvement is not punitive; it’s educational. It is also worth noting that those docs determined not to learn never do’...so therein lies the dichotomy, sharing with superior clinical reason’ers makes us better clinicians, but there’s little motivation to become better at what we do and be accountable for that.

That’s going to have to be it for now....I feel good in that I’ve laid the ground work for future blog posts...even though this a random smattering of thoughts I’ve had for the duration of my career....as I’ve said before, stay tuned....this might get good....and hey, patients might get even better....