Evidence-Based Prac/ce and Paent-Centered Careaskdrlehman.com/ub-ortho/ebp1.pdf · Evidence-Based...
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Evidence-Based Prac/ce and Pa/ent-Centered Care Dr. James J. Lehman Associate Professor of Clinical Sciences University of Bridgeport College of Chiroprac/c
Transcript of Evidence-Based Prac/ce and Paent-Centered Careaskdrlehman.com/ub-ortho/ebp1.pdf · Evidence-Based...
Evidence-BasedPrac/ceand
Pa/ent-CenteredCareDr.JamesJ.Lehman
AssociateProfessorofClinicalSciencesUniversityofBridgeportCollegeofChiroprac/c
Whatdoesevidence-basedprac/cemeantoyou?
Areyouanevidence-basedprac//oner?
ACAEvidence-BasedPrac/cear/cle
Discussion
Whatispa/ent-centeredcare?
Pa/entcenteredcarerequiresmedicaldoctorsandchiropractorstoworkside-by-side.
MyMessage
• Integra/onofevidence-basedchiroprac/cservicesintothehealthcaresystemenhancespa/entsafetyandqualityofcare.
• TheAffordableCareActpermitschiropractorstofunc7onasmembersoftheprimarycareteam.Thelanguageinthebillensuresthatdoctorsofchiroprac7ccanbeincludedonthesepa7ent-centeredandholis7cteams.Thenon-discrimina7onprovisionli=ssomeoftheburdenimposedbyunfairlimita7onsofcertaininsurancecompanies.
PainCareinAmericaMustChange
• Mostpeopleinpain,includingthosewithchronicsymptoms,gotoprimarycareproviderstogetrelief.Butcurrentsystemsofcaredonotadequatelytrainorsupportinternists,familyphysiciansandpediatricians,theotherhealthcareproviderswhoprovideprimarycareinmee7ngthechallengeoftrea7ngpainasachronicillness.Primarycareproviderso=enreceiveliDletrainingintheassessmentandtreatmentofcomplexchronicpaincondi7ons.
CurrentStatusofChiroprac/cPhysiciansinHealthCareSystem
1. Misunderstood2. Overtrained(Limitedscope)3. Undertrained(Chiroprac/cspecialist)4. Underpaid5. Underu/lized
Pa/entcenteredcarerequiresmedicaldoctorsandchiropractorstoworkside-by-side.
KeystoIntegra/on
• Competentandcaring• Evidencebased• Holis/candkind• Pa/entcentered• Willingtointroduceyourself
NewPainManagementModel
• Healthcareteam• Primarycarproviders– MD– DO– NP– PA
• Chiroprac/cfacultymembers,residentsandstudents
• Behavioralhealth
Chiroprac/cServicesatCHCIMeridenpilotevalua/on
IanitaZlatevaDarenAnderson
ProjectSTEP-ingOut
“Integration of Chiropractic Services and Training into a Community Health Center”
RISK
STEP1
STEP2
STEP3
PCMHPrimaryCarePodsRou/nescreeningforpresence&intensityofpainComprehensivepainassessmentandfollowupManagementofcommonpainfulcondi/ons
StructuredfollowupassessmentNurseCarecoordina/on
Complexity
TreatmentRefractory
Comorbidi8es
RISK
OnsiteCo-managementOn-sitebehavioralhealthco-management
PainmanagementgroupsessionsStressreduc/onChiroprac/c
ProjectECHOconsulta/on
Ter/aryInterdisciplinaryPainCentersAdvanced diagnostics & interventions CARF accredited pain rehabilitation
Integrated chronic pain and SUD treatment
TheSteppedCareModelforPainManagementatCHC
0%
0%
0%
14%
7%
0%
7%
3%
16%
3%
0%
0%
0%
14%
9%
0%
6%
4%
20%
3%
0%
0%
0%
13%
12%
0%
6%
7%
25%
4%
Addic/onMedicine
Chiropractor
Acupuncturist
PhysicalTherapy
PainManagement
Physiotherapy
PhysicalMedandRehab
NeurologicalSurgery
OrthopedicSurgery
Rheumatology PainReferralsbycohort
ChronicOpioidCohort(n=1019)
OpioidCohort(n=3663)
PainCohort(n=6746)
Action plan
Lackofpaintraining/lowknowledgescores
Lackofpainspecialtysupport
Lowbehavioralhealthco-
management
LowuseofCAM
Poordocumenta/on
ofpainassessment
andtreatment
lowratesofpain
reassessment
Lowratesofopioid
agreement/u-toxmonitoring
NewCHCPolicy• Utoxq6month• Opioidagreementqyr• Documentedf/uq3mo• PainfollowupHPIfolder• Paindashboard
ProjectECHOOnlinepainCME
Chiroprac/cand(?)
acupuncturesvcatCHC
Behavioralhealthpainreferrals
CHCMeridenChiroprac/cPDSA
• UniversityofBridgeportContractual• Dr.JimLehman+3students• 4hrsessionsWed.andSat.• InternalreferralinECW• ECWHPIfolders• Collabora/vemanagementforpain/musculoskeletalproblems
• PreliminaryResults1/04-4/18/2012– NumberofUniquePa8entsSeen–45– NumberofPa8entVisits–152
<35
years
23.91%
36-50 years
50.0%
>50 years
26.09%
Age Range Distribution
Asian 2.2%
Black or African
American 6.5%
Caucasian 39.1%
Hispanic 52.2%
Race
Medicaid 21.7%
Medicaid Managed Care Fee
for Service 34.8%
Medicare 2.2%
Uninsured 13.0%
Unknown 28.3%
Last Medical Financial Class
Who are the Chiropractic Patients?
male
41.3
% female
58.7%
Gender
CHCMeridenChiroprac/cPDSA
CHCMeridenChiroprac/cPDSA
CHCMeridenChiroprac/cPDSA
CHCMeridenChiroprac/cPa/ents
Period:Jan.4-April18Average/4hrsession TOTALS–N(%)
Booked 8.90 267
ShowTotal 5.07 152(57%)
Show-Ini8al 1.50 45(30%)
Show-Established 3.53 107(70%)
CancelTotal 1.97 59(22%)
Cancel-Ini8al 1.10 32(54%)
Cancel-Established 0.90 27(46%)
NOshow 1.90 56(21%)
NOShow-Ini8al 0.90 24(43%)
NOShow-Established 1.07 32(57%)
CHCMeridenChiroprac/cPDSA:Results
92.1%
50.0%
21.1% 18.4% 18.4%
13.2% 7.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Back Neck Leg Arm Hand/ Wrist Other Foot/ Ankle
Perc
enta
ge
of
Pat
ients
CHCI Chiropractic Services General Area of Treatment
34.1%
22.7%
15.9%
9.1%
4.5% 4.5% 4.5%0%
5%
10%
15%
20%
25%
30%
35%
40%
724.50 724.20 338.40 V82.9 723.10 723.90 728.85
Perc
enta
ge
of
Pat
ients
CHCIChiroprac8cServices
ReferralICD-9Codes
724.50 Backpain(chronic)724.20 LOWBACKPAIN338.40 Chronicpainsyndrome
V82.9 SCREENFORCONDITIONNOS
723.10 CERVICALGIA
723.90 NECKDISORDER/SYMPTNOS
728.85 MUSCLESPASM
CHCMeridenChiroprac/cPDSA:Study
• Painfunc/onalassessmenttool:veryuseful,assessedimpactofpainonavarietyoffactors
• Ptsa/sfac/onwithchiroprac/cassessmenttool:highlysa/sfied
2.5
2.5
2.5
2.5
5.3
5.3
2.6
13.2
2.5
7.5
7.5
7.5
7.9
10.5
13.2
7.9
12.5
10.0
22.5
15.0
13.2
21.1
13.2
13.2
35.0
45.0
37.5
40.0
50.0
36.8
39.5
39.5
42.5
30.0
25.0
30.0
23.7
26.3
31.6
26.3
0.0 20.0 40.0 60.0 80.0 100.0 120.0
day to day activities
work around the home
ability participate in
social activities
your enjoyment of life
things you usually do for
fun
enjoyment of social activities
your household chores
your family life
How much did pain interfere with:
Percent of Patients
Pain functional assessment tool - Chiropractor Patients - time 1
Not at all A little bit Somewhat Quite a bit Very much
2.7
2.7
2.7
2.7
5.4
14.6
14.6
2.7
13.5
5.4
5.4
10.8
10.8
20.6
20.6
18.9
83.8
91.9
91.9
86.5
83.8
64.7
64.7
78.4
0 20 40 60 80 100 120
spent enough time with me
thoroughly explains the
treatment(s) I receive
treats me respectfully
listens to my concerns
answered all my questions
advises me on ways to avoid
future problems
gives me detailed instructions
regarding my home program
Overall, I am completely
satisfied with the services I receive
Percent of Patients
My chiropractor:
Pt satisfaction with chiropractic services assessment tool: highly satisfied
Disagree Agree Strongly Agree
Howmuchdidpaininterferewith:
Time1(Pre-Treatment)Mean(N=40)
Time2(Post-Treatment)Mean(N=8)
yourdaytodayac8vi8es 4.20 2.87
workaroundthehome 4.00 2.37
yourabilitytopar8cipateinsocialac8vi8es
3.80 2.75
yourenjoymentoflife 3.90 2.75
thethingsyouusuallydoforfun
3.77 3.00
yourenjoymentofsocialac8vi8es
3.67 2.87
yourhouseholdchores 3.87 3.00
yourfamilylife 3.6 2.75
PainFunc8onalAssessmentTool
Note:PainInterferenceScale.Scoresonpaininterferenceitemsrangefrom1(notatall)to5(verymuch).
Pa/ents’CommentsfromtheSurveys• Dr.Lehmanandhisstaffof4thyr.internswereabsolutelygreat.Iwasveryimpressedandwouldrecommendthemtoanyone.
• Youareawesome.Ifeelgreat:-)• Iwouldrecommendyourservicestoanybody.Thankyouvery,verymuch!
• Allareashavebeenaddressed,Iamimproving100%.• IwanttoappreciatethetreatmentsIreceivedwithmychiropractorwhenIcameinthefirst/meIwasinalotofpainandIwasn'tabletofunc/onatallandtodayI'mfeelingwonderful.ThankstoyouallandIwishandpraythattheseservicesstaywithus.GoodLuck!
CommunityHealthCarePilotStudyStudentComments
• Thankyouforallowingmetopar7cipate…• Theone-on-onetrainingwasfantas7c…• Seeingpa7entswithseriouspainrespondtochiroprac7ccarewasveryvaluable…
• Excellentclinicaltraining…• Ilearnedmorein6weeksthantheprioryear…
CommunityHealthCenter,Inc.
SiteofthefirstUBCC/CHCchiroprac/cservice
CommunityHealthCenter,Inc.Middletown
CommunityHealthCenterInc.NewsiteswithChiroprac/cServices
• Bristol• Danbury• Norwalk• Meriden• Middletown• NewBritain• NewLondon• Stamford• Waterbury
Thankyou
Ques/ons?
