|04-03-2011, 03:39 AM||#1|
Join Date: Feb 2008
Location: Huffman, TX
Thanked 795 Times in 286 Posts
Clinical outcomes - fooling ourselves?
The editor of the American Journal of Sports Medicine recently quipped "Nothing ruins success like follow up". The more I delve into research and its potential applicability to clinical practice, the more my skepticism regarding clinical outcomes grows.
The outcomes we typically measure IMO are often of the continuous variety. Pain, ROM, questionnaire scores, etc...they all have one thing in common: they can turn on a dime and either make the provider/researcher look like a genius or just average (i.e. natural history / regression to the mean etc.)
PTs are fortunate enough not to deal with the ultimate end-point: death. The downside here is that we have to grapple with the complexities of managing continuous outcomes. Often this means manipulating them to make the plan of care fit with expectations of payors or referring providers. I know it has to be done (doesn't it?).
I've spent the last few years going out of my way to be gently honest with patients, referral sources and even payors regarding outcomes. It seems having these discussions (tweaking expectations) has had a positive impact on our practice. Providers (particularly orthopedic surgeons) don't feel as edgy about what's going to happen with their patients at our clinic, payors slowly realize we are trying to do things the right way, and BTW the patients feel they aren't up against some timeline or functional milestone they must reach before "time runs out" on them.
Maybe the best way to work our way through this messy system of clinical practice and health care financing is by simply being intellectually honest with ourselves and others.
Count this as the 1,000,000 time this has probably been said on this forum. It was just on my mind tonight as I was reflecting on a patient I saw today.
Thanks! Off to catch up on Spartacus.
Reider B. Success or Failure? The American Journal of Sports Medicine. 2010;38(1):23 -24.
Rod Henderson, PT, ScD, OCS
It is useless to attempt to reason a man out of a thing he was never reasoned into. — Jonathan Swift
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