Patient-Client Management Model PDF

[00:00:00] >> [MUSIC] [00:00:08] Welcome everyone to this lecture, where I look to provide an introduction to the Patient Client Management Model to set the stage for what we'll be discussing within the PT fundamentals course. So with that being said, sit back, relax, and enjoy this presentation. B...

[00:00:00] >> [MUSIC] [00:00:08] Welcome everyone to this lecture, where I look to provide an introduction to the Patient Client Management Model to set the stage for what we'll be discussing within the PT fundamentals course. So with that being said, sit back, relax, and enjoy this presentation. By the end of this presentation, you should be able to list the steps involved in the Patient Client Management Model. [00:00:32] Starting at the initial examination all the way to outcomes. Additionally, you should be able to explain how the model guides the decision-making process within the physical therapy profession, as this model is the way in which physical therapists conduct patient care. Seen here on the screen is the patient and client management model. [00:00:55] As per the Guide to Physical Therapy Practice, you can see that this is broken into several components including examination, evaluation, diagnosis, prognosis, intervention, and finally, outcomes. So looking into the first step of this model, which is the examination component. For each patient We must first administer an examination, which includes taking a patient history, carrying out a systems review. [00:01:29] And based on the information gathered during both the patient interview process and the systems review, we then select and perform specific tests and measures for our given patient. So after all of the data has been gathered in the examination process, a problem list is created with all of the relevant and pertinent examination findings identified. [00:01:55] The therapist then evaluates the problem list and forms an opinion about the data that was gathered, which allows for a physical therapy diagnosis to be made and a prognosis to be made in order to predict the outcomes that the patient will have at certain times in the therapy process. [00:02:20] Next, a plan of care is developed, taking into account all of the examination findings and the evaluation and prognosis decisions. And during this process, specific goals are established and we carry out specific interventions to help the patient work towards achieving these goals or patients Specific outcomes that we have developed for that patient. [00:02:44] While carrying out the interventions, we are constantly re-evaluating our outcomes on how the patient is progressing towards their goals, and we make adjustments as needed. Hence all of the two weight arrows seen here on the right side of the graph During our evaluation process, we may also decide that the patient may benefit from working with other healthcare providers, and hence the referral and or consultation box being a part of this model as well. [00:03:24] This is better represented from this diagram found in the guide to Physical Therapy Practice. When a patient presents to our clinic, the first question that we must always ask ourselves is whether the patient is appropriate for our care and services, or whether the patient is appropriate to delegate to a physical therapy assistant. [00:03:45] In order to successfully answer these questions, you have to understand the steps required within the physical therapy patient- client management model, as we just discussed, in order for you to make these types of decisions. Within this diagram, we can see that we may decide that the patient would benefit from consulting with other healthcare providers to gather more information. [00:04:15] This may include other physical therapists, other disciplines, such as medical doctors, nurse practitioners, physician assistants, psychologists, social workers, maybe even occupational or speech therapists. Or perhaps the patient may need to be co-managed by these same healthcare providers while we are working with them still. Or we may decide that PT is just not indicated at all and may refer them out to be managed by another healthcare provider. [00:04:50] If we do decide to manage the patient and deem them appropriate for our care, we are then responsible for developing a patient's specific plan of care and are also accountable for this plan of care throughout the process. We will also be responsible for determining which personnel that we will use, whether this includes a physical therapy assistant or physical therapy technician, and we will then provide direct supervision of this personnel. [00:05:19] I want to also highlight the last bullet point here that it is our responsibility to share information about the management plan including the progress or lack of progress with the individual providers as indicated. In other words, the need for ongoing communication is crucial throughout the patient's plan of care. [00:05:41] So going back to the patient and client management model within the physical therapy fundamentals course, we will be focusing our time around the development of your examination skill set. Thus, let's take a closer look into what the examination component consists of. As mentioned previously, the examination component is comprised of three separate components. [00:06:08] First, the patient history, second, the systems review, and lastly, specific tests and measures. This course is designed to develop your skill set in all three of these areas of the examination process. Taking a closer look at the history component specifically, this begins with an appropriate chart review, in order to determine if there are any red flags to look for and or to further question with the patient. [00:06:42] Regardless of the setting, whether in an inpatient hospital, an outpatient facility, home healthcare, or within a skilled nursing facility, the therapist can look into the medical record to find the patient's identification factors, medical diagnoses, comorbidities, precautions, etcetera. Within the inpatient hospital setting, more specific aspects related to nursing care such as lab values or information around lines and tubes that you may have to manage will be found. [00:07:14] This provides you with a heads-up before you go in and meet with your client. The next component is the patient history. To understand the patient's perspective around their current condition, determine what is their chief complaint and question their symptom behavior and symptom history to help with formulating hypotheses around what's going on. [00:07:36] Additionally, we're going to do gather information surrounding their medical history, along with their social history, such as the environment they work and live in, discuss what activities they enjoy, and gain an overall understanding of their functional levels. We'll also better understand what the patient's goals are and why they're coming to physical therapy. [00:08:01] In the systems review, we will perform a variety of brief screenings for the patient's primary body systems that physical therapists work with that will be used to give the therapist a general idea of what is going on. These systems include the cardiopulmonary system, musculoskeletal system, integumentary system, and the neuromuscular system. [00:08:25] And during this process, we will gain input into the patient's communication ability, their aspect, their cognition, their language and their learning style, which comprises this other category seen here. This process also allows us to identify any red flags that may prompt a therapist refer to another health care professional as needed. [00:08:52] So throughout this systems review process is what we as Physical Therapists are known for. And that is task analysis or observation of movement and is often the most difficult to learn and perfect. This component of the systems review involves a trained eye to recognize normal movement and then subsequently spot movement that is abnormal. [00:09:16] When does this process start? Really It begins as soon as the patient or therapist enters the room. Observation is ongoing and occurs all the time. So it kind of encompasses everywhere during this process. With observation or task analysis, we're really focused around how the patient completes an activity versus whether the patient can perform an activity. [00:09:39] For example, how does the patient conduct bed mobility? Did the patient need to grab onto the bed rails to roll over? Did the patient have to use their arms to go from sitting to standing? These observations can occur anywhere during the process of our examination. Performing the history and systems review allows us to select the most appropriate test and measures from the numerous ones that are available to us. [00:10:08] Usually these tests are focused on the body functions and structures realm of the ICF model, which will be discussed in more depth in detail in a separate course. But this may also Include some outcome measures that look at the activities and participation constructs of the ICF model so that we are able to identify and quantify functional limitations, as well as have additional data to come up with a PT diagnosis and develop a plan of care for the patient. [00:10:41] So the question that I pose is this, what does this examination process have in common with the funnel as seen here on the screen? Well, similar to a funnel that starts wide and narrows down, during the physical therapy examination process, we gather lots of information and data obtained from the examination. [00:11:04] With each step of the process which starts with looking at the intake form during the chart review, performing a patient history, performing a system's review, and then going through specific tests and measures. This process allows us to narrow down until we end up with a pretty refined working hypothesis list for the patient that allows us to develop an accurate PT diagnosis and choose appropriate interventions to address the identified impairments and work towards achieving the patient goals. [00:11:41] Take a patient who comes to see you for lower back pain, for example. There are a number of reasons a patient's lower back may be hurting. This may include a muscle strain, vertebral joint issue, nerve impingement, or even more serious underlying conditions such as kidney issues or cancer. [00:12:00] Again, a wide range of things could be causing low back pain for this patient, but through the questions we ask in our history such as having them describe their symptoms and what makes them worse, what makes them better. We can narrow down the list of possibilities by subjectively ruling conditions in and out such as kidney issues and or cancer. [00:12:22] Furthermore, by performing a systems review, we can quickly know if they are safe to continue with the examination as well as see how they are moving generally and identify other possible impairments that will narrow down the list of tests and measures that we need to perform and perhaps rule out some of the possible sources of low back pain. [00:12:43] Finally, as we do specific tests and measures, we'll be able to further narrow down the list of possible sources of the patient's lower back pain until we are fairly confident with our working primary hypothesis. We then come up with a physical therapy diagnosis for the patient based on the ICF model and that includes the impairments that we identified during the examination related to the activity and participation restrictions that the patient reports to us. [00:13:15] The results of these tests and measures will also give us some quantifiable data that will allow us to know the amount of impairment present, like how much they are limited in their range of motion that we can then set as our patient's goals. All of these will also help us identify which interventions are appropriate, and then we can use this data gathered during the examination process to benchmark progress towards the patient's goals as we apply our physical therapy interventions. [00:13:50] In summary, the main takeaways from this lecture is that there is consistency in how we approach patient care, utilizing the patient- client management model, but recognize that it is not linear in nature and that therapists must treat each patient individually and understand that there will be variability in how a patient progresses through this process. [00:14:13] Also, I hope that you recognize that performing the components of the physical therapy examination is more than just checking off boxes to say that we did it. There is a why, and if we understand this why, we will be able to be refined and efficient, yet still thorough as we carry out our examinations. [00:14:35] Listed here are my references for this presentation. Thank you for listening and please bring any questions you may have surrounding this content to the synchronous session. Enjoy the rest of your day, cheers.