Implementing an Integrated Electronic Outcomes and Electronic Health Record Process to Create a Foundation for Clinical Practice Improvement

Deutscher, Daniel; Hart, Dennis L.; Dickstein, Ruth; Horn, Susan D.; Gutvirtz, Moshe

doi:10.2522/ptj.20060280

Cited by 82 publications

(92 citation statements)

References 51 publications

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“…7 Differences between those with complete (intake and discharge FS measures) versus those with intake FS measures alone were assessed using chi-square tests of independence if data were categorical or t tests if data were continuous (TABLE 1). Patients with intake and discharge FS measures compared to patients with just intake FS measures were older (P<.01), had more surgery (P = .02), had less chronic symptoms (P<.01), were more likely to receive benefits from indemnity, Medicare Part A, Medicare Part B, and workers' compensation plans (P<.01), reported higher intake FS (P<.01), received more visits (P<.01), and were treated over a longer treatment duration (P<.01).…”

Section: Patientsmentioning

confidence: 99%

“…Data were collected according to methods that have been described. 7,8,25,30,69 Briefly, patients seeking rehabilitation entered demographic, fear-avoidance, and FS data using a computer in the clinic, prior to initial evaluation and intervention. Clinicians entered demographic information at intake and discharge via the computer.…”

Section: Data Collectionmentioning

confidence: 99%

“…7,8 Briefly, items in the lumbar CAT item bank represent functional activities, like "bending or stooping." There are 6 response choices for items from the Back Pain Functional Scale 57 and 3 response choices for physical functioning items.…”

Section: Lumbar Cat and Fs Measuresmentioning

confidence: 99%

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Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

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Functional status (FS) outcomes of patients with lumbar spine dysfunctions managed in outpatient rehabilitation clinics are affected by many variables, including patient demographic variables. 35 Before clinicians can interpret associations between treatments and outcomes in a meaningful way, FS outcomes must be statistically risk-adjusted to control the effect of variables that may or may not be related to clinical care. 8,23,33,35,52 Although statistical risk adjustment models can appear complicated, 53,54 results of these models tend to be clinically logical. For example, it is clinically logical that patients who are older or patients whose symptoms are more chronic should report less FS change compared to patients who are younger or have more acute symptoms, and, indeed, results support this inverse relationship (ie, as patients age, or symptoms become chronic, FS T T STUDY DESIGN: Retrospective analysis of a prospective, longitudinal cohort study of 30 858 patients being treated for a lumbar spine dysfunction in outpatient physical therapy. T T OBJECTIVES:To determine effect of adding a single-item screening variable classifying patients with elevated versus not-elevated scores of fearavoidance beliefs of physical activities at intake, on a model predicting risk-adjusted functional status (FS) outcomes. T T BACKGROUND:Outcomes must be risk-adjusted before making meaningful interpretations. Elevated fear-avoidance beliefs scores have been predictive of poor outcomes. But the importance of elevated fear-avoidance scores in a multivariable model predicting FS outcomes needs further study. T T METHODS:Using retrospective analyses, predictive ability (R 2 ) of multivariable linear regression models of discharge FS with and without classification by elevated versus not-elevated fearavoidance scores were compared, while controlling for intake FS, age, symptom acuity, surgical history, gender, number of comorbidities, and payer. Percent variance controlled and beta coefficients (95% confidence intervals) of each variable in both models were compared. A split-half design was used for model cross-validation. Predictive ratios (predicted FS, divided by actual discharge FS) were assessed. T T RESULTS:Adding fear-avoidance beliefs classification to the discharge FS model improved (P<.001) model predictive ability but only slightly (R 2 without, and with, fear-avoidance classification, 0.2997 and 0.3010, respectively). Variables impacted models similarly (95% confidence intervals not different). Fear-avoidance classification added 0.2% data variance control to the existing model. Cross-validation was supported. Predictive ratios were 1.09 and 1.10, without and with fearavoidance, respectively. T T CONCLUSION:Although screening for elevated fear-avoidance beliefs of physical activities significantly improves the FS outcomes predictive model, the amount of additional meaningful interpretation of FS outcomes was minimal. Exploration of other clinically relevant variables designed to improve outcomes prediction is warranted...

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Section: Patientsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Hart¹,

Werneke²,

Deutscher³

et al. 2011

J Orthop Sports Phys Ther

Self Cite

View full text Add to dashboard Cite

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“…43 Reasons for not starting data collection included computer system was down (n59), cognitive deficits (n55), language barriers (n58), visual deficits (n52), one visit, patient referred for home program only (n53), and no reason given (n56). Of the 692 patients, 64 patients did not have classification data (Table 1).…”

Section: Subjectsmentioning

confidence: 99%

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

Werneke

Hart²,

Oliver³

et al. 2010

Journal of Manual & Manipulative Therapy

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Objectives: Aims were (1) to determine the proportion of patients with lumbar impairments who could be classified at intake by McKenzie syndromes (McK) and pain pattern classification (PPCs) using Mechanical Diagnosis and Therapy (MDT) assessment methods, manipulation, and stabilization clinical prediction rules (CPRs) and (2) McK -derangement 67%, dysfunction 5%, posture 0%, other 28%; PPC -CEN 43%, Non CEN 39%, NC 18%; manipulation CPR -positive 13%; Stab CPR -positive 7%. For patients positive for manipulation CPR (n579), prevalence rates for derangement were 89% and CEN 68%. For patients positive for stabilization CPR (n541), prevalence rates for derangement were 83% and CEN 80%. Discussion: The majority of patients classified based on initial clinical presentation by manipulation and stabilization CPRs were also classified as derangements whose symptoms centralized. Manipulation and stabilization CPRs may not represent a mutually exclusive treatment subgroup but may include patients who can be initially treated using a different classification method.

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“…Resistance to the information system (Deutscher et al, 2008;Zandieh et al, 2008) has been noted as being a detriment to the success of electronic health record implementations. All physicians using the system with few instances of resistance can indicate that the implementation will be fairly problem-free (Kleaveland, 2008).…”

Section: Literature Reviewmentioning

confidence: 99%

Electronic Health Records and User Participation: Digital Natives versus Digital Immigrants

House¹,

Mishra²

2015

IJBM

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The need for clarity in the healthcare management is a matter of frequent discussion and concern among healthcare professionals, practitioners, patients and academicians. Electronic Health Records would provide clarity, transparency, interoperability and transferability in the health care information and data of the patients. It will also reduce the human mistakes and will reduce the likelihood of wrongly reading or interpreting the information. This paper introduces this useful concept and links it to the two classes of health care practitioners-'digital natives' and 'digital immigrants'. The paper further identifies and discusses the relationship between user participation and system success and analyses the impact of moderation by digital natives and digital immigrants. The paper draws evidences from the existing state of literature to propose the relationships. Implications of the research to the practitioners and researchers are discussed.

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Implementing an Integrated Electronic Outcomes and Electronic Health Record Process to Create a Foundation for Clinical Practice Improvement

Cited by 82 publications

References 51 publications

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Effect of Fear-Avoidance Beliefs of Physical Activities on a Model That Predicts Risk-Adjusted Functional Status Outcomes in Patients Treated for a Lumbar Spine Dysfunction

Prevalence of classification methods for patients with lumbar impairments using the McKenzie syndromes, pain pattern, manipulation, and stabilization clinical prediction rules

Electronic Health Records and User Participation: Digital Natives versus Digital Immigrants

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