Evidence-based practice, technology and rehabilatation

Evidence-based practice, technology and rehabilatation Evidence-Based Approach to Comp and Rehab: New Tools and Actionable Approaches Chris E. Stout, PsyD Department of Research and Data Analytics, ATI College of Medicine, University of Illinois, Chicago

Please note that this is a March 2014 presentation. While you can see most of what was displayed, you cannot hear what I said, and I wish you could. You may reach me via http://about.me/DrChrisStout if I may be of help to you in your work. Cheers, Chris

OFFICIAL DISCLAIMER: Cool stuff we’ll not be covering

It’s nice to work with workers’ comp outcomes because… Outcomes are VERY Quantified – RTW at the same job description and PDL or not? – How many days passed before RTW? – Nice, clean, and tidy!

Surgeon’s Perspective on a Good Outcome • • • • • No anesthesia issues No surprises during or after No complications Good wound healing No post-op infection

But how does the story end? Is the patient back at work? Quickly? At the same PDL as prior to injury? With the same job classification?

Just the facts, er, evidence…

Evidence is predicated on clinical outcomes

So, evidence-based practice ROCKs! Right…?

Half of what is taught in medical school will be wrong in 10 years’ time, the problem is we don’t know which half. Sydney Burwell, MD, former Dean, Harvard Medical School

It took an average of 17 years for new knowledge generated by RCTs to be incorporated into practice. –IOM

Not a problem of too little, but too much

Just for Coronary Heart Disease… • 3600 statistical articles are published on average each year • Do you know how long it would take you to keep up…?

If you read 1 article/15 minutes You would have to read >10 articles For 2 hours/day 7 days/week Forever…

OK, So, now WHAT?

It’s about tech…

Onset Location Duration Character Aggravating/Alleviating Relieving factors Timing & severity

Got an image? Onset Location Duration Character Aggravating/Alleviating Relieving factors Timing & severity

• 75% hit rate for NEJM’s weekly puzzler via cut-and-paste • 96% if fill in the fields

There are a number of resources available

EvidenceUpdates • A joint collaboration of BMJ Group and the Health Information Research Unit at McMaster University • Best new evidence tailored to your interests. • 2-step process shrinks ~50,000 articles/year (from >140 clinical journals) down to the most important 1 - 2 articles per month = "noise reduction" of over 99.9%.

And, wouldn’t it be cool if surgeons could have their latest post-op protocol available to their rehab-referrals? They already do (and for free).

And I have been doing some experimenting….

I was always frustrated with the disconnect of getting evidence-based practice in real-time to the clinician while with the patient

But we may have cracked the code

PRN Tx Guideline Consult (brought to you by your EMR)

As a nice side-effect of building this we found…

And now for something completely different…

It’s about tools…

Curated Library

>15,000 prior-managed bills were loaded and rerun against the ODG Treatment UR Advisor for each ICD9CPT combination on frequency, number of visits, recommendations from ODG Treatment, and the "Bill Review Payment (or ODG Approval) Flags" divided into Green, Yellow, Red…

Green, OK to auto-pay up to ODG Codes for Automated Approval max number of visits; Yellow, OK to auto-pay up to 25th %tile number of visits Red, need to review

Evidence-based practice is sort of like MoneyBall

Evidence-based practice is not…

Please be in touch Chris.Stout@ATIPT.com or visit DrChrisStout.com and get these slides (and a lot more)

Evidence-based practice, technology and rehabilatation