Showing Our Value: Now Is the Time : Journal of Acute Care Physical Therapy

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PRESIDENT'S MESSAGE

Showing Our Value

Now Is the Time

Norris, Traci L. PT, DPT; President

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Journal of Acute Care Physical Therapy: October 2022 - Volume 13 - Issue 4 - p E1-E2
doi: 10.1097/JAT.0000000000000206
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During his 2022 annual message at House of Delegates, APTA President Roger Herr asked all of us not to dwell in the past, and instead to “exercise foresight.”1 What does that mean? Foresight is defined as “the ability to predict what is going to happen in the future and plan your actions based on this knowledge.”2

What are the opportunities that exist right now and in our near future?

During the first 2 years of the pandemic, many acute care therapists stopped indirect patient care–related activities. These additional professional pursuits included active participation in interdisciplinary rounds and mobility training programs for other patient-facing professions such as nursing and patient care technicians. What are the deleterious consequences of more than 2-year hiatus of physical therapy involvement?

Have the fall rates gone up in your institution? Prior to the pandemic, the Agency for Healthcare Research and Quality estimated that between 700 000 and 1 000 000 patients in the United States fell in the hospital annually and evidence suggests that almost a third of those falls could have been prevented.3 Physical therapy has an essential role in fall prevention due to our expertise and ability to assess movement, our capacity to develop individualized plans of care, and our ability to promote safe interprofessional plans that advance function and mobilization of hospitalized patients.4

Hospitalization-associated disability develops between the onset of the acute illness and discharge from the hospital and may even occur from brief hospitalizations.56 Risk factors identified for hospitalization-associated disability include restricted mobility and enforced dependence with little encouragement of independence,7 and, unfortunately, patients are largely inactive during hospitalization.8–10

Has incidences of hospital acquired disability in your facility gone up?

This preventable loss of function is even more prevalent in hospitalized older adults, as well as can have a profound adverse effect on their overall health, independence, and quality of life after hospital discharge.11–14

How as the national nursing shortage impacted your institution's culture of patient mobility? Has the program lost its momentum? Are patients restricted to getting out of bed solely with physical therapy or not at all?

What is the impact of our inconsistent or absent contributions at interdisciplinary rounds? Evidence indicates that when physical therapy discharge recommendations are followed, patients are less likely to be readmitted.15 Physical therapists' expertise with movement and functioning is essential in discharge planning decisions.16 Have there been complicated discharge planning scenarios that would have produced better outcomes had physical therapists been involved?

The time to show our value and to demonstrate that physical therapy services are essential is now. We need to educate key stakeholders of our value as movement specialists, as well as advocate for the extraordinary services we provide for acutely ill patients.

The need for physical therapy to prove value has been discussed in various platforms for many years. The Journal of Acute Care Physical Therapy reader can search through this publication and find several articles that relate to productivity, value equations, and examine numerous studies that have highlighted our value at an institutional level.17–21 Recognizing physical therapy positions in acute care is often not revenue generating—we must demonstrate the profession's value to our customers, which includes the patient, interprofessional colleagues, and our employer. I believe most would agree that measures of productivity, while widely used, are not effective indicators of the value of physical therapy. APTA Acute Care created a position statement on productivity that supported this stance.22 In the statement, our Academy maintains “The measurement of productivity in acute care physical therapy practice requires an effective system which captures the value of physical therapist services to the patient, as well as value to the healthcare system and society.” 22 In 2021, the APTA adopted HOD P09-21-23-13, stating “The APTA supports productivity standards that balance the patient experience and outcome, respect clinical judgment, adhere to the APTA Code of Ethics, consider the economics of care delivery models, and improve the work experience of the providers.”2324 Based on that position, the APTA is conducting an environmental scan and will develop resources to assist with professional practices consistent with ethical standards, and clinician's well-being. Those resources will help all of us advocate for improvement within our institutions.

On an individual level, what can we do? I challenge you to consider the items below.

Understand what is being considered in your productivity metrics. Colleagues report benefits from taking a step back to better understand the financial and quality dashboard for their department. What metrics are employers utilizing to assess whether physical therapy or the rehabilitation department is successful? Is it number of patients seen, missed visits, or responsiveness to referrals? Once you fully understand that metric, ask yourself what can be done to create movement toward measure of value? Can that become a renewed focus for your department? How can you educate colleagues on those items to create buy-in? Are you treating the right patient, at the right time, for the right condition? Do you have a triage system in place to appropriately allocate caseloads, which assists with hospital throughput, and allows for patients to transition from the emergency department, to inpatient units, to the next level of care once medically appropriate?

Unwarranted variation of practice persists in the profession. Dr Tara Jo Manal, in her 22nd John H. P. Maley Lecture, stated that “the greatest challenge to the value of physical therapy is unwarranted variation—situations in which wide variation of care is not explained by the type or severity of the condition or by patient preferences.”25 Are we adopting evidence-based methodology and utilizing best evidence to decrease unwarranted variations to continuously improve patient outcomes? Are we aware of the clinical practice guidelines that are currently available and are we committed to utilize knowledge translation tools to advance the care we deliver?26–28

Are you overwhelmed or struggling with a particular task and reluctant to seek assistance? We need to advocate for help. We can network with other physical therapists using the listserves and during academy-sponsored events. I recommend that you access resources that currently exist within the APTA and our Academy. I encourage you to step up as volunteers to help with these efforts.

How to show our value is a straightforward question, however as noted above, there are many complex factors to consider. I challenge each of us to strive to identify and implement one item in the goal toward demonstrating the value of acute care physical therapy within your institution.

We don't have to prove our value, alone. Now is a time to collaborate and highlight what we can bring to the interdisciplinary team.

Respectfully,

Traci L. Norris, PT, DPT
President

REFERENCES

1. American Physical Therapy Association. 2022 Presidential Address. https://www.apta.org/article/2022/08/14/2022-presidential-address. Accessed August 14, 2022.
2. Cambridge Dictionary. Foresight. https://dictionary.cambridge.org/us/dictionary/english/foresight. Accessed August 13, 2022.
3. Agency for Healthcare Research and Quality. Preventing Falls in Hospitals. Rockville, MD: Agency for Healthcare Research and Quality. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html. Content last reviewed March 2021. Accessed August 13, 2022.
4. American Physical Therapy Association. The Value of Physical Therapy in Reducing Fall Risk and Fall-Related Injury. https://www.apta.org/contentassets/1b4efd4734c24cffb81afa9e5c21abf0/apta-handout-falls-research.pdf. Last Updated September 21, 2020. Accessed August 8, 2022.
5. Loyd C, Markland AD, Zhang Y, et al. Prevalence of hospital-associated disability in older adults: a metaanalysis. J Am Med Dir Assoc. 2020;21(4):455–461.e5.
6. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence is activities of daily living in older adults hospitalized with medical illnesses: increased vulnerability with age. J Am Geriatr Soc. 2003;51(4):451–458.
7. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: “she was probably able to ambulate, but I'm not sure.” JAMA. 2011;306(16):1782–1793.
8. Baldwin C, van Kessel G, Phillips A, Johnston K. Accelerometry shows inpatients with acute medical or surgical conditions spend little time upright and are highly sedentary: systematic review. Phys Ther. 2017;97(11):1044–1065.
9. Brown CJ, Redden DT, Flood KL, et al. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc. 2009;57:1660–1665.
10. Fazio S, Stocking J, Kuhn B, et al. How much do hospitalized adults move? A systematic review and meta-analysis. Appl Nurs Res. 2020;51:151189. doi:10.1016/j.apnr.2019.151189.
11. Wald HL, Ramaswamy R, Perkin MH, et al. The case for mobility assessment in hospitalized older adults: American Geriatrics Society White Paper Executive Summary 2018. J Am Geriatr Soc. 2019;67(1):11–16.
12. Greysen SR. Activating hospitalized older patients to confront the epidemic of low mobility. JAMA Intern Med. 2016;176(7):928–929.
13. Gill TM, Allore HG, Gahbauer EA, et al. Change in disability after hospitalization or restricted activity in older persons. JAMA. 2010;304(17):1919–1928.
14. Growdon ME, Shorr RI, Inouye SK. The tension between promoting mobility and preventing falls in the hospital. JAMA Intern Med. 2017;177(6):759–760.
15. Smith BA, Fields CJ, Fernandez N. Physical therapists make accurate and appropriate discharge recommendations for patients who are acutely ill. Phys Ther. 2010;90(5):693–703.
16. Lopker M, DeLorm P, Gilroy N, et al. Physical therapists: the missing link to safe care transitions from the acute care setting [published online ahead of print April 13, 2022]. J Acute Care Phys Ther. doi:10.1097/JAT.0000000000000192.
17. Johnson JK, Young DL, Marcus RL. An explanatory model for the relationship between physical therapists' self-perceptions of value and care prioritization decisions in the acute hospital. J Acute Care Phys Ther. 2021;12(4):165–184.
18. Hull BL, Thut MC. Improving operational efficiency, effectiveness, and value in acute care physical therapy using the therapy value quotient. J Acute Care Phys Ther. 2019;10(3):107–116.
19. Hull BL, Thut MC. A simple tool using AM-PAC “6-Clicks” to measure value added in acute care physical therapy: the therapy value quotient. J Acute Care Phys Ther. 2018;9(4):155–162.
20. Gorman SL. Capturing the unmeasured value acute care physical therapy provides. J Acute Care Phys Ther. 2015;6(2):35–36.
21. Smith JL. The praxis of physical therapy-acute care lecture. J Acute Care Phys Ther. 2019;10(3):77–84.
22. Task Force on Productivity/Value, Acute Care Section-APTA. Position Statement on Value vs. Productivity Measurement in Acute Care Physical Therapy. https://cdn.ymaws.com/www.aptaacutecare.org/resource/resmgr/files/2014-11_productivity_value_b.pdf. Published 2014. Accessed August 10, 2022.
23. American Physical Therapy Association. HOD P09-21-23-13. https://www.apta.org/apta-and-you/leadership-and-governance/policies/productivity-standards-physical-therapy-workforce. Accessed August 6, 2022.
24. American Physical Therapy Association. https://www.apta.org/news/2021/09/14/hod-2021. 2021 House of Delegates Recap. Accessed August 6, 2022.
25. Manal TJ. “Strike while the Iron is Hot.” 22nd John H. P. Maley Lecture. American Physical Therapy Association NEXT Conference 2017 Boston, MA. https://www.apta.org/article/2017/06/26/news-at-next-variation-in-care-is-the-professions-greatest-challenge-maley-lecturer-says#:∼:text=%22The%20greatest%20challenge%20to%20the,APTA's%20NEXT%20Conference%20and%20Exposition. Accessed August 6, 2022.
26. Jette DU, Hunter SJ, Burkett L, et al., for the American Physical Therapy Association. Physical therapist management of total knee arthroplasty. Phys Ther. 2020;100(9):1603–1631. doi:10.1093/ptj/pzaa099.
27. Hillegass E, Lukaszewicz K, Puthoff M. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: evidence-based clinical practice guideline 2022. Phys Ther. 2022;102(8):pzac057. doi:10.1093/ptj/pzac057.
28. American Physical Therapy Association. Evidence-Based Practice Resources. https://www.apta.org/patient-care/evidence-based-practice-resources. Accessed August 6, 2022.
© 2022 Academy of Acute Care Physical Therapy, APTA