Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study

Authors

Philip J. van der Wees, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA vanderwees@gwu.edu.
Emily J. Balog, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
James J. Irrgang, Clinical Rehab Services, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
Hallie Zeleznik, Clinical Rehab Services, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
Paige L. McDonald, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Kenneth J. Harwood, Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.

Document Type

Journal Article

Publication Date

3-1-2024

Journal

BMJ open quality

Volume

13

Issue

1

DOI

10.1136/bmjoq-2023-002338

Keywords

Implementation science; Patient Reported Outcome Measures; Quality improvement; Rehabilitation

Abstract

OBJECTIVE: Measuring health outcomes plays an important role in patient-centred healthcare. When aggregated across patients, outcomes can provide data for quality improvement (QI). However, most physical therapists are not familiar with QI methods based on patient outcomes. This mixed-methods study aimed to develop and evaluate a QI programme in outpatient physical therapy care based on routinely collected health outcomes of patients with low-back pain and neck pain. METHODS: The QI programme was conducted by three teams of 5-6 physical therapists from outpatient settings. Plan-do-study-act cycles were used based on team-selected goals. Monthly feedback reports of process and outcomes of care, including pre-post treatment changes in Oswestry Disability Index (ODI) and Neck Disability Index (NDI), guided the QI efforts. Primary outcomes were pre-QI and post-QI changes in knowledge and attitudes towards outcome measures through a survey, and administered and self-reported compliance with using the ODI and NDI. Semistructured interviews and a focus group were conducted to evaluate the perceived value of the programme. RESULTS: Post-QI, the survey showed improvements in two items related to the role of patients and implementation of outcome measures. Registered pre-QI and post-QI completion rates were high at intake (ODI:91% pre, 88% post; NDI:75% pre, 84% post), while completion rates at discharge improved post-QI (ODI:14% pre, 66% post; NDI: 32% pre, 50% post). Perceived benefits of the QI programme included clinician and institutional accountability to processes and strategies aimed at continuous improvement in patient care. An important facilitator for programme participation was autonomy in project selection and development, while a main barrier was the time required to set up the QI project. CONCLUSION: A QI programme based on the feedback of routinely collected health outcomes of patients with low back pain and neck pain was feasible and well accepted by three pilot teams of physical therapists.

APA Citation

van der Wees, Philip J.; Balog, Emily J.; Irrgang, James J.; Zeleznik, Hallie; McDonald, Paige L.; and Harwood, Kenneth J., "Using feedback on patient health outcomes to improve orthopaedic physical therapist practice: a quality improvement study" (2024). GW Authored Works. Paper 4587.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4587

Department

Clinical Research and Leadership