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"Mirror, mirror on the wall...": Reflecting on outcomes

Nikki Rasmussen, P.T., Cert. MDT

Every morning, we look in the mirror while we comb our hair, brush our teeth, and ready ourselves for the day.  Once we are satisfied with our reflection, we head out to face whatever the universe has in store for us.  Sometimes we are satisfied with a clean t-shirt and a baseball cap, and we are on our way quickly.  Other days, we need to spend more time on a more formal appearance.  But no matter what the day, we all check the mirror at least once.

For as often as we do that with our personal appearance, how frequently do we reflect on our professional one?  Of course, we know how to do this exceptionally well with individual patients.  While the patients are with us in the clinic each day, we measure their range, their strength, use special tests and our evaluative skills, and of course, ask them how they think they are doing.  We interpret the results of this information to determine if they are progressing toward the goals that we have agreed are appropriate. 

Consider this, though.  How frequently do we step back, look at the combined results of all of our patient data, and assess how we are performing and give ourselves the “once-over”?    

It is easy to skim over it and think we are doing well, and move on. This is like the baseball cap and t-shirt appearance check.  The quick assessment is especially likely to be true if the clinic is busy, referrals are coming in, and people seem happy.  But for a moment, imagine something more.  Imagine how much more information we could have if we looked deeper.  If we gathered the data we collect from every patient doing what we do every day - and then organized it - we would have very remarkable information.

Acquiring that information by ourselves would take effort and a stack of spreadsheets.  And most of us would prefer analyzing a gait pattern any day of the week over analyzing a spreadsheet.

So, how does this get accomplished?  Easy.  Electronic Outcomes Measurement.

For those who are using FOTO (Focus on Therapeutic Outcomes) for Electronic Outcomes Measurement, the process for the desired and needed information is already in place.  The collection mechanism is well-researched and validated, and the patient-specific reports generated by FOTO tell us a lot about the patient we are treating, before we even get in the exam room.  But that is only the beginning. 

A tremendous amount of data is right at our fingertips and FOTO does all the analysis for us.  

For this to happen, though, an accurate reflection of our overall performance is imperative, and we must do the work and ask our patients to help us provide it.  We all agree that excellent care for every patient is always our priority and we all believe that we are the best at providing that.  Without the patients’ surveys, we have little to support our opinions about ourselves as providers of excellent care.  If we can’t prove it, then quite simply, we can’t prove it.  It is essential then to make sure episodes are completed.  That means not only capturing an intake when patients start care, but also inviting them to provide a status update every few visits while active during care.  Explaining the value of their information to them encourages their interest in participation.  Sharing report information with patients advances it even further.  Additionally, catching the final status and closing the episode as close to the actual discharge date is a key element in accurately reflecting patients’ progress and satisfaction.  Once the episode is completed and closed, it becomes part of the overall outcomes data, rendering it available for reflection both for the individual patient and for the overall dataset.

FOTO provides quarterly reports containing a vast volume of information gleaned from the overall dataset, covering everything from patient satisfaction to average number of visits and change score.  All data is risk adjusted to offer a true “apples to apples” comparison.  Comparing data from this year or quarter to previous years or quarters is simple with the FOTO report portal.  We can also compare ourselves to international averages for effectiveness and efficiency, and compare our patients’ progress to predicted averages.  Reporting is available for the entire organization and can be separated for individual clinics and clinicians and by care type and region of the body.

Now, think of all the questions we might ask about statistics for our practices.  What if we want to know the average improvement score for all shoulder patients?   FOTO’s got it.  What if we want to see which clinicians are showing the highest completion rates?  Absolutely.  How about satisfaction of neuro patients from the third quarter of 2016?  No problem.  What about the staff member who joined the group six months ago – might he benefit from a spine workshop? FOTO is great at identifying areas where someone may need to consider continuing education.

An ongoing and consistent effort is key for keeping the data coming and offering us valuable information.  More completed episodes result in a larger number in the dataset, and therefore, stronger representation of our true outcomes in the reports.  Consider if only 40% of our FOTO cases were complete and we were using this for research.  Would we trust a study with a 60% dropout rate?  Of course not.  We look for studies with large volumes and little attrition to be confident in the results.  The same applies to what we should expect from our outcomes.  Therefore, it is up to us to gather the data on all patients, giving us a sufficient sample size, so we can continually evaluate our overall performance. 

Reflecting on the data requires us to objectively evaluate it with an eye that sets the emotion aside and looks at the numbers as if they were someone else’s.  We must understand what the report is telling us, because this is what our patients collectively are telling us.  Consider what advice would be given to the practitioner whose data is being assessed.  We must ask the difficult questions.  Then we must answer them and celebrate or make changes accordingly. 

We absolutely cannot miss the opportunity to give ourselves the “once-over” before we head out the door and make certain that we truly look the way we think we do.  We can’t avoid looking in the mirror tomorrow just because we thought we looked good today.


Nikki Rasmussen, P.T., Cert. MDT

Clinical Lead, Provider Relations, FOTO, Inc.

Nikki joined the FOTO team in July of 2016 as the Clinical Lead in Provider Relations after 21 years in clinical practice in Wisconsin.  At FOTO, Nikki assists clinics and clinicians with their clinical questions and processes concerns, and instructs clinics implementing FOTO and PT students whose universities use FOTO on clinical rotation.  She also does a monthly webinar series for Canadian FOTO users called FOTO Op Canada, which offers a clinician’s perspective on clinical use of FOTO and is free for CPA members to attend. 

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