Last week was the 2012/2013 Orthopedic and Neurologic Residency graduation at the Harris Health System. It was a great experience watching the current residents pass across the stage. Working with them for the past 2 weeks had been a good experience. It was impressive to see how far they had come as clinicians and educators in the field of physical therapy in just one year.
Another good aspect of being part of a reputable residency program is that they bring in a very distinguished keynote speaker. Our was Anthony Delitto. Delitto has done an incredible amount for the field of physical therapy, especially in the area of low back pain. For example he authored the Clinical Prediction Guideline on Low Back Pain. In addition to a keynote address, he gave a 2 hour con-ed lecture following the reception. The lecture focused more on his current initiative- how to reduce the overwhelming cost of low back pain. It was not your typical facts and stats that things need to change. He mentioned one statistic at the beginning: Low Back Pain costs Americans over $85 BILLION each year. This is the third greatest cost in all of healthcare, trumped only by heart disease and strokes. From there, he started talking about what he and his medical system in Pittsburgh, The University of Pittsburgh Medical Center (UPMC) are doing to decrease the costs associated with Low Back Pain. In its simplest form what they did was provide evidence based care. Amazing right? Well, the literature shows that only ~50% of PTs consistency use what is considered evidence based practice. Delitto and UPMC have created algorithms for low back pain that each PT must complete after an evaluation. The algorithm is essentially a checklist making sure you performed certain tests and obtained the necessary information. The algorithm also directed you toward a specific treatment classification in line with what is the highest evidence of care. He has also worked with hospital management and the insurance companies to create a bundling package, that ensures all patients considered for spinal surgery go to physical therapy prior to having surgery. This has significantly lowered costs as well.
Bottom line: He challenged us to think about our current level of practice. Are we consistently using evidence based practice? I am sure your patients are getting better- so do mine- but are you doing it as quickly and efficiently as possible? To be consistently successful we must have a systematic approach to our treatment sessions.