Chances are, at some point between April 21, 1989, and this very moment, you said these words: "If you build it, they will come." You're far from alone. That Field of Dreams movie line has been tossed around so much that the stitching's starting to come apart.
But here's why this seemingly worn-out phrase continues to hang around: "if you build it, they will come" speaks to a wish fulfillment fantasy. If we put in the hours, the promotion will be handed to us. If we lay out the facts, we'll win our case. If we turn on the "Open for Business" sign, the customers will flood in. If we build it, they will come. Right?
It's a concept that's as true in physical therapy as anywhere else, particularly when it comes to how the profession goes about not only establishing the effectiveness of physical therapy in transforming lives, but in actually getting health care systems to recognize that effectiveness and do something about it. We're building a growing body of evidence rooted in solid clinical research—but in the end, will that by itself be enough to change entire systems and policies?
The Center on Health Services Training and Research (CoHSTAR) is anchored in the idea that "if you build it, they will come" is a line best left to the movies. In the real world, the physical therapy profession needs to add its perspective to the thinking around health services and health policy, just as it is adding its perspective to the thinking around clinical interventions.
Bottom line: the world needs more PT health services and health policy researchers, and CoHSTAR is making that happen.
CoHSTAR officially launched in early 2015 as the winning proposal in the Foundation for Physical Therapy's search to create a "center of excellence" program. It's a $2.5 million initiative run out of the Brown University School of Public Health in partnership with Boston University and the University of Pittsburgh. APTA contributed $1 million to the Foundation's campaign, which was also funded by gifts from 50 APTA components, individual PTs, foundations, and corporations.
Even though CoHSTAR isn't yet a year old, much is happening. Among the activities: a "pilot studies" initiative that serves as an incubator for research possibilities. Under the program, researchers are awarded grants to begin developing promising studies to be expanded later through additional, outside funding sources. Often these sources require results from a pilot before they'll commit the money to a full-scale study—the CoHSTAR program allows for that to happen.
Here is the first wave of pilot studies funded through CoHSTAR:
Developing a cross-walk for functional measures in postacute care settings
What's the big idea? This project addresses the lack of uniform assessment instruments across postacute care settings by developing a "cross walk" to make it easier to compare data from these assessments. The assessments are getting at different pieces of the same picture, or describing the same picture in different ways, and connections need to be made.
Where it's starting. Researchers are focusing on the Activity Measure for Post-Acute Care (AMPAC), creating a look-up table for scores, and applying those scores to a Medicare data set.
Investigating the associations between continuity of care for LBP and future LBP-related utilization and costs
What's the big idea? Even when physical therapy is used to treat a condition, from a systems standpoint there can be big variations in how that care is delivered: a single PT vs more than 1 PT providing services, for example, or care provided inside vs outside a primary care provider's delivery system. Is it possible to implement a system with improved provider and system continuity that will in turn reduce utilization and costs?
Where it's starting. Researchers are focusing on a population of patients aged 18-64 who have consulted a primary care provider for LBP, and received a subsequent evaluation by a PT (the study excludes patients with probable nonmusculoskeletal causes). They're following these patients for a year to find out how continuity differences affected utilization and costs.
Development and preliminary implementation of a registry for PTs' management of knee pain
What's the big idea? Clinical registries are the key to identifying patterns in practice and outcomes, and with the physical therapy profession developing what will be the nation's largest registry through the Physical Therapy Outcomes Registry, it's time to explore just how key demographic, examination, classification, and outcome variables can be analyzed to identify effective patterns for practice.
Where it's starting. Knee pain. A panel of experts will generate a list of examination, classification, intervention, and outcome procedures, develop an operations manual, and set up a pilot data collection process in selected clinics across the US. Researchers will also provide training to clinics, and conduct interviews with PTs for input on how well the system works and how it might be improved.
This article is a part of APTA's "Profession in Transformation" series. Check it out!