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  • PTJ: Physical Therapy Outcomes Registry as a Potential Leader in 'Systems Science'

    "What are the risk-adjusted outcomes for individuals with a specific classification/movement diagnosis?" "Are patient outcomes better if the treatment provided matches the patient's classification/movement diagnosis?"

    Those are the kinds of questions that can be answered through systems science, which emphasizes collecting and analyzing clinical data using a common language, say authors of a "Point of View" article in the November issue of PTJ (Physical Therapy). They believe it's a scientific approach that could make APTA's Physical Therapy Outcomes Registry (Registry) a crucial tool in reducing unwarranted variation in practice.

    In the article, Karen Chesbrough, MPH, director of the Physical Therapy Outcomes Registry; Matt Elrod, PT, DPT, MEd, APTA practice department lead specialist; and James J. Irrgang, PT, ATC, PhD, FAPTA, chair of the Registry's Scientific Advisory Panel, explain the how the 4 pillars of systems science—measurement, innovation, replication, and a continuous cycle of quality improvement—continue to inform the Registry's development and refinement.

    But, authors say, a team approach involving all stakeholders is crucial to improving quality of care, outcomes, documentation, and payment, as well as research. This involves adopting a common data-sharing language across electronic health records (EHRs) and "standardizing a core set of data elements." This electronically migrated EHR data, they write, "would provide opportunities for health services research that is more robust and rich than what is currently possible with existing databases."

    Authors believe that the potential for the physical therapy profession to amass sufficient data to create a robust system is strong. By way of comparison, they describe how the American Academy of Ophthalmology's Intelligent Research in Sight Clinical Data (IRIS) registry accumulated more than 148 million patient visits from just over 13,000 ophthalmologists in just 3 years, making it the country's largest specialty society registry. "Imagine the possibilities of health systems science in rehabilitation with that same number of physical therapists, which would be less than 15% of current APTA membership, contributing data to the Physical Therapy Outcomes Registry," they write.

    While they say that it's "still too early to draw any generalizable conclusions across the profession," authors describe how data from the Registry already being are used to identify gaps in the documentation—gaps that can make a difference in patient outcomes and payment. In addition, they write, "practices and organizations are also starting to portray their workforce through Registry data and to use that information for promotional purposes."

    More teamwork and implementation of systems science principles will help the Registry grow stronger in the future, but even now, authors write, "data representing physical therapist practice, with the assistance of informaticians, has become actionable in practice."

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