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  • Board of Directors: PT Outcomes Registry Gearing Up for 2015 Launch

    Though its pilot test will be delayed until June because of changes to the Physician Quality Reporting System (PQRS), the APTA Physical Therapy Outcomes Registry (PTOR) is becoming more of a reality each day, with workflows, sample data entry screens, and staff ready or nearly ready to proceed.

    The APTA Board of Directors received an update on PTOR progress during its April 3-5 meeting in Alexandria, where staff outlined progress on one of the association's top priorities for 2014. Current plans are for PTOR to begin pilot testing in early June, and to make its official debut in conjunction with the 2015 APTA Combined Sections Meeting (CSM) in February.

    When complete, the registry will provide a user-friendly system to collect uniform data on patient and client outcomes. That data will help guide best practices, help providers meet regulatory reporting demands, generate benchmarking reports, help shape policy, and contribute to emerging payment models. APTA believes that the overall impact of the registry will be to demonstrate the value of physical therapist practice and the ways it can transform society.

    At the Board meeting, APTA staff described the standard elements of the system, which will include visit report forms, workflow and patient management lists, and a data exchange that provides real-time access. Users will be able to opt in to other features that would make it possible to run quality measures on patient populations and connect to other electronic health records (EHR) systems.

    Board members also got a glimpse "beyond the build" to learn how APTA is managing the legal, communications, and marketing side of the project, including a logo—a clean design that will help create identity and recognition.

    With most of the program creation elements in place, the registry will transition during the first half of 2014 from a project overseen by an APTA task force to a full-fledged association-managed product. Current plans are for the task force to conclude its duties in July.

    The PTOR webpage includes a video dispatch created after Board deliberations in August of 2013. APTA will post updates and further information on the registry there as they become available.

    To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.

    APTA Board: First Quarter Strategic Plan Report Shows Progress

    Time marches on, and so does APTA's progress on its 2014 strategic plan.

    An accounting of activities and achievements shared with the Board of Directors at its most recent meeting adds up to one bottom line: solid gains in each of APTA's goals around effectiveness of care, patient and client-centered care across the lifespan, professional excellence, and value and accountability.

    During the Board's meeting April 4-6 in Alexandria, Virginia, staff and board liaisons outlined the work being done to achieve the objectives that support each of the association's 4 major goals. This work is tied to specific metrics that define individual activities and programs and identify timelines to measure progress. It's a long list of activities that ranges from the operational to the aspirational, and touches all of the association's major projects. Highlights from each goal area include:

    Effectiveness of care

    • The physical therapy outcomes registry (PTOR)—a high-priority objective for APTA—is in the build phase, with pilot testing to begin in the summer of 2014 and a full-scale launch in early 2015.
    • PTNow is well on its way to achieving its objective of offering 400 clinical practice guidelines (CPGs) to members, with hundreds of CPGs now available in full text.
    • A CPG endorsement process for externally developed CPGs is now in place, with 2 externally developed CPGs already in review.
    • Products and educational offerings continue to be developed to help PTs integrate research into practice and increase PT knowledge of existing quality measures and their application. These offerings include videos, podcasts, live events, and webcasts.

    Patient and client-centered care across the lifespan

    • Data from the APTA Practice Profile, which now includes information on PTs who provide prevention and wellness services, has been collected and will be used to establish a baseline measure for these activities. A future Practice Profile will measure PT participation in collaborative care models.
    • A report on models of care delivery will be expanded to include findings from a third-party health policy analysis requested by the Board, with a final version to be completed in time for review at the 2014 House of Delegates session in June.
    • With learning domains now in place, APTA will reorganize and enhance educational and supportive resources for PTs reentering the workforce.

    Professional excellence

    • The development of a website for Advanced Proficiency Pathways (APP) is under way, with a pilot program completed.
    • APTA is promoting several programs around professionalism and is refining its communication strategy to highlight the ways in which professionalism is modeled in the association's offerings. Additionally, staff is developing a tool for patients and clients to use to assess the professionalism of their physical therapy providers.
    • A Board task force has completed a gap analysis of documents that guide physical therapist assistant (PTA) curriculum planning and development as part of an effort to identify opportunities for enhancement of PTA education. Additional opportunities for enhancements may be discussed at the 2014 House of Delegates and 2014 Education Leadership Conference.

    Value and accountability

    • The development of a more appropriate payment system—another high-priority objective for the association—has advanced. In February, the physical therapy classification and payment system (PTCPS) was submitted at the American Medical Association's Current Procedural Terminology (CPT) Editorial Panel meeting. The CPT panel decided to postpone a decision on these codes pending pilot testing and further refinement.
    • APTA staff met with Recovery Audit Contractors (RACs) and other CMS representatives to suggest numerous changes to the Medicare audit process, including modifications that would make the alternative dispute resolution process more applicable to PTs.
    • Investigation into the effects of physician self-referral continues. The Government Accountability Office (GAO) is expected to publish a report on self-referral in physical therapy this spring, while work continues on a Foundation for Physical Therapy-commissioned study on self-referral in physical therapy.
    • Efforts to increase direct access to PTs at both the federal and state levels have included discussions with relevant congressional staff and the identification of 3 states—Florida, Louisiana, and Virginia—for potential legislation to remove restrictions on direct access.

    The 2014 Strategic Plan is both an extension of the 2013 plan that was based on APTA’s former Vision 2020, and a “bridge” to the new, more outward-facing vision that APTA adopted at the 2013 House of Delegates—“Transforming society by optimizing movement to improve the human experience.”

    The 2015 Strategic Plan will be based on the new vision.

    To see the full discussion on this and other topics from the April Board of Directors meeting, watch the archived livestream of all open sessions.

    AAP Says Neuromuscular Training Could Lower Risk of ACL Injury in Adolescent Athletes

    A new clinical report from the American Academy of Pediatrics (AAP) asserts that the continued rise in anterior cruciate ligament (ACL) injuries in adolescent athletes could be partially countered by neuromuscular training to "preprogram" safer movement patterns before an injury occurs. Better training could be of particular benefit to female adolescent athletes, who could see their rates of ACL injury risk drop by as much as 72%.

    The recommendation was part of the conclusions and guidance presented in a report (.pdf full text available for free) published in the April 28 edition of Pediatrics. The report addressed diagnosis, treatment, and prevention of ACL injuries in adolescent athletes, which have been on the rise over the past 2 decades due to growing numbers of children participating in sports and more intensive training programs, among other reasons. Intrinsic risk factors include higher BMI, subtalar joint overpronation, generalized ligamentous laxity, and decreased neuromuscular control of the trunk and lower extremities, according to the report.

    While incidence rates among adolescent athletes are still lower than among college athletes (5.5 vs 15 per 100,000 athlete-exposures), the rates are increasing and rise more dramatically during puberty—particularly for girls. Authors of the report write that female athletes between the ages of 15 and 20 account for the largest numbers of ACL injuries among adolescent athletes, and that, overall, girls suffer ACL injuries at a rate 2.5–6.2 times higher than boys in gender-comparable sports.

    The report cautions against surgical interventions for adolescent ACL injuries, particularly when the surgery may cause growth disturbances, but authors also acknowledge the role patient and parent cooperation play in this consideration. While nonoperative treatments such as braces, rehabilitation, and sports restriction are often recommended until skeletal maturity is reached, authors write that "many … athletes and their parents are less inclined to agree to restrict the athlete's activity," which can lead to additional injuries and early-onset arthritis. "Therefore, most recent literature now supports early surgery for pediatric athletes with an ACL-deficient knee and recurrent episodes of instability," they write. Certain techniques minimize the risk of growth plate injury.

    More certain results can be achieved in prevention, where neuromuscular training can have an impact, according to the report. More so than bracing (which authors say is "unlikely" to reduce risk of ACL injury), the training has a preventive effect by helping athletes to "'preprogram' safer movement patterns that reduce injury risk during landing, pivoting, or unexpected loads or perturbations during sports movements," authors write.

    Adolescent female athletes could see the biggest risk reduction, if this training is introduced in their mid-teens. Training that "incorporates plyometric and strengthening exercises, combined with feedback to athletes on proper technique, appears to be most effective," authors write. "Pediatricians and orthopedic surgeons who work with schools and sports organizations are encouraged to educate athletes, parents, coaches, and sports administrators about the benefits of neuromuscular training in reducing ACL injuries and direct them to appropriate resources."

    Research-related stories featured in News Now are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.