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A Little Look at Big Data

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    a little look at big data

    A Little Look at Big Data

    Chris Stout, PhD, Vice President

    Research and Data Analytics

    it was nice to come to ati work with workers comp

    It was nice to come to ATI work with

    workers’ comp outcomes

    because…

    Outcomes are VERY Quantified

    – RTW at the same job description and PDL

    or not?

    – How many days passed before RTW?

    – Nice, clean, and tidy!

    i was always frustrated with the disconnect

    I was always frustrated with the

    disconnect of collecting PROs in real-

    time for the clinician (as well as me!)

    but we may have cracked the code

    But we may have

    cracked the code

    passionate about patient satisfaction since

    Passionate about Patient Satisfaction:

    Since its inception, ATI has been focused on our mission to provide the highest quality of care in a friendly and

    encouraging environment. We have the most inclusive, methodologically sound, and productive program in physical

    therapy. Last year alone, we sent out 222,354 patient satisfaction surveys and received 55,082 in return (a 25%

    response rate).

    • Each day, returned surveys are scanned into our IT infrastructure and are immediately available to the Clinic

    Director and Operations Leadership. This allows the Clinic Director to share praises with the staff, as well as

    address anything that is not exceeding expectations related to quality of care or customer service. It is a concrete

    example of how the benefit of a strong IT platform enables ATI to maintain an extremely high-touch

    management environment where clinicians and managers can be immediately responsive to patient feedback.

    • We are not content with small samples or biased data, so ATI invested in industry-leading methodology and was

    published in Advance for Physical Therapy for “What Patients Want: Innovative uses of patient satisfaction data in

    quality improvement and clinical management.”

    10

    ati also introduced the use of the net promoter

    ATI also introduced the use of the Net Promoter Score (NPS) to the physical therapy industry. The NPS is a

    customer loyalty metric used across many industries, including healthcare. It was introduced in Fred Reicheld’s 2003

    Harvard Business Review article on the topic. Patients are asked, on a scale of 0-10, how likely they are to

    recommend ATI to friends and family. ATI outperforms many other well-known companies, which is a reflection of

    our commitment to delivering on our mission for every patient, every day.

    11

    pioneering patient outcome management

    Pioneering Patient Outcome Management in PT:

    ATI embedded a complete set of functional outcome tools directly into our EHR that are concise, easy to complete,

    reliable, valid, and universally recognized and respected by professionals in the field. They are immediately scored,

    have descriptive pop-up result information, and provide patient item responses. The findings are available to the

    clinician in real-time, and are aggregated for post-discharge analyses.

    enhancing patient clinical outcomes while

    Enhancing Patient Clinical Outcomes While

    Favorably Influencing the Episodic Cost of Care

    for Musculoskeletal (MSK) Conditions

    MSKore  is a proprietary tool developed by ATI to reference various descriptive

    analytical aspects of patient care specific to musculoskeletal (MSK) conditions

    Leveraging

    member

    Outcomes Report establishes a baseline of the

    existing care continuum and its impact on

    patients’ quality of life. This customizable tool

    facilitates the creation and implementation of

    care plans that enhance clinical effectiveness,

    reduce the cost of care, and improve the

    patient experience.

    quality

    satisfaction

    clinical

    scores,

    outcomes

    the

    and

    Patient

    MSKore®

    41 of the population in this examination was male

    41% of the population in this examination was male, 59% female.

    Most were between the ages of 50 to 59, with females exceeding males in this age group.

    The majority of patients fall into the normal category, followed by those considered to be

    overweight.

    patient demographics

    Patient Demographics

    12,520

    12,520

    42% of the population in this examination was

    male, 58% female.

    9,116

    9,116

    3

    %

    33

    %

    32

    %

    32%

    Female

    Male

    Most were between the ages of 50 to 59, with females far exceeding males in this age

    group.

    The majority of patients fall into the obese category, followed by those considered to be

    overweight.

    all referring physician the number of referrals

    All Referring Physician: The number of

    referrals by type

    Referral Diversity: Percentage of total

    referrals by physician specialty

    Physical Medicine

    & Rehabilitation

    Orthopedic

    Family Practice

    Pediatric

    Internal Medicine

    Podiatrist

    OB/GYN

    15,000

    Nurse Practitioner

    Physician Assistant

    Health Care Education

    Physician Specialty

    Neurosurgeon

    Neurologist

    Orthopedic

    Other*

    56%

    56%

    Family Practice

    Internal Medicine

    7%

    Podiatrist

    Physician

    Assistant

    Neurosurgeon

    10,000

    2%

    Physical Medicine

    and Rehabilitation

    12%

    12%

    2%

    2%

    5,000

    9%

    9%

    3%

    3%

    Physician Demographics

    0

     The Majority of referrals came from Orthopedic Physicians

     Distant second was Family Practice and Internal Medicine Physicians

    ati investment in market specific outpatient

    ATI Investment in

    Market-Specific

    Outpatient Therapy

    As XYZ-Comp may have regions in Illinois that would

    benefit from more outpatient treatment venues as well as

    improved rural outpatient coverage, this examination notes

    regions of Member density and potentials of partnership.

    Patient Distribution by Clinic

    17

    physical therapy at ati

    Physical Therapy at ATI

    Total Number of

    Patients

    Average Number of

    Comorbids

    Most frequently occurring

    comorbidity

    Body Part

    Mean PT Duration Days

    Neck

    Shoulder

    Elbow/Wrist/Hand

    Low back/Lumbar spine

    Hip

    Knee

    Foot

    987

    1919

    765

    2265

    879

    2309

    1429

    xxx

    Xxx

    Xxx

    xxx

    Xxx

    Xxx

    Xxx

    2.6

    2.2

    2.2

    2.8

    2.6

    2.2

    1.8

    Arthritis

    Arthritis

    Arthritis

    Arthritis

    Arthritis

    Arthritis

    Other Allergy

    Totals

    10553

    xx.x

    2.3

    Arthritis

    general health measures

    General Health Measures

    Instrument

    SF-12

    Subjective General Health Status

    ADLs and Functionality

    Pain/ Discomfort

    Mood/ Emotion/ Affect

    Body Part

    Mean Pre-tx

    Mean Post-tx

    Mean Pre-tx

    Mean Post-tx

    Mean Pre-tx

    Mean Post-tx

    Mean Pre-tx

    Mean Post-tx

    Neck

    2.9

    2.3

    5.4

    3.7

    3.9

    2.5

    6.5

    4.6

    Shoulder

    2.4

    1.9

    5.3

    3.3

    3.4

    2.1

    5.0

    3.6

    Elbow/ Wrist/Hand

    2.2

    1.8

    5.4

    3.5

    3.1

    2.1

    4.9

    3.7

    Low back/ Lumbar spine

    3.1

    2.4

    6.7

    4.6

    4.0

    2.6

    6.7

    5.0

    Hip

    2.6

    1.9

    6.8

    4.0

    3.5

    2.0

    5.7

    3.8

    Knee

    2.6

    2.0

    6.9

    4.0

    3.6

    2.1

    5.7

    3.9

    Foot

    2.4

    1.9

    5.9

    3.4

    3.1

    2.0

    4.9

    3.6

    Total

    2.6

    2.0

    6.1

    3.8

    3.5

    2.2

    5.6

    4.0

    NOTE: Lower scores indicate improvement. Red scores indicate lack of improvement.

    SF-12

    Subjective General Health Status

    ADLs and Functionality

    Pain/ Discomfort

    Mood/ Emotion/ Affect

    Clinical Interpretation

    0 = Pain Free

    1 – 2 = Minimal Pain

    3 – 4 = Moderate Pain

    5 – 6 = Marked Pain

    7 – 8 = Extreme Discomfort

    Clinical Interpretation

    0 = No Emotional Concerns

    1 – 5 = Few Emotional Concerns

    6 – 10 = Mild Emotional Concerns

    11 – 15 = Moderate Emotional Concerns

    16 – 20 = Extreme Emotional Concerns

    Clinical Interpretation

    0 = Excellent General Health Status

    1 – 2 = Very Good General Health Status

    3 – 4 = Good General Health Status

    5 – 6 = Fair General Health Status

    7 – 8 = Very Poor General Health Status

    Clinical Interpretation

    0 = No Limitations

    1-2 = Good Functionality

    3-4 = Few Limitations

    5-7 = Minimal Limitations

    8-9 = Moderate Limitations

    10-11 = Marked Functional Limitations

    12 = Profound Functional Limitations

    20

    quality and patient satisfaction

    Quality and Patient Satisfaction

    2016

    Clinical Staff & Customer Service

    Clinic Facilities

    Professional

    attitude, &

    appearance of

    all staff

    Billing and

    Payment

    process

    explanation

    Were clearly

    defined goals

    set for your

    treatment?

    Overall

    comfort &

    appeal of

    clinic

    Clinical

    quality &

    treatment

    Customer

    Service of all

    Staff

    Were your

    treatment

    goals achieved

    Payer

    Location

    of clinic

    Patient

    Satisfaction

    RESP #

    XYZ

    ALL ATI

    1696

    28877

    92.94%

    93.68%

    98.21%

    98.09%

    99.45%

    99.10%

    98.59%

    98.62%

    89.87%

    93.12%

    93.82%

    94.23%

    95.44%

    94.50%

    97.32%

    96.82%

    99.37%

    99.30%

    ati patient outcomes registry ati s patient

    ATI Patient Outcomes Registry

    ATI’s Patient Outcomes Registry has been evaluated and accepted into the federal Agency for Healthcare Research

    Quality’s AHRQ) Registry of Patient Registries. This is a unique honor and distinction as no other physical therapy

    organization has ever accomplished this. AHRQ’s mission is to produce evidence to make healthcare safe, higher

    quality, more accessible, equitable, and affordable. AHRQ works within the U.S. Department of Health and Human

    Services with other partners to make sure that the evidence is understood and used. Our Registry was also

    submitted, evaluated, and accepted in U.S. National Institutes of Health’s ClinicalTrials.gov.

    We currently can query over 800 variables in our Registry.

    24

    half of what is taught in medical school will

    Half of what is taught in medical school will be

    wrong in 10 years’ time, the problem is we

    don’t know which half.

    Sydney Burwell, MD, former Dean,

    Harvard Medical School

    it took an average of 17 years for new knowledge

    It took an average

    of 17 years for

    new knowledge

    generated by

    RCTs to be

    incorporated into

    practice.

    –IOM

    just for coronary heart disease

    Just for Coronary Heart Disease…

    • 3600 statistical articles are published

    on average each year

    • Do you know how long it would

    take you to keep up…?

    if you read 1 article 15 minutes

    If you read 1 article/15 minutes

    You would have to read >10

    articles

    For 2 hours/day

    7 days/week

    Forever…

    ok so now what

    OK,

    So, now

    WHAT?

    15 000 prior managed bills were loaded and rerun

    >15,000 prior-managed bills were loaded and rerun

    against the ODG Treatment UR Advisor for each ICD9-

    CPT combination on frequency, number of visits,

    recommendations from ODG Treatment, and the "Bill

    Review Payment (or ODG Approval) Flags" divided

    into Green, Yellow, Red…

    green ok to auto pay up to odg codes

    Green, OK to auto-pay up to ODG Codes for

    Automated Approval max number of visits;

    Yellow, OK to auto-pay up to 25th%tile

    number of visits

    Red, need to review

    apple healthkit

    Apple HealthKit

    In 14 of 23 major hospitals are trialing

    (Google and Samsung discussing

    health-based technology plans)

    Healthcare + fitness apps =

    comprehensive picture

    Send to MD or case manager

    and it s not just kinect for rehab

    And, it’s not just Kinect for rehab…

    …yes, you guessed it, there is also…

    evidence based medicine

    Evidence-Based Medicine

    Precision Medicine

    Model

    General

    Specific

    Sample

    Large cohorts

    “N of 1” but a massive

    number of data-

    points/inputs

    Limited to no

    generalizability

    Decisions

    Infer recommendations

    applied to all thus “one size

    fits all”

    Ignored

    Outliers

    None

    Statistical Power

    Good

    Poor

    reconciling evidence based medicine

    Reconciling evidence-based medicine

    and precision medicine*

     Can be viewed as mutually complementary.

     Merging the strengths of both will be based on our capacity to

    perform deep investigations of large cohorts of patients.

     The conversion from single cases to an evidence-based

    approach will imply collation and meta-analyses of big data

    from cross-institutional and transnational large-scale registers

    and cohorts.

     “N-of-one” cases to an “N-of many” paradigm.

    reconciling evidence based medicine 1

    Reconciling evidence-based medicine

    and precision medicine*

     This transition to an “evidence-based precision medicine” will,

    however, necessitate standardization as well as responsible

    sharing and mutualizing across numerous interoperable data

    warehouses.

     Following the same rationale, the numerous registries and

    large biobanks that are assembled all over the world should

    also be constructed in such a way as to warrant this need for

    inter-operability.

    * Beckmann, JS & Lew, D. (2016). Reconciling evidence-based medicine and precision medicine in the era of big data: challenges and opportunities, Genome

    Medicine20168:134. DOI: 10.1186/s13073-016-0388-7

    we are in the midst of some wonderfully

    We are in the midst of some

    wonderfully revolutionalry and

    promising changes afoot…

    please be in touch chris stout@atipt com

    Please be in touch

    Chris.Stout@ATIPT.com

    or visit DrChrisStout.com for these

    slides and references

    disclosures

    Disclosures

     All disclosures up to date on AAOS

     None relevant to this topic