Patient management process

THEPROCESSOFPATIENTMANAGEMENT
DR. QURATULAIN MUGHAL
DPT (2019)
ISRA UNIVERSITY
1

CONTENTS
Examination
Evaluation
Diagnosis
Prognosis and plan of care
Interventions
Outcomes
2

Examination
Examination is the systematic
process by which a therapist
obtains information about a
patient’s problem(s) and his or
her reasons for seeking physical
therapy services
The examination process
involves both comprehensive
screening and specific
diagnostic testing..
3

Therearethree
distinctelementsofa
comprehensive
examination
1. The patient’s health history
2. A relevant systems review
3. Specific tests and measures
4

1. Information
Generated from
the Initial History
 Demographic Data
• Age, sex, race, ethnicity • Primary language • Education
 Social History
• Family and caregiver resources • Cultural background •
Social interactions/support systems
 Occupation/Leisure
• Current and previous employment • Job/school-related
activities • Recreational, community activities/tasks
 Growth and Development
• Developmental history • Hand and foot dominance
5

CONTINUE……
Living Environment
• Current living environment • Expected
destination after discharge
• Community accessibility
General Health Status and Lifestyle Habits
and Behaviors: Past/Present (Based on Self
or Family Report)
• Perception of health/disability • Lifestyle
health risks (smoking, substance abuse) • Diet,
exercise, sleep habits
6

CONTINUE…..
Medical/Surgical/Psychological History
Medications: Current and Past Family
History
• Health risk factors • Family illnesses
Cognitive/Social/Emotional Status
• Orientation, memory • Communication
• Social/emotional interactions
7

CONTINUE….
 Current Conditions/Chief Complaints/Concerns
• Conditions/reasons physical therapy services sought
• Patient’s perceived level of disability
• Patient’s needs, goals
• History, onset (date and course), mechanism of injury, pattern and
behavior of symptoms
• Family or caregiver needs, goals, perception of patient’s problems
• Current or past therapeutic interventions
• Previous outcome of chief complaint(s)
 Functional Status and Activity Level
• Current/prior functional status: basic ADL and IADL related to self-
care and home
• Current/prior functional status in work, school, community- related
IADL DR. QURATULAIN MUGHAL
8

Key Questions to
Consider During
the Initial
Examination
 What are the most complete and readily available sources for
obtaining the patient’s history?
 Is there a need to obtain additional information about the
patient’s presenting pathology or medical diagnosis if one is
available?
 Based on initial working hypotheses, which of the patient’s
signs and symptoms warrant additional testing by physical
therapy or by referral to another health-care practitioner?
 Do the patient’s problems seem to fall within or outside the
scope of physical therapy practice?
 What types of specific tests and measures should be selected
to gather data about the patient’s impairments, functional
limitations, or disability?
 Based on scientific evidence, which diagnostic tests have a
high level of accuracy to identify impairments, functional
 What are the most important tests to do first? Which could be
9

2.AreasofScreening
forthe
SystemsReview
System Screening
Cardiovascular/
pulmonary
Heart rate, respiratory rate, and blood
pressure; pain or heaviness in the chest
or pulsating pain; lightheadedness;
peripheral edema
Integumentary Skin temperature, color, texture,
integrity, scars, lumps, growths
Musculoskeletal Height, weight, symmetry, gross ROM,
and strength
Neuromuscular General aspects of motor control
(balance, locomotion, coordination);
sensation, changes in hearing or vision;
severe headaches
Gastrointestinal/
genitourinary
Heartburn, diarrhea, vomiting, severe
abdominal pain, problems swallowing,
problems with bladder function,
unusual menstrual cycles, pregnancy
10

CONTINUE….
System Screening
Cognitive and
social/ emotional
Communication abilities
(expressive and receptive),
cognition, affect, level of
arousal, orientation, ability
to follow directions or learn,
behavioral/emotional
stressors and Responses
General/
Miscellaneous
Persistent fatigue, malaise,
unexplained weight gain or
loss, fever, chills, sweats
11

3. Specific Tests
and Measures
Assessment of pain
Goniometry
Joint mobility, stability, and integrity
tests (including ligamentous testing)
Tests of muscle performance (manual
muscle testing, dynamometry)
Posture analysis
Gait analysis
Assessment of assistive, adaptive, or
orthotic devices
12

Guidelines for
Selection of
Specific Tests and
Measures
 Consider why particular tests are performed and how the interpretation of
their results may influence the formulation of a diagnosis.
 Select tests and measures that provide accurate information and are valid
and reliable and whose efficacy is supported by evidence generated from
sound scientific studies.
 Administer tests that target multiple levels of disablement: impairments,
functional limitations, the patient’s perceived level of disability.
 Prioritize tests and measures selected to gather in-depth information about
key problems identified during the history and systems review.
 Decide whether to administer generic tests or tests that are specific to a
particular region of the body.
 Choose tests that provide data specific enough to support or reject working
hypotheses formulated during the history and systems review and to
determine a diagnosis, prognosis, and plan of care when the data are
evaluated.
 Select tests and measures that help determine the types of intervention
that most likely are appropriate and effective.
 To complete the examination in a timely manner, avoid collecting more
information than is necessary to make informed decisions during the
evaluation, diagnosis, and treatment planning phases of management.
13

Evaluation
Evaluation is a process
characterized by the
interpretation of collected
data.
The process involves
analysis and integration of
information to form
opinions by means of a
series of sound clinical
decisions. DR. QURATULAIN MUGHAL
14

Diagnosis
The term diagnosis can
be used in two ways; it
refers to either a
process or a category
(label) within a
classification system.
15

Diagnostic
Process
begins with:
(1)the collection of data
(examination);
(2)the analysis and interpretation of all
relevant relevant data collected,
leading to the generation of working
hypotheses (evaluation); and
(3)organization of data, recognition of
clustering of data (a pattern of
findings), formation of a diagnostic
hypothesis, and subsequentDR. QURATULAIN MUGHAL
16

Diagnostic
Classifications for
the
Musculoskeletal
System
 Primary prevention/risk reduction for skeletal demineralization
(pattern 4A)
 Impaired posture (pattern 4B)
 Impaired muscle performance (pattern 4C)
 Impaired joint mobility, motor function, muscle performance, and
range of motion (ROM) associated with connective tissue
dysfunction (pattern 4D)
 Impaired joint mobility, motor function, muscle performance, and
ROM associated with localized inflammation (pattern 4E)
 Impaired joint mobility, motor function, muscle performance,
 ROM, and reflex integrity associated with spinal disorders (pattern
4F)
17

CONTINUE…
 Impaired joint mobility, muscle performance, and
ROM associated with fracture (pattern 4G)
 Impaired joint mobility, motor function, muscle
performance, and ROM associated with joint
arthroplasty
 (pattern 4H)
 Impaired joint mobility, motor function, muscle
performance, and ROM associated with bony or soft
tissue surgery (pattern 4I)
 Impaired motor function, muscle performance, ROM,
gait, locomotion, and balance associated with
amputation (pattern 4J)
18

Key Questions to
Consider During the
Evaluation and
Diagnostic Processes
 What is the extent, degree, or severity of impairments, functional
 What is the stability or progression of dysfunction?
 Is the current condition(s) acute or chronic?
 What actions/events change (relieve or worsen) the patient’s signs and
symptoms?
 How do preexisting conditions (co-morbidities) affect the current
condition?
 How does the information from the patient’s medical/ surgical history
and tests and measures done by other health-care practitioners relate
to the findings of the physical therapy examination?
 Have identifiable clusters of findings (i.e., patterns) emerged relevant
to the patient’s dysfunction)?
 Is there an understandable relationship between the patient’s extent of
impairments and the degree of functional limitation or disability?
 What are the causal factors that seem to be contributing to the
patient’s impairments, functional limitations, or disability?
19

Prognosis and
plan of care
A prognosis is a prediction of a
patient’s optimal level of function
expected as the result of a course of
treatment and the anticipated
length of time needed to reach
specified functional outcomes
20

Factors That
Influence a
Patient’s
Prognosis/Expec
ted Outcomes
 Complexity, severity, acuity, or chronicity and expected
course of the patient’s condition(s) (pathology),
impairments, and functional limitations
 Patient’s general health status and presence of
comorbidities and risk factors
 Patient’s and/or family’s goals
 Patient’s motivation and adherence and responses to
previous interventions
 Safety issues and concerns
 Extent of support (physical, emotional, social)
21

Theplanofcare,an
integral
componentofthe
prognosis,
delineatesthe
following
 Anticipated goals
 Expected functional outcomes that are meaningful, utilitarian,
sustainable, and measurable
 Extent of improvement predicted and length of time
necessary to reach that level
 Specific interventions
 Proposed frequency and duration of interventions
 Specific discharge plans
22

Key Questions
to Establish
Patient-
Centered Goals
and Outcomes
in
the Plan of
Care
 What activities are most important to you at home, school, work, or
during your leisure time?
 What activities do you need help with that you would like to be able
to do independently?
 Of the activities you are finding difficult to do or cannot do at all at
this time, which ones would you like to be able to do better or do
again?
 Of the problems you are having, which ones do you want to try to
eliminate or minimize first?
 In what areas do you think you have the biggest problems during the
activities you would like to do on your own?
 What are your goals for coming to physical therapy?
 What would you like to be able to accomplish through therapy?
 What would make you feel that you were making progress in achieving
your goals?
 How soon do you want to reach your goals?
23

Interven
tion
Intervention, a component of
patient management, refers to any
purposeful interaction a therapist
has that directly relates to a
patient’s care.
 There are three broad areas of intervention:
Coordination, communication, and
documentation
Procedural interventions
Patient-related instruction
24

Outcomes
 Simply stated, outcomes are results.
 There are several broad areas of outcomes.
• Level of a patient’s physical function, including impairments,
functional limitations, and perceived disability
• Extent of prevention or reduced risk of occurrence or recurrence of
future dysfunction related to pathology, impairments, functional
limitations, or disability
• Patient’s general health status or level of wellness and fitness
• Degree of patient satisfaction
25

REFERENCE
26

Patient management process

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Ähnlich wie Patient management process

Ähnlich wie Patient management process (20)

Mehr von QURATULAIN MUGHAL

Mehr von QURATULAIN MUGHAL (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Patient management process