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| EDITORIAL |
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| Year : 2022 | Volume
: 16
| Issue : 1 | Page : 1-3 |
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Delivering high-quality patient care using evidence-based practice
Tarang K Jain1, Sonia Rawal2
1 Department of Physical Therapy and Athletic Training, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona, USA
2 Stefani Doctor of Physical Therapy Program, University of Saint Mary, Leavenworth, Kansas, USA
| Date of Submission | 23-Jun-2022 |
| Date of Decision | 28-Jun-2022 |
| Date of Acceptance | 29-Jun-2022 |
| Date of Web Publication | 22-Jul-2022 |
Correspondence Address:
Tarang K Jain
Department of Physical Therapy and Athletic Training, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/pjiap.pjiap_37_22
How to cite this article:
Jain TK, Rawal S. Delivering high-quality patient care using evidence-based practice. Physiother - J Indian Assoc Physiother 2022;16:1-3 |
How to cite this URL:
Jain TK, Rawal S. Delivering high-quality patient care using evidence-based practice. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 3];16:1-3. Available from: https://www.pjiap.org/text.asp?2022/16/1/1/351863 |
We were at different time points invited for a brief discussion on the topic “How can health-care professionals deliver high-quality care to their patients.” Although physiotherapists provide care to patients in multiple health-care settings, the concept of quality care is gaining more attention in medicine and rehabilitation. In the era of ever-shrinking health-care resources and increased competition, we are always challenged to act in the best interests of the patient while following the principles of professional duty, excellence, and accountability. As we started preparing for the discussion, we could not find formal quality care initiatives implemented in the field of physiotherapy. Further, as we talked more to colleagues and professionals in the field, I realized that the definition and understanding of quality care varied among them and often therapists lacked knowledge on outcomes (such as clinical outcomes, patient/caregiver satisfaction, costs, etc.) and clinical practice components (effectiveness, efficiency, patient-centeredness, timeliness, equity, safety, etc.) that show the value of physiotherapy care to multiple stakeholders. If we are to demonstrate the value of physiotherapy services to different decision-makers (government bodies, professional organizations, health-care professionals, patients, and their family members), we need to provide evidence that physiotherapy care can deliver a better patient experience of care and improve population health at affordable costs.
As we embark on establishing physiotherapy as an indispensable medical system and providing quality care to our patients, we need to first define what high-quality patient care is and how can we evaluate quality care in our health-care settings. We need to not only demonstrate the effectiveness of physiotherapeutic interventions but also generate strong evidence that may influence the perception of physiotherapeutic care among multiple stakeholders. To be able to do this, it is imperative that the physiotherapy community must increase their engagement in describing, measuring, providing, and disseminating high-quality patient care.
Health-care quality is a multidimensional concept and has evolved with time.[1] Despite health-care quality improvement issues being described as early as 1860s, quality health care remains a topic of discussion. The lack of a consistent definition and clear conceptualization of quality care has affected our ability to provide high-quality health care. Merriam-Webster's Collegiate Dictionary defines quality as how good or bad something is, a characteristic or feature, a high level of value or excellence, and the standard of something as measured against other things of a similar kind.[2] In contrast to the quality definition in lay terms, the term quality in health care has more broader and complex implications. For example, multiple stakeholders, such as patients, caregivers, physiotherapists, payers, or society may view patient care differently, leading to different but overlapping perspectives on quality patient care. In rehabilitation, the International Classification of Functioning, Disability, and Health framework is frequently utilized to assess domains associated with functioning, health, and disability to assess patient-centered care.[3] Allen-Duck et al. recently analyzed the concept of health-care quality and stated that “health-care quality is the provision of effective and safe care, reflected in a culture of excellence, resulting in the attainment of the optimal or desired outcome.”[1]
Since quality health care and associated outcomes are defined and measured by different stakeholders in different ways, it may be better to look at certain attributes that characterize high-quality patient care. Walker and Avant outlined four categorical themes for measuring the quality of patient care effectiveness, safety, culture of excellence, and desired outcomes.[4] The report described effectiveness as the use of equitable, consistent, and timely evidence-based practices to provide the most beneficial interventions and procedures to patients; safety as avoidance of environmental, physiological, and psychosocial injuries from care; culture of excellence as consideration of patients' preferences and ensuring that patients' values, collaboration, communication, compassion, competence, advocacy, respect, responsibility, and trustworthiness are included in the decision-making for their care; and desired health outcomes as engaging patients for goal achievement, the best possible results, shared decision-making, patient-centered care, and patient satisfaction.[4] To ensure that physiotherapists are delivering high-quality health care, they need to make sure that these attributes are present in their health-care delivery. Future research using these attributes, combined with the utilization of culturally appropriate condition-specific functional patient outcome tools, patient and caregiver satisfaction surveys, and cost assessment of care delivery may lead to significant knowledge development in evidence-based physiotherapy care, public safety, and trust.
While searching for evidence for writing this editorial, we found many studies showing evidence reviews/efficacy of physiotherapeutic interventions but could not find any published study on demonstrating comparative effectiveness (pragmatic trials) or economic value of physiotherapy care (value for money) in the current Indian health-care system. Physiotherapy community needs to better describe their value to different stakeholders and decision-makers. Academicians in physiotherapy programs could partner with physiotherapists in different health-care settings to design more pragmatic and realistic real-world studies and identify the comparative effectiveness (benefits and risks) of different physiotherapeutic interventions.[5] We can further demonstrate the value of physiotherapy by adding patient and stakeholders' engagement in our studies. The patient-centered outcome research focuses on research questions and outcomes that are meaningful to patients and caregivers, thus assisting multiple stakeholders in their decision-making.[6] An additional way to show the value of physiotherapy care is through economic analysis (cost consequences, cost-effectiveness, cost minimization, cost–utility, and cost–benefit).[7] Although difficult to perform health economic analyses in the fragmented Indian health-care system, physiotherapists should challenge themselves to collaborate with health economists and provide comparative information on costs (direct and indirect), outcomes, risks/benefits associated with volume/intensity of physiotherapy service utilization (in short-term as well as long-term). If physiotherapy community does not provide evidence to inform high-quality care, we risk substandard clinical care and stakeholders' perception of physiotherapy being made on incomplete evidence. To ensure that we produce sufficient evidence and continue to deliver high-quality patient care, the Indian Association of Physiotherapy (IAP) and established educational institutions should collaborate and find ways to promote and fund such research.
Not only IAP and established educational institutions should lead this effort, but individual therapists could also contribute and should collaborate with each other toward promoting high-quality patient care. We will need a collective effort of the physiotherapy community to ensure that our patients get the best care. Although out of scope for this editorial to describe research processes in detail, therapists can follow certain steps to establish priorities and strategies to generate evidence for quality care in their health-care settings.
- Identify the patient population and ask questions/categorize evidence gaps in the literature about the optimal patient care
- Prioritize your clinical questions and identify the sequential way to answer those questions
- Identify collaborators, resources, and funding (if available) to generate evidence for high-quality care
- Share findings at the local, regional, and national levels to implement the findings and disseminate research in relevant health-care journals
- Work with local physiotherapy community, health-care systems, and national physiotherapy representative bodies to influence stakeholders and physiotherapy practice.
Easier said than done but providing high-quality patient care will challenge the status quo and requires therapists to restructure their approach toward providing patient care. If we are to achieve high-quality patient care for all, therapists will have to overcome their misaligned financial incentives and ethical concerns by providing substandard care. To better themselves as well as serve the physiotherapy profession, therapists will need to get actively involved in applying new knowledge, track patient outcomes, perform regular quality assurances, and continuously advocate for high-quality patient care. Physiotherapists have the expertise and capabilities to positively affect their patients and influence society's health care/outcomes.
| References | |  |
| 1. | Allen-Duck A, Robinson JC, Stewart MW. Healthcare quality: A concept analysis. Nurs Forum 2017;52:377-86.  |
| 2. | Staff MW. Merriam-Webster's Collegiate Dictionary. Springfield, Mass., U.S.A: Merriam-Webster; 2005. |
| 3. | World Health Organization. International Classification of Functioning, Disability and Health: ICF. Geneva, Switzerland: World Health Organization; 2001. |
| 4. | Walker L, Avant K. Strategies for Theory Construction in Nursing. 5 th ed. Upper Saddle River, NJ: Pearson; 2011. |
| 5. | Schneeweiss S, Seeger JD, Jackson JW, Smith SR. Methods for comparative effectiveness research/patient-centered outcomes research: From efficacy to effectiveness. J Clin Epidemiol 2013;66:S1-4. |
| 6. | Lusk JM, Fater K. A concept analysis of patient-centered care. Nurs Forum 2013;48:89-98. |
| 7. | Nixon J, Stoykova B, Glanville J, Christie J, Drummond M, Kleijnen J. The U.K. NHS economic evaluation database. Economic issues in evaluations of health technology. Int J Technol Assess Health Care 2000;16:731-42. |
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