For those of us practicing in a clinical setting, it is doubtful we have the capability to easily analyze each intervention we provide as its own entity. On top of that, in clinical practice we practice. Patients are paying for services. Our clinics have certain reputations and preconceived perceptions. Patients experience a lot more than just the intervention. Clinical practice is messy with all sorts of uncontrolled variables. Although all of that is true, that doesn't necessarily mean a clinician's experience has no role or even a limited role in treatment efficacy. I've learned the value of how quantifying clinical experience plays a role in effectiveness.
Prior to 2000, I honestly thought I knew my clinical experience. I set out on a journey to actually attempt to quantify my clinical experience to see if I perceived my experience accurately. I completed that stage of my journey and realized I did not perceive how well I thought I did with patients who received services for low back pain. By quantifying my clinical experience, I was able to immediately know that my patients were ending an episode of care with 24-30% disability. Sure, I had a large effect size, but I wasn't really reducing disability as much as what I had been seeing in research. I also knew from analyzing the data that I probably used too much heat and traction. I also saw that I didn't utilize manual interventions very often. This data set the course for my continuing education to choose interventions that would have higher efficacy for individuals who came to me for low back pain. In other words, the first stage of my journey indicated I had lots of room to grow because I wasn't as effective as I could be.
Fast forward to now.
I no longer have a workbook filled with multiple spreadsheets of data. I no longer run calculations to determine if the care I provide is effective. I never had the ability to risk adjust patients nor did I ever have the ability to compare my care to any benchmarked data. What FOTO does for me is magically quantify my clinical experience. FOTO not only quantifies it, FOTO risk adjusts the patients and predicts a final outcome for each patient which then allows for a comparison of my performance to benchmarked data. The data gives me an objective way to self-reflect on the care I provide. I either meet the prediction for each patient or I don't. I know when I see green squares, I'm performing well. I know when I see red, I need to figure out where I might need to make different clinical decisions.
Because I've been really focusing on my clinical experience and quantifying it since 2000, I do know if the services I provide will be effective. However, if I begin to change things up with how I am providing services or even the interventions I am choosing to provide, I won't immediately know the effectiveness of the change until I've seen enough patients to analyze if the change was beneficial.
This type of data is termed pratice based evidence. Practice based evidence is quantified clinical experience or expertise. What you will begin to see more and more of in the future are clinicians, like me, who have years of data at our fingertips beginning to offer our expertise and services to colleagues. The reason: value based purchasing will be here in no time. The rehabilitation world will begin to have a shift in thoughts from what I'd call a strong focus on traditional research in controlled environments and the resulting research findings to this whole concept of practice based evidence. More and more rehabilitation clinicians will be desiring to learn from those who have strong practice data defining the effectiveness of their practice. Clinicans won't be the only parties interested in this upcoming twist: prospective patients and payers will be just as interested.
I say yes to clinical experience definitely having a role in effectiveness of treatment/interventions. The only way it can accurately have a role is if 1) the clinician has data and 2) if the clinician self-reflects on the data.
Until next time,