Background/purpose: Patient satisfaction and better outcomes are at the forefront of Medicare reimbursements under the 2010 enactment of the Affordable Care Act. Reforms to the Medicare payment system have shifted provider payments from pay for services to pay for performance reimbursements. When hospitals meet or exceed benchmarks for providing better outcomes and increasing their patients' satisfaction then they receive monetary incentives. Private insurance companies are sure to follow suit and therapeutic ancillary services will be included. Patient satisfaction increases patient compliance which leads to decreased costs and increases outcomes. The purpose of this project was to determine how continuity of care impacts patient satisfaction and outcomes within the field of physical therapy. This leads to the PICO question: Do patients with a higher level of continuity of care report being more satisfied with their physical therapy and achieve functional outcomes sooner? Case Description: Mr. R was a 77 year old male hospitalized for pneumonia derived sepsis. He had a multitude of existing comorbidities and residual weakness following a prior cerebral vascular accident (CVA). He had numerous encounters with healthcare providers and settings. He has been admitted to a regional hospital, local hospital, skilled nursing facility (SNF), home healthcare, and outpatient physical therapy. He presented to outpatient physical therapy for decreased motor function, strength, and possible prosthetic training. Outcomes: A review of evidence based literature reveals that a higher level of continuity care increases patient satisfaction and leads to improved patient outcomes. Patients who are satisfied are more compliant with their exercise programs and have better attendance to scheduled visits. This decreases the number of visits needed to achieve patient goals which decreases patient costs. Other research provides a link between decreasing readmission rates and the number and severity of activity limitations. Continuity of care influences a patient's recovery in numerous ways. Discussion: There is limited research in physical therapy pertaining to continuity of care and the impacts on recovery. Of the eight articles reviewed there is a high correlation of continuity of care increasing patient satisfaction and outcomes. Six out of the eight articles were specific to physical therapy. Of these, four pertained to outpatient physical therapy. One dealt with the transitions between acute care to rehabilitation hospitals, long term care, home health care and outpatient physical therapy. The last considered how continuity of care in home health physical therapy impacts re-hospitalization. The remaining two of the eight articles studied continuity of care and primary care physicians. All eight studies researched how higher levels of continuity of care impacts patient satisfaction and/or outcomes. With the new healthcare reimbursement standards, having a higher continuity of care will benefit a facility's bottom line, as well as, provide the best clinical format to make physical therapy more efficient and effective. From the patients'standpoint, they want to get better sooner, be satisfied with their service and pay less for it. A clinical model that includes the highest level of continuity of care influences all these aspects in patient care.


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Document Type


First Advisor

Ron Andrews


Continuity of Patient Care; Home Care Services; Physical Therapy Modalities

Available for download on Monday, March 14, 2118