1. health and fitness

Combined Sections Meeting 2013
January 21 - 24, 2013, San Diego
SESSION HANDOUT
Doing Today's Work Today: How to Reduce
Inefficiencies in Physical Therapy Service
Delivery through the Application of "Just in
Time" Management Principles
Speakers
Todd E. Davenport, PT, DPT; Nicholas J. Ferlatte, PT, MBA; Ivan Matsui, PT, FAAOMPT; Carol Jo Tichenor,
PT, MA
20 pages total
Value-based health care involves matching the correct treatment to the correct patient at the correct time. To an increasing degree,
health care administrators are expecting departments to meet the needs for "patient driven access"—to align the patient's goals,
treatment options, and speed of access—in order to optimize treatment outcomes, satisfaction, and health expenditures. This idea is
consistent with "just in time" management principles (JIT). JIT has been applied across many areas of business to improve efficiency
by reducing wait times along a supply chain; strategies that reduce wait times for physical therapy evaluation and treatment should
optimize patient outcomes and costs. This session will provide cutting-edge information about JIT physical therapy management
principles and practices from an experienced group of clinicians and researchers who work in an integrated health setting. In this
session, an experienced panel will discuss the theoretical basis of JIT management and its application to health care; and specific JITrelated physical therapy programs, oriented to primary care, telehealth, and workplace injury prevention. This session is directed
toward staff members, supervisors, and administrators who are interested in developing strategies to make change in the delivery of
physical therapy care within their departments.
Upon completion of this course, you'll be able to:




Discuss "Just in Time" management principles.
Apply "Just in Time" management to health care service delivery.
Describe the workflow and use of a specific program for physical therapists in primary care settings and telehealth services,
and in work injury prevention.
Develop tools and strategies using JIT principles to facilitate change in your practice setting.
This information is the property of the author and should not be copied or otherwise used
without express written permission of the author(s).
Sponsored by
Section on Health Policy & Administration
of the American Physical Therapy Association
PO Box 4553 • Missoula, MT 59806-4553
877.636.4408 • www.aptahpa.org
DAWNING OF A NEW DAY:
HPA IS CREATING A MOVEMENT
YOU ARE INVITED TO JOIN US
What: HPA the Catalyst Town Hall Meeting
When: Wednesday, January 23, 2013, 6-8 PM
Where: Hilton Bayfront, Cobalt 500 Room, San Diego, CA
Snacks and Surprises
12/11/12
Doing Todays Work Today:
How to Reduce Inefficiencies in
Physical Therapy Service Delivery
Through Just In Time
Management Principles
Kaiser Hayward PT Fellowship
in Advanced Orthopedic Manual Therapy
Rapidly changing landscape
Doing Todays Work
Today in Physical Therapy
Kaiser Hayward PT Fellowship
in Advanced Orthopedic Manual Therapy
Nicholas J. Ferlatte,
PT, MBA
Disruptive Innovation
• Assumptions are being undermined and
business models are eroding
•Competition for shrinking dollar
Among
ourselves
Against
other types of practices with overlapping
scope
•Value, quality, efficiency
Fast
cheap and good
Netflix
IKEA
Specialty
Shops
Accountable
Kaiser
Care Organizations
Permanente
Lean Management
Lean Management
• Management philosophy focused on
•Lean management eliminates waste
improving work flows
Toyota
disrupted American auto industry
– Continuous quality improvement
– Process refinement
Waste= erosion of value
Decrease waste by eliminating unnecessary steps
Just in time promotes efficiency
–Traditionally applied to inventory
– Just in time
1
12/11/12
Lean management for health care
Just in Time Care Delivery
•Customer not provider at center of workflow
•Initiating intervention on demand
Streamline care linkages
Diagnostics
Just in time consults
Consults
Eliminate appointment wait times
Eliminate bureaucratic redundancies
•One stop shop
•Initiate course of care simultaneously with
referral
• Focused on increasing the value of the patients
experience
Strong association between timeliness and perception of
quality
Brief
assessment
Advice
Goals of Session
•Provide overview of our Roving PT Model
Roving Physical Therapy
Patient Centered Model
•Impetus behind and evolution of Roving PT
•Case examples
Kaiser Hayward PT Fellowship
in Advanced Orthopedic Manual Therapy
Ivan Matsui,
PT, FAAOMPT
•Summary of Challenges and Successes
Brief Overview of Roving PT Model
Roving PT Model: Other Options
•PT On-call for 3-4 hours segments for consults
•PT sees patient with or without MD or Nurse
in adjacent primary care clinics.
Practitioner in the room for 10 min interaction.
Responds
•Primary Care Provider contacts PT by phone
related to musculoskeletal questions or
requests
to provider questions and offers
suggestions to provider and patient.
Provides
handouts on home interventions or other
online video resources OR
May
recommend further evaluation and intervention
in more traditional appointment.
•Questions resolved by phone without direct PT
interface.
2
12/11/12
Impetus Behind and Evolution of Roving
PC to Consultant Referrals: Problems
•Office visits to primary care is most common entry
•Referrals frequently
point to health care.
•60% of one billion visits annually to PC
include inadequate info to
and from the consultant.
•Referrals frequently
include inadequate info to
and from the consultant.
•5-8% of PC referrals result in referral to another
provider.
•Within our PT Departments, approx 90% of the
•Consultants perceive that approx 30% of their
referrals are from primary care.
referrals are inappropriate.
Forces Driving a Change in our Practice
Selection of PTs for New Role
•Strategic priority of organization
•Broad continuing education and orthopedic
Increase
overall access to PT for same day service
Provide
options for patient to access specialists on
same day as PC visit when already at clinic ONE
STOP SHOP
Provide
a WOW experience to patient
experience
•Minimum of 3 years of clinical experience
•Excellent communication skills and
professional maturity
•High level of differential diagnosis skills
•Experience in acute care management of
patients with movement dysfunctions
Services to MD and Patient
Development of Roving PT: Challenges
•Direct consultation with MD
•Ramp up time with MDs to get familiar with
Confirm,
refine, or offer alternative diagnosis/
hypothesis
Recommend
referrals to other specialists.
Development
of physician exam skills
Input
to MD related to work modifications needs,
imaging, injections, NSAIDS
•Patient home exercises, and/or ergonomic
instruction
role
•Need to insure compliance with Practice Act
issues
•Finding balance of PT availability and
productivity
•Initial reticence of PT to work in a new,
challenging setting
•Phone reception, phone caller; Medical
Assistant vs MD
3
12/11/12
Case Example #1
Case Example #1
•MD call to PT:
•Primary care MD Questions:
I
think she has a ITB syndrome, do you think you
can come by and tell me what you think?
PT
What
is the patient problem?
Does
it require PT or other referral?
consult (MD present)
–~63 yo, sedentary female, wide hips, overweight but
not obese
–Pain aggravated with sidelying ipsilaterally, not with
walking, denies running or any other exercise.
–Tender to palpation over and above greater
trochanter
•PT Actions/recommendations
Signs/sx
trochanteric bursitis
Recommend
ice, sleep position, gentle stretches
Call
MD in 10 days if no improvement to consider
joint injection.
–Non ttp over ITB
Case #2 Example
Same Day Service
•65 yo female with RA
• Hx of fall 3 days ago
•Stood up and fell,
•Primary Care MD Call:
+bruise, and swelling,
+pain.
•Palpable defect
above patella
•Mild tenderness to
Can
Is
you tell me what this looks like to you?
this treatable PT condition or require referral?
•PT Actions/recommendations
Possible
Have
quad tear?
patient call Ortho On-Call today
palpation medial and
lateral patella
Case #2 Continued
What We Have Gained from New Model
•
•High visibility of PT with MDs and pts in high level
•
Orthopedic On-Call assessment
Possible quad tear
Schedule MRI
MRI resulted in dx of patellar fracture.
Patient decided not to have surgery.
role
•Opportunity to broaden role of PT in a challenging
and dynamic new role
•Recognition from Senior Leadership on value of
PT in management of patients with
musculoskeletal dysfunctions
•Added value for patients
4
12/11/12
The Jury Is Still Out
Telemedicine:
Options for Improving
Service and Access
Chart
Kaiser Hayward PT Fellowship
in Advanced Orthopedic Manual Therapy
Wheres Telemedicine Going?
•Projected to grow from 2.4 billion in 2011 to 6
billion in 2012
•Over 6800 papers in 2004 (Taylor P, 2005)
•Federal govt grants in Agriculture, Commerce,
Defense, Health/Human services to expand
service
•Worldwide impact
Carol Jo
Tichenor, PT,
MA,
HFAAOMPT
Telehealth Worldwide Use
•Telehealth models in numerous health
professions:
Teledermatology
Telemedicine
in Emergency rooms
Telerehab
Telestroke
Networks
Telepsychiatry
Teleopthalomology
Overview of Studies to Date
•Safety:
Are
•Effectiveness
medical decisions disadvantaged?
Does
Overview of Studies to Date since 1960s
management disadvantage the patient?
•Practicality:
Patient
Cost
and provider satisfaction
effectiveness
Accessibility
Can
a proposed service be implemented in a
chosen setting (patients, specialists, technology)
5
12/11/12
Cost Issues for Patients and Impact on PT
Challenges of Current Health Care
• Greater scrutiny in delivery of all aspects of
Lean thinking employers
care using system wide metrics
•Employers shifting health plan costs to
Quality
Patient
employees
•Increasing costs of premiums to employees
•Decreasing coverage of dependents
•Decreasing scope of provider panels available
Satisfaction
to care
Accessibility
– Attitudes play a role in
outcomes.
Productivity
31
1
Group Premium Increases Compared
to Inflation: California, 2002-2010
140%
Premium Increases 2002-2010
Average annual premiums for employeesponsored coverage were $14,396 for
family coverage in 2010
Average annual premiums for employee sponsored
coverage were $14,396 for family coverage in
2010 in California.
134.4%
117.5%
120%
101.8%
100%
86.3%
80%
72.1%
Premium Increases
Projected costs to insure a family in 2020 is
$39,000 or 40% of median income!
58.3%
60%
46.3%
40%
20%
Overall CA Inflation
31.3%
13.4%
0%
2.8%
2002
5.6%
7.4%
2003
2004
11.6%
2005
16.0%
19.5%
2006
2007
23.8%
23.1%
25.4%
2008
2009
2010
Source: CHCF, California Employer Health Benefits Survey, 2010
Current and Future Care Delivery
What will Patients do?
•Less time available per patient interaction
•More patients per caseload
•Fewer overall resources per patient
Lean thinking patients
•Patient less willing to come to PT due to:
Higher co-pays
Travel costs
Loss of work time
•Highly informed patient wants value for their
money.
35
36
36
6
12/11/12
Increasing our Value in the Patient Experience
•Recruit and retain healthy health plan
members!
•Meet the needs of busy patients.
Working
professionals
Mothers
with busy work and child care
schedules
College
students who are seldom home
How We Launched Telemedicine PT
•SKYPE was not secure
•Organization selected user friendly software
for patients with call over internet or with
phone
•Plug and play webcam
•Started with follow-up visits to build upon
prior rapport
Retirees
are willing to sacrifice in person care
for improved access (Whitten P & Love B,2005)
What We Learned About Our Patients
•Interest in video visits
•Patient access to equipment
•Experience with Skype, Gotomeeting,
Webex
•Why Not Interested in Video Visits?
•When do you want a visit?
What We Learned About Communication
•Communicate what you are doing:(Bulik RJ, 2008;
Onor MI & Misan, S. 2005)
Inform
patient of what you are doing, i.e.
Looking at the medical record
Im
thinking about.. rather than reflecting in
silence.
Avoid
distracting movements of your arms.
Wear
color not white lab coat.
What We Learned About Communication
•Human Factors of Delivering Care (Bulik RJ, 2008;
Onor MI and Misan, S. 2005)`
Brief
small talk to provide time to develop a
conversation with patient.
Tone
of voice and express interest (I see, I
understand, Go on..)
Wait
time to allow patient to respond.
Camera
placement for eye contact
Forward
leaning posture = engagement
What We Learned About Communication
Keep
good eye contact with the screen.
Avoid
extraneous movements of arms
Have
clean, uncluttered background.
Practice
with your distance from the webcam.
7
12/11/12
Key Elements for Success
•Select your better communicators at the start
•Practice, practice, practice to gain speed and
efficiency.
Takes
at least 7-11 visits to start feeling efficient
and comfortable.
What do we know about patient satisfaction?
• Current studies suggest (Whitten P & Love B, 2005)
Satisfaction
consistently quite high.
–Easier access to specialists
–Reduced travel
–Better access and continuity of care
–Financial savings
–Personalized care
–Like having options to participate in health care
Challenges for the Provider
•Factors influencing provider acceptance (Whitten
PS & Mackert MS, 2005)
Preconceived notions of telemedicine value
Belief: We are already providing the BEST care
Using new technology in already busy day
•Finding patients to participate
•Ease of use over technological quality
•Pressure from upper management
Lean thinking by the Provider
•Must respond to organizations priorities!
•Facilitate understanding of self-management in
their own environment.
•Answer questions and reduce anxieties that
require more than a phone contact.
•Move PT from hands on to hands off when
patient wants other delivery options.
Case Examples
Telemedicine Revolution
•Continue contact with college students who
•Almost all patient/provider interactions will
are home only limited periods.
•Provide care for patients who cannot afford to
come in due to high co-pays.
involve an electronic workflow
•Patients wish to become full partners in their
health care and wellness
Access
to vast amounts of data about their
condition
Providers
will push more and more info to pts.
8
12/11/12
Telemedicine Revolution
•Patient/provider interaction will be forever
changed:
Providers
will use tools to dx, treat and support
patient centered needs and community needs
worldwide
Value to Our Customers
•Contribute to patient experience and outcome
from patients perspective (Trebble TM & Hydes T, 2011)
•Build reputation of the health care plan.
Providers
will need to focus on the art of care
given across technology-mediated lines.
networks will be the digital glue between
providers.
(Weiner JP, 2012)
IT
50
Telemedicine Use Case
Initial Evaluation: History
•19 year old male college student
•History / Subjective Examination (In Person)
History
•Going back to college out of state the week
following initial evaluation
of present condition:
–Patellar ligament tear 8 weeks ago while playing
basketball
–Now 4 weeks status post patellar ligament repair
Chief
•4 weeks status post patellar ligament repair
50
concerns:
–Knee pain (8/10 at maximum)
–Limited active range of motion
•Referred to physical therapy for evaluation and
management
Initial Evaluation: Physical Examination
–Limited sleeping secondary to knee pain
Cleared
for partial weightbearing activities
Assessment
•Physical Examination (In Person)
Non-weightbearing
gait with bilateral axillary
crutches
Incision
Range
sites are clean, dry, and intact
of motion
–Right knee AROM (involved): 0-40o
–Left knee AROM uninvolved): 5-0-135o
Strength
Pain, swelling, range of motion and strength/
motor control deficits status post apparently
uncomplicated patellar ligament rupture and
subsequent repair
and motor control
–Unable to perform a left quadriceps set
9
12/11/12
Plan
Course of Care / Outcomes
•Extensive patient and family education
•Patient followed every 2 weeks through
regarding post-surgical protocol, including
stages and milestones, anticipated prognosis,
and indications to contact primary physical
therapist
telemedicine
•Returned to functional activities excluding
basketball
•Follow-up using telemedicine for re-evaluation
and progression of home exercise program
•Returned to clinic at next available school
break for instruction in higher level activities
to facilitate return to basketball
Why Bother With Prevention?
Doing Tomorrows
Work Today:
•Point prevalence 4-5 million new occupational
Occupational Injury
Prevention & Physical
Therapy
injuries annually Department of Labor 2012
•Cost of Workers Compensation claims was
$85 billion USD in 2007 Sengupta et al 2009
Kaiser Hayward PT Fellowship
in Advanced Orthopedic Manual Therapy
Work Injury Costs Are Increasing!
Bhushan & Leigh 2011 Public Health Reports
Todd E. Davenport,
PT, DPT, OCS
However, Work Injuries Are Decreasing!
Bhushan & Leigh 2011 Public Health Reports
10
12/11/12
Sources of Increased Relative Cost
Positive covariates
Who Uses Physical Therapy?
Negative covariates
Significant predictors
of general utilization:
•Medical covariates
•Number of lost time
cases
•Dow Jones
Industrial Average
•Treasury bill interest
rate
•Including all
Younger
age
Male
gender
Work
as a laborer
Disorders
reported cases
of the joints
Bhushan & Leigh 2011 Public Health Reports
Berecki-Gisolf et al 2012 J Occup Rehab
Who Uses Physical Therapy?
Preventing the Need for Costly Services
High utilization
predicted by:
Age
Health
Protection
&
Occupational
Safety
50-60
Female
gender
Health
Promotion
+
=
Enhancement of
Health/Well-being &
Prevention of Injury/Illness
Working
as a
tradesperson
High
Total Occupational Health!
hospital costs
Berecki-Gisolf et al 2012 J Occup Rehab
National Institute for Occupational Safety and Health
What Is Total Occupational Health?
Who Does Total Occupational Health?
Total Health
Organization
Employee
Shared Responsibility
&
Partnership
• Safety and health
• Ergonomics
• Education & training
• Early interventions
• Wellness culture
• Accept responsibility
• Use body properly
• Keep body well & fit
• Build wellness
BODY
Health Protection + Health Promotion
MIND
SPIRIT
11
12/11/12
Physical and Total Occupational Health
Movement as Preventive Medicine
Organization
• Safety and health
• Ergonomics
• Education & training
• Early interventions
• Wellness culture
Physical Therapists are
The Ultimate Ambassadors for
Total Occupational Health!
Physical Activity: Is It Feasible?
Chart
Physical Activity: Does It Help?
Chart
Physical Activity: Is It Feasible?
Chart
Physical Activity: Does It Help?
Chart
12
12/11/12
Description of a Program
Examples of Interventions
•Level I and Level 2 ergonomic consultations
•High workplace injury rates in selected
departments
•Analysis of job site and work functions
•Pre-shift and outside-of-work exercise programs
•Each physical therapist assigned to one highrisk department
•Provide just-in-time services to the high-risk
department
Case Application #1
Radiology Department
•Total health promotion
Stress management
Weight management
Activity promotion
Case Application #2
Materials Management Department
Benefits of the Program
•Overall, organization-wide reduction in
workplace injuries during the past 15 years
•Awareness of total health perceived as
beneficial for employees
•Safety is becoming recognized as a collective
responsibility
13
Doing Today’s Work Today: How to Reduce Inefficiencies in
Physical Therapy Service Delivery Through
“Just In Time” Management Principles
Health Policy and Administration Section
American Physical Therapy Association
Combined Sections Meeting 2013
San Diego, California
Presentation Reference List
Lean Management References:
Brackett T, Comer L, Whichello R. Do Lean Practices Lead to More Time at the Bedside? J
Healthc Qual. 2011 Oct 12. [Epub ahead of print]
Deans R, Wade S. Finding a balance between "value added" and feeling valued: revising
models of care. The human factor of implementing a quality improvement initiative using
Lean methodology within the healthcare sector. Healthc Q. 2011 Oct;14 Spec No 3:5861.
Christensen CM, Grossman JH, Hwang J. The Innovator's Prescription: A Disruptive Solution for
Health Care. New York: McGraw-Hill; 2009
Gupta A. A conceptual JIT model of service quality. International Journal of Engineering
Science and Technology [IJEST]. 2011 Mar;3(3):2214-27.
Halvorson GC. Health Care Reform Now!: A Prescription for Change. San Francisco:
Institute for Healthcare Improvement. Going Lean in Health Care. IHI Innovation Series white
paper. Cambridge, MA: Institute for Healthcare Improvement; 2005. (Available on
www.IHI.org)
Manos A, Sattler S, Alukal, G. Make Healthcare Lean. Quality Progress. 2006 Jul;39(7):24-30.
Young TP, McClean SI. A critical look at Lean Thinking in healthcare. Qual Saf Health Care.
2008 Oct;17(5):382-6.
Roving Physical Therapy References:
Akbari A, Mayhew A, Al-Alawi MA, et al. Interventions to improve outpatient referrals from
primary care to secondary care. Cochrane database of systematic reviews.
2008(4):CD005471.
Benson CJ, Schreck RC, Underwood FB, Greathouse DG. The role of Army physical therapists
as nonphysician health care providers who prescribe certain medications: observations
and experiences. Physical therapy. May 1995;75(5):380-386.
Boissonnault WG, Badke MB, Powers JM. Pursuit and implementation of hospital-based
outpatient direct access to physical therapy services: an administrative case report.
Physical therapy. Jan 2010;90(1):100-109.
Calman NS, Hyman RB, Licht W. Variability in consultation rates and practitioner level of
diagnostic certainty. The Journal of family practice. Jul 1992;35(1):31-38.
Davenport TE, Sebelski CA. The physical therapist as a diagnostician: how do we, should we,
and could we use information about pathology in our practice? Physical therapy. Nov
2011;91(11):1694-1695.
Davenport TE, Watts HG, Kulig K, Resnik C. Current status and correlates of physicians' referral
diagnoses for physical therapy. The Journal of orthopaedic and sports physical therapy.
Sep 2005;35(9):572-579.
Davis S, Machen MS, Chang L. The beneficial relationship of the colocation of orthopedics and
physical therapy in a deployed setting: Operation Iraqi Freedom. Military medicine. Mar
2006;171(3):220-223.
Donato EB, DuVall RE, Godges JJ, Zimmerman GJ, Greathouse DG. Practice analysis: defining
the clinical practice of primary contact physical therapy. The Journal of orthopaedic and
sports physical therapy. Jun 2004;34(6):284-304.
Donohoe MT, Kravitz RL, Wheeler DB, Chandra R, Chen A, Humphries N. Reasons for
outpatient referrals from generalists to specialists. Journal of general internal medicine.
May 1999;14(5):281-286.
Forrest CB, Nutting PA, Starfield B, von Schrader S. Family physicians' referral decisions:
results from the ASPN referral study. The Journal of family practice. Mar
2002;51(3):215-222.
Forrest CB, Nutting PA, von Schrader S, Rohde C, Starfield B. Primary care physician specialty
referral decision making: patient, physician, and health care system determinants.
Medical decision making : an international journal of the Society for Medical Decision
Making. Jan-Feb 2006;26(1):76-85.
Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication
breakdown in the outpatient referral process. Journal of general internal medicine. Sep
2000;15(9):626-631.
Davenport, Ferlatte, Matsui, & Tichenor
2
Greathouse DG, Schreck RC, Benson CJ. The United States Army physical therapy experience:
evaluation and treatment of patients with neuromusculoskeletal disorders. The Journal of
orthopaedic and sports physical therapy. May 1994;19(5):261-266.
Hendriks EJ, Kerssens JJ, Nelson RM, Oostendorp RA, van der Zee J. One-time physical
therapist consultation in primary health care. Physical therapy. Oct 2003;83(10):918-931.
James JJ, Abshier JD. The primary evaluation of musculoskeletal disorders by the physical
therapist. Military medicine. Jul 1981;146(7):496-499.
James JJ, Stuart RB. Expanded role for the physical therapist. Screening musculoskeletal
disorders. Physical therapy. Feb 1975;55(2):121-131.
Jette DU, Ardleigh K, Chandler K, McShea L. Decision-making ability of physical therapists:
physical therapy intervention or medical referral. Physical therapy. Dec
2006;86(12):1619-1629.
Mehrotra A, Forrest CB, Lin CY. Dropping the baton: specialty referrals in the United States.
The Milbank quarterly. Mar 2011;89(1):39-68.
Moore JH, McMillian DJ, Rosenthal MD, Weishaar MD. Risk determination for patients with
direct access to physical therapy in military health care facilities. The Journal of
orthopaedic and sports physical therapy. Oct 2005;35(10):674-678.
O'Cathain A, Froggett M, Taylor MP. General practice based physiotherapy: its use and effect
on referrals to hospital orthopaedics and rheumatology outpatient departments. The
British journal of general practice : the journal of the Royal College of General
Practitioners. Jul 1995;45(396):352-354.
Overman SS, Larson JW, Dickstein DA, Rockey PH. Physical therapy care for low back pain.
Monitored program of first-contact nonphysician care. Physical therapy. Feb
1988;68(2):199-207.
Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A Comparison of Health Care Use for
Physician-Referred and Self-Referred Episodes of Outpatient Physical Therapy. Health
services research. Sep 23 2011.
Pinnington MA, Miller J, Stanley I. An evaluation of prompt access to physiotherapy in the
management of low back pain in primary care. Family practice. Aug 2004;21(4):372-380.
Rhon DI, Gill N, Teyhen D, Scherer M, Goffar S. Clinician perception of the impact of deployed
physical therapists as physician extenders in a combat environment. Military medicine.
May 2010;175(5):305-312.
Rhon DI. A physical therapist experience, observation, and practice with an infantry brigade
combat team in support of Operation Iraqi Freedom. Military medicine. Jun
2010;175(6):442-447.
Davenport, Ferlatte, Matsui, & Tichenor
3
Telemedicine References:
Bulik RJ. Human factors in primary care telemedicine encounters. J Telemed Telecare.
2008;14(4):169-72.
Kern J. Evaluation of teleconsultation systems. Int J Med Inform. 2006. Mar-Apr;75(3-4):330-4.
Liu X, Sawada Y, Takizawa T, Sato H, Sato M, Sakamoto H, Utsugi T, Sato K, Sumino H,
Okamura S, Sakamaki T. Doctor-patient communication: a comparison between
telemedicine consultation and face-to-face consultation. Intern Med. 2007;46(5):227-32.
Nouhi M, Fayaz-Bakhsh A, Mohamadi E, Shafii M. Telemedicine and its potential impacts on
reducing inequalities in access to health manpower. Telemed J E Health. 2012
Oct;18(8):648-53.
Onor ML, Misan S. The clinical interview and the doctor-patient relationship in telemedicine.
Telemed J E Health. 2005 Feb;11(1):102-5.
Taylor P. Evaluating telemedicine systems and services. J Telemed Telecare.2005;11(4):16777.
Whitten P, Love B. Patient and provider satisfaction with the use of telemedicine: overview and
rationale for cautious enthusiasm. J Postgrad Med. 2005 Oct-Dec;51(4):294-300.
Whitten PS, Mackert MS. Addressing telehealth's foremost barrier: provider as initial
gatekeeper. Int J Technol Assess Health Care. 2005 Fall;21(4):517-21.
Zanni GR. Telemedicine: sorting out the benefits and obstacles. Consult Pharm. 2011
Nov;26(11):810-2, 814, 821-4.
Prevention References:
Berecki-Gisolf J, Collie A, McClure RJ. Determinants of Physical Therapy Use by Compensated
Workers with Musculoskeletal Disorders. J Occup Rehabi. 2012 Aug 7 [Epub ahead of
print]
Bhushan A Leigh JP. National trends in occupational injuries before and after 1992 and
predictors of workers' compensation costs. Public Health Rep. 2011;126(5):625-34.
da Costa BR, Vieira ER. Stretching to reduce work-related musculoskeletal disorders: a
systematic review. J Rehab Med. 2008;40(5):321-328.
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