Priorities of Hybrid Clinician-Managers: A Qualitative Study of How Managers Balance Clinical Quality Among Competing Responsibilities.

OBJECTIVE: Oversight of clinical quality is only one of physical therapy managers' multiple responsibilities. With the move to value-based care, organizations need sound management to navigate this evolving reimbursement landscape. Previous research has not explored how competing priorities affect physical therapy managers' oversight of clinical quality. The purpose of this study was to create a preliminary model of the competing priorities, motivations, and responsibilities of managers while overseeing clinical quality. METHODS: This qualitative study used the Rapid Qualitative Inquiry method. A purposive sample of 40 physical therapy managers and corporate leaders was recruited. A research team performed semi-structured interviews and observations in outpatient practices. The team used a grounded theory-based immersion/crystallization analysis approach. Identified themes delineated the competing priorities and workflows these managers use in their administrative duties. RESULTS: Six primary themes were identified that illustrate how managers: (1) balance managerial and professional priorities; (2) are susceptible to stakeholder influences; (3) experience internal conflict; (4) struggle to measure and define quality objectively; (5) are influenced by the culture and structure of their respective organizations; and (6) have professional needs apart from the needs of their clinics. CONCLUSION: Generally, managers' focus on clinical quality is notably less comprehensive than their focus on clinical operations. Additionally, the complex role of hybrid clinician-manager leaves limited time beyond direct patient care for administrative duties. Managers in organizations that hold them accountable to quality-based metrics have more systematic clinical quality oversight processes. IMPACT: This study gives physical therapy organizations a framework of factors that can be influenced to better facilitate managers' effective oversight of clinical quality. Organizations offering support for those managerial responsibilities will be well positioned to thrive in the new fee-for-value care structure.

Criterion validity, reliability and clinical responsiveness of the CareConnections Functional Index.

This study established the criterion validity, test-retest reliability and responsiveness of the CareConnections Functional Index (CCFI). The CCFI is composed of four body-region specific subscales, measuring functional ability. Reference standards included the Neck Disability Index; Modified Oswestry Disability Index; Quick Disabilities of the Arm, Shoulder and Hand and the Lower Extremity Functional Scale. One hundred subjects per body region were enrolled. Subject's rated their perceived improvement based on the 15-point Global Rating of Change questionnaire. Minimal clinically important differences (MCID) were calculated via receiver operator characteristic curve. Test-retest reliability coefficients were good to excellent. Validity correlations with the reference standard measures were acceptable (r > 0.7) for all subscales. MCID for the cervical subscale = 7 points, lumbar = 8 points, upper extremity = 16 points and lower extremity = 11 points. The results of this study support the use of the CCFI in outpatient physical therapy practice as a responsive tool with good reliability and validity. The results also indicate that future work should focus on the impact of baseline patient factors that may affect future outcome.