Date Presented 04/22/2023
This study demonstrates that a student-run pro bono clinic can reintegrate patients back to meaningful life roles, prepare OT students for future clinical practice, and generate evidence with a wide reach. These results were made possible by using a logic model, which was instrumental in planning, implementing, evaluating, and iteratively modifying the clinic semester by semester.
Primary Author and Speaker: Nathaniel Nazareno Baniqued
Additional Authors and Speakers: Rose McAndrew
Contributing Authors: Victoria Kaskutas
PURPOSE: We used a logic model to create a pro-bono Hand Therapy Student Experiential Learning Clinic (SELC-HT) to reintegrate under-insured patients back to meaningful life roles , prepare OT students for future clinical practice , and generate evidence (McAndrew and Kaskutas, 2020).
DESIGN: Retrospective cross-sectional cohort design.
METHOD: Standardized assessments measured patients’ disability, work disability, work ability, global health, and pain. The Hand Therapy Certification Commission Self-Assessment Tool (HTCC) measured students’ knowledge and an alumni survey measured beliefs about SELC-HT participation on professional growth. Measures of central tendencies and Wilcoxon Sign-Rank Tests compared baseline and outcome measurements. Potential reimbursement for services provided during 4 semesters was estimated based on assigned billing codes (CMS, n.d.).
RESULTS: Fifty-seven patients participated in 260 visits (mean=5 visits/patient) valued at $31,824. The subset of 25 patients with baseline and discharge data was 52% male, 60% Black, and 57% unemployed. Fractures (44%) and soft tissue injuries (24%) were most common, with 44% of conditions in the digit or hand. Scores on the Disability Shoulder Hand Questionnaire decreased by 14.8 points (p=.001), well above the minimal clinically significant change of 10.81 (Franchignoni et al., 2014). Work disability decreased by 22.9 points (p=.002) and the Work Ability Score increased (p=.014). The proportion of patients working doubled from baseline to discharge. Pain decreased and global health improved but lacked statistical significance. Patients expressed high levels of satisfaction with the services provided. Student therapists (n=13) displayed increases (p<.006) in all UE knowledge areas of the HTCC. All alumni noted the SELC-HT enhanced professional development and 9 of 12 alumni were employed in UE settings one-year post-graduation. We published five peer-reviewed manuscripts (which have been accessed over 1,000 times) and 16 presentations at national conferences.
CONCLUSION: These results demonstrate that the HT-SELC achieved all logic model defined outcomes; including reintegrating patients back to meaningful life roles, preparing OT students for future clinical practice, and generating evidence with a wide reach. The logic model was instrumental in planning, implementing, evaluating, and iteratively modifying the clinic semester by semester.
References
Franchignoni, F., Vercelli, S., Giordano, A., Sartorio, F., Bravini, E., & Ferriero, G. (2014). Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH). Journal of Orthopaedic & Sports Physical Therapy, 44(1), 30–39. https://doi.org/10.2519/jospt.2014.4893
McAndrew, R., & Kaskutas, V. (2020). Use of a logic model to develop an innovative hand therapy clinic to provide experiential learning for occupational therapy students. Journal of Occupational Therapy Education, 4(3), 16.
Search the Physician Fee Schedule | CMS. (n.d.). Retrieved August 7, 2021, from https://www.cms.gov/medicare/physician-fee-schedule/search/license-agreement?destination=/medicare/physician-fee-schedule/search%3FY%3d0%26T%3d4%26HT%3d0%26CT%3d2%26H1%3d97165%26C%3d61%26M%3d5
