Locations:
Search IconSearch

6 Clicks Functional Measurement Tool: Why It’s Drawing Crowds at Conferences Far and Wide

Interest swells in the promise of data-driven care value

17-NEU-4133-Stilphen-650×450

Ever since Cleveland Clinic rolled out its 6 Clicks functional measurement tool in 2011-2012, Mary Stilphen, PT, DPT, has been scrambling to keep up with all the invitations she receives to speak about it.

Advertisement

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

“I’ve presented on 6 Clicks to the American Hospital Association, the American Physical Therapy Association, the American Medical Rehabilitation Providers Association and a host of regional organizations,” says Stilphen, Senior Director of Rehabilitation and Sports Therapy at Cleveland Clinic and a leader of the 6 Clicks initiative.

“There’s a lot of interest in how we’re using this tool at Cleveland Clinic to promote a culture of mobility, reduce inappropriate referrals for therapy and optimize post-acute discharge planning,” adds Stilphen, shown above at a 2016 speaking engagement.

6 Clicks in brief

6 Clicks has been covered on Consult QD before, from the standpoint of validation studies confirming its accuracy and reliability and successful efforts to integrate it into Cleveland Clinic’s electronic medical record enterprisewide.

Briefly, the tool was developed at Cleveland Clinic as a short form of the AM-PAC™ (Activity Measure for Post Acute Care™) instrument developed by Boston University researchers. Designed to be minimally burdensome to both providers and patients, 6 Clicks is an electronically administered pair of questionnaires that assess — through six questions each — patients’ mobility and self-care abilities. Cleveland Clinic physical therapists (PTs) and occupational therapists (OTs) complete the tool at each evaluation of every hospitalized patient for whom a consult for PT/OT is requested by a physician.

The initial objectives were to determine appropriate referrals for PT/OT, guide discharge recommendations, and improve allocation of therapy resources and personnel in the acute care hospital. The tool has since been introduced in some skilled nursing facilities (SNFs) in Northeast Ohio to efficiently help SNF staff better monitor patients’ functional progress during their SNF stay.

Advertisement

What audiences want to know

Stilphen says that across her many speaking engagements about 6 Clicks — which has been licensed for use by numerous healthcare organizations across the country — audience interest tends to focus on the following three ways 6 Clicks is used:

1) To educate physicians about therapy referrals. “Our early use of 6 Clicks documented that our PTs and OTs were frequently being asked to consult on inpatients who were functionally independent and didn’t need PT or OT services,” says Stilphen. “We’ve since been able to use 6 Clicks data to show physicians throughout the organization that not all inpatients need the skills of a therapist and to teach physicians which patients are appropriate for therapy consults — and which ones aren’t.”

Stilphen continues to meet weekly with clinical areas throughout Cleveland Clinic to review their inpatients’ 6 Clicks scores and opportunities to make consult referrals ever more appropriate. “We’re using 6 Clicks to really focus our interventions on the right patients at the right time,” she says.

2) To drive value and system change. 6 Clicks is all about data: Meaningful discrete data are collected by therapists at every inpatient encounter and then used to drive clinical decisions, guide resource use in the hospital and help determine the most appropriate discharge disposition. The result has been collection of millions of data points on patients’ function, with approximately 68,000 inpatients evaluated via 6 Clicks in 2016 alone.

“Having data to show how we should be directing our resources has been invaluable — it really makes a difference in getting all hands on deck with these initiatives,” Stilphen says. Of course, avoiding consults for patients who don’t need them results in direct cost savings, and 6 Clicks’ broad promotion of a culture of mobility also fosters quality of care and associated cost savings “because patients don’t get so deconditioned while they’re in our care,” Stilphen explains. “Hospital leadership understands how this translates to value across the board, and that’s resulted in strong buy-in.”

Advertisement

3) To curb unneeded precertification requests. Recent interest has focused on one particular area of value: Using the 6 Clicks score to reduce inappropriate precertification requests for transfer to an SNF. This initiative stemmed from therapist perceptions that precertification requests were sometimes prompting unnecessary therapy visits and needlessly delaying SNF transfer and prolonging hospital stays — perceptions that were supported by disposition data.

In response, Stilphen and Department of Physical Medicine and Rehabilitation leadership developed an idea: Hospital patients with an initial 6 Clicks score of 18 or below (out of 24, which indicates maximal function) and for whom PT has recommended SNF transfer should not require an updated PT/OT note for admission to an SNF unless required by their insurance.

The idea was tested in a small pilot with one payer, which confirmed the concept: This approach was found to reduce requests for precertification visits, length of stay in both hospital and SNF, and administrative burden for all parties — hospital, SNF and payers. The concept has since been implemented across multiple Cleveland Clinic hospitals.

“We presented data to payers and convinced them to use our 6 Clicks-based approach in lieu of a precertification visit for selected transfers to an SNF,” Stilphen explains. “The aim is to get patients to the appropriate level of care as soon as they’re medically stable and avoid unnecessary precertification when patient status hasn’t changed. In the process, we believe it’s reducing costs significantly by avoiding prolonged hospital stays. We look forward to sharing more about this initiative’s impact on costs and outcomes in the future.”

Advertisement

Related Articles

20-NEU-1915483 Navigated TMS to guide management of refractory epilepsy_CQD_650x450
How Navigated Transcranial Magnetic Stimulation Is Advancing Epilepsy Care

A noninvasive approach to map eloquent areas before surgery

17-CCC-4475-Telehealth-650×450
Behind the Scenes in Telehealth Amid COVID-19: Physicians Help Shape the Narrative of Patient Care During the Pandemic

Physician reimbursement policy experts join forces with IT and coders to enable digital transformation

minority-stroke-program-650×450
Tailoring Stroke Treatment and Prevention to Populations Who Need It Most

Minority Stroke Program focuses on outreach to racial and ethnic minority communities

geriatric-patient_650x450
About the Recent AAN Cognitive Screening Guidelines for Older Adults

Metrics support proactive cognitive care, demand more research

botulinum toxin injection for pediatric migraine
Botulinum Toxin Injections Are Bringing Relief for Intractable Pediatric Migraine

Excellent response seen with ongoing use in patients as young as 11

19-NEU-5592-AltinayTransgenderPsychiatry-650×450
Caring for Transgender Adults: Essentials for Behavioral Health Providers

Q&A with a psychiatrist in Cleveland Clinic’s Transgender Surgery and Medicine Program

19-NEU-5594_back-on-trek-650×450
Multidisciplinary Chronic Back Pain Program Identifies – and Addresses – Risk Factors for Noncompletion

Time constraints, language barriers, substance misuse, mood disorders targeted for improvements

19-NEU-3981-pediatric-epilepsy-650×450
Charting a Course for the Future of Pediatric Epilepsy Care

Project draws $1.6M to leverage telemedicine to create medical home, ease transition to adult care

Ad