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Implementing Prehab: Laying Groundwork to Maximize Value

presented by Megan Pfarr, DPT, CLT

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Disclosure Statement:

Financial— Megan Pfarr receives compensation from MedBridge for the production of this course. There are no other relevant financial relationships. Nonfinancial— No relevant nonfinancial relationship exists.

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

MedBridge is committed to accessibility for all of our subscribers. If you are in need of a disability-related accommodation, please contact [email protected]. We will process requests for reasonable accommodation and will provide reasonable accommodations where appropriate, in a prompt and efficient manner.

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"Prehab" is an external-facing, patient-friendly term alluding to improved health and fitness in preparation for a procedure--similar to training for a marathon. To the health care professional, prehabilitation is a multimodal approach to withstand a physiologic challenge. Shifting the initiation of care to begin before the medical event can be beneficial to the patient, health care system, and even to the payer. This course will offer resources and analogies to build engagement in the growing field of prehabilitation. Of note, many examples default to cancer prehabilitation, given the strenuous nature of cancer treatment and the known deleterious effects. However, benefits and supportive theories can be easily applied to various medical events.

Meet Your Instructor

Megan Pfarr, DPT, CLT

Megan is a physical therapist and certified lymphedema therapist practicing in outpatient cancer care after graduating from Saint Louis University in 2005. She serves Health Sisters Hospital Systems (HSHS) Eastern Wisconsin Division as manager of Anew Cancer Survivorship and program development across a four hospital division. Anew Cancer Rehab successes include 57% referral rate within…

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1. Defining and Debunking Prehab

“Prehab” has a varied level of understanding depending on the audience. Clearly defining what prehab is to your health care system, and therefore clearly relaying that to the patient, is crucial. To the patient, prehab is the work they are doing to prepare for surgery, treatment, or radiation. To the provider team, prehab is any intervention prior to and throughout the initiation of treatment that may aide in sustaining a safe level of function. To the Payor, prehab is a "dirty" word indicating the visit is pre-event and there would not be a functional impairment. We know this to be a common misconception.

2. Identify Outcomes and Supportive Content

When we are involved with “getting patients earlier,” it can be easy to overpromise results. Aligning the vision of the referring team and the treatment team will alleviate disconnect down the line. This section will cover the current research and implications, as well as options for assessment tools to demonstrate effective outcomes. The role of a rehab clinician is an optimal fit for a variety of reasons as well as advising on wellness.

3. Prehab vs. Wellness

Organizing and offering a continuum of care beginning with prehab, onto rehab, and finally to wellness is often a goal for health care organizations. However, each of these points within the episode of care has distinct goals and intentions. Discussing appropriate patient populations and appropriate referrals to each will keep all stakeholders satisfied.

4. Prehab Appropriate Populations

When launching a prehab program, it is vital to determine which patient populations can best benefit from intervention. Blindly referring patients will result in negative feedback, as not all patients will find value added from these services. Discussion will include potential for high impact on particular patient populations.

5. Program Considerations and Community Partners

As is common with patients who undergo significant medical care, they quickly become savvy consumers of health care knowledge and will be able to “sniff out” any providers that are not aware of current standards, etc. It will be a pillar of success for colleagues to be up on information, have access to patient plan of care, and open communication channels to the medical team. Discussion will include methods for competency and opportunities for multidisciplinary collaboration.

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