title: Pursuit and implementation of hospital-based outpatient direct access to physical therapy services: an administrative case report.
abstract: OBJECTIVE
  Despite legislative approval of direct access to physical therapy, other regulatory barriers and internal institutional policies often must be overcome before this practice model can be fully adopted. Few institutional initiatives have been published describing strategies designed to change policies restricting direct patient access. This case report describes steps and strategies associated with successful implementation of a direct access physical therapy model at a large academic medical center.
  
  
  METHODS
  The process of obtaining institutional medical board and hospital authority board approval and implementing a pilot program is described. Program details, including therapist qualifications and scope of practice, the required internal training program, and program outcome assessment, are provided. The therapist scope of practice includes the ability to refer patients directly to a radiologist for plain film radiography. Early pilot program findings, including challenges faced and subsequent actions, are described.
  
  
  RESULTS
  Reviewed patient care decisions by therapists participating in the pilot program were deemed appropriate 100% of the time by physician chart reviewers. Approximately 10% of the patients seen were referred to a radiologist for plain film imaging, and 4% and 16% of the patients were referred to physicians for pain medications or medical consultation, respectively. The pilot program's success led to institutional adoption of the direct access model in all physical therapy outpatient clinics.
  
  
  CONCLUSIONS
  Autonomy is described, in part, as self-determined professional judgment and action. This case report describes such an effort at a large academic medical center. The interdependent, collaborative relationship among physical therapists, physicians, and hospital administrators has resulted in the implementation of a patient-centered practice model based on the premise of patient choice.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, 1300 University Ave, 5190 MSC, Madison, WI 53706, USA. boissonnaultw@pt.wisc.edu
authors.forename: William G
authors.initials: WG
authors.lastname: Boissonnault
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Badke
authors.forename: Jane Megan
authors.initials: JM
authors.lastname: Powers
mesh_terms: D000046:Academic Medical Centers; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D019982:Organizational Case Studies; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*; D010814:Physical Therapy Department, Hospital / Q000458:organization & administration*; D026761:Physical Therapy Specialty / Q000458:organization & administration; D016730:Program Development; D014922:Wisconsin