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Preparing the Next Generation of Physical Therapists for Transformative Practice and Population Management: Example From Macquarie University

The new and major challenge to health care is the advent of chronic diseases. The successes of treating people with infectious diseases, the wave of the aging population, changing lifestyles, obesity, and physical inactivity have contributed to a public health epidemic of chronic diseases (ie, diabetes, stroke, Alzheimer disease, arthritis, and heart failure). Because of its personal, social, and economic impact, tackling chronic disease is the new frontier of modern medicine. Management of chronic diseases will not be solved by “magic bullets,” a surgical intervention, or the “heroics of medical rescue.” Chronic disease management requires holistic, patient-centered care, with collaborating and respectful teams of interdisciplinary providers (physicians, nurses, pharmacists, and allied health workers). These teams will coordinate care across the continuum. In addition, our current medical and public health initiatives must be prepared to address not only the medical conditions but also the social determinants of health. Atul Gawande, a surgeon and health care thought leader, wrote that health care “now requires large enterprises, teams of clinicians, high-risk technologies, and knowledge that outstrips any one person's abilities [our emphasis].”1(p183) Individual professional and personal autonomy is not the ideal we should seek. The next generation of solutions will require new skills among physical therapists to be partners in the treatment of populations of patients across the continuum of health care settings and coach patients and families in lifestyle management and be accountable for sustaining and improving functional status.

The Centers for Medicare & Medicaid Services recently implemented bundled payments for hip and knee replacements in 67 geographic areas in the United States.2 Under this comprehensive joint replacement model, the hospital that performs the surgery will be accountable for the costs and quality of related care for the episode of care, which is from the time of the surgery through …