# Treatment Plans Skill ## Overview Skill for generating **concise, clinician-focused** medical treatment plans across all clinical specialties. Provides LaTeX/PDF templates with SMART goal frameworks, evidence-based interventions, regulatory compliance, and validation tools for patient-centered care planning. **Default to 1-page format** for most cases - think "quick reference card" not "comprehensive textbook". ## What's Included ### 📋 Seven Treatment Plan Types 1. **One-Page Treatment Plan** (PREFERRED) - Concise, quick-reference format for most clinical scenarios 2. **General Medical Treatment Plans** - Primary care, chronic diseases (diabetes, hypertension, heart failure) 3. **Rehabilitation Treatment Plans** - Physical therapy, occupational therapy, cardiac/pulmonary rehab 4. **Mental Health Treatment Plans** - Psychiatric care, depression, anxiety, PTSD, substance use 5. **Chronic Disease Management Plans** - Complex multimorbidity, long-term care coordination 6. **Perioperative Care Plans** - Preoperative optimization, ERAS protocols, postoperative recovery 7. **Pain Management Plans** - Acute and chronic pain, multimodal analgesia, opioid-sparing strategies ### 📚 Reference Files (5 comprehensive guides) - `treatment_plan_standards.md` - Professional standards, documentation requirements, legal considerations - `goal_setting_frameworks.md` - SMART goals, patient-centered outcomes, shared decision-making - `intervention_guidelines.md` - Evidence-based treatments, pharmacological and non-pharmacological - `regulatory_compliance.md` - HIPAA compliance, billing documentation, quality measures - `specialty_specific_guidelines.md` - Detailed guidelines for each treatment plan type ### 📄 LaTeX Templates (7 professional templates) - `one_page_treatment_plan.tex` - **FIRST CHOICE** - Dense, scannable 1-page format (like precision oncology reports) - `general_medical_treatment_plan.tex` - Comprehensive medical care planning - `rehabilitation_treatment_plan.tex` - Functional restoration and therapy - `mental_health_treatment_plan.tex` - Psychiatric and behavioral health - `chronic_disease_management_plan.tex` - Long-term disease management - `perioperative_care_plan.tex` - Surgical and procedural care - `pain_management_plan.tex` - Multimodal pain treatment ### 🔧 Validation Scripts (4 automation tools) - `generate_template.py` - Interactive template selection and generation - `validate_treatment_plan.py` - Comprehensive quality and compliance checking - `check_completeness.py` - Verify all required sections present - `timeline_generator.py` - Create visual treatment timelines and schedules ## Quick Start ### Generate a Treatment Plan Template ```bash cd .claude/skills/treatment-plans/scripts python generate_template.py # Or specify type directly python generate_template.py --type general_medical --output diabetes_plan.tex ``` Available template types: - `one_page` (PREFERRED - use for most cases) - `general_medical` - `rehabilitation` - `mental_health` - `chronic_disease` - `perioperative` - `pain_management` ### Compile to PDF ```bash cd /path/to/your/treatment/plan pdflatex my_treatment_plan.tex ``` ### Validate Your Treatment Plan ```bash # Check for completeness python check_completeness.py my_treatment_plan.tex # Comprehensive validation python validate_treatment_plan.py my_treatment_plan.tex ``` ### Generate Treatment Timeline ```bash python timeline_generator.py --plan my_treatment_plan.tex --output timeline.pdf ``` ## Standard Treatment Plan Components All templates include these essential sections: ### 1. Patient Information (De-identified) - Demographics and relevant medical background - Active conditions and comorbidities - Current medications and allergies - Functional status baseline - HIPAA-compliant de-identification ### 2. Diagnosis and Assessment Summary - Primary diagnosis (ICD-10 coded) - Secondary diagnoses - Severity classification - Functional limitations - Risk stratification ### 3. Treatment Goals (SMART Format) **Short-term goals** (1-3 months): - Specific, measurable outcomes - Realistic targets with defined timeframes - Patient-centered priorities **Long-term goals** (6-12 months): - Disease control targets - Functional improvement objectives - Quality of life enhancement - Complication prevention ### 4. Interventions - **Pharmacological**: Medications with dosages, frequencies, monitoring - **Non-pharmacological**: Lifestyle modifications, behavioral interventions, education - **Procedural**: Planned procedures, specialist referrals, diagnostic testing ### 5. Timeline and Schedule - Treatment phases with timeframes - Appointment frequency - Milestone assessments - Expected treatment duration ### 6. Monitoring Parameters - Clinical outcomes to track - Assessment tools and scales - Monitoring frequency - Intervention thresholds ### 7. Expected Outcomes - Primary outcome measures - Success criteria - Timeline for improvement - Long-term prognosis ### 8. Follow-up Plan - Scheduled appointments - Communication protocols - Emergency procedures - Transition planning ### 9. Patient Education - Condition understanding - Self-management skills - Warning signs - Resources and support ### 10. Risk Mitigation - Adverse effect management - Safety monitoring - Emergency action plans - Fall/infection prevention ## Common Use Cases ### 1. Type 2 Diabetes Management ``` Goal: Create comprehensive treatment plan for newly diagnosed diabetes Template: general_medical_treatment_plan.tex Key Components: - SMART goals: HbA1c <7% in 3 months, weight loss 10 lbs in 6 months - Medications: Metformin titration schedule - Lifestyle: Diet, exercise, glucose monitoring - Monitoring: HbA1c every 3 months, quarterly visits - Education: Diabetes self-management education ``` ### 2. Post-Stroke Rehabilitation ``` Goal: Develop rehab plan for stroke patient with hemiparesis Template: rehabilitation_treatment_plan.tex Key Components: - Functional assessment: FIM scores, ROM, strength testing - PT goals: Ambulation 150 feet with cane in 12 weeks - OT goals: Independent ADLs, upper extremity function - Treatment schedule: PT/OT/SLP 3x week each - Home exercise program ``` ### 3. Major Depressive Disorder ``` Goal: Create integrated treatment plan for depression Template: mental_health_treatment_plan.tex Key Components: - Assessment: PHQ-9 score 16 (moderate depression) - Goals: Reduce PHQ-9 to <5, return to work in 12 weeks - Psychotherapy: CBT weekly sessions - Medication: SSRI with titration schedule - Safety planning: Crisis contacts, warning signs ``` ### 4. Total Knee Replacement ``` Goal: Perioperative care plan for elective TKA Template: perioperative_care_plan.tex Key Components: - Preop optimization: Medical clearance, medication management - ERAS protocol implementation - Postop milestones: Ambulation POD 1, discharge POD 2-3 - Pain management: Multimodal analgesia - Rehab plan: PT starting POD 0 ``` ### 5. Chronic Low Back Pain ``` Goal: Multimodal pain management plan Template: pain_management_plan.tex Key Components: - Pain assessment: Location, intensity, functional impact - Goals: Reduce pain 7/10 to 3/10, return to work - Medications: Non-opioid analgesics, adjuvants - PT: Core strengthening, McKenzie exercises - Behavioral: CBT for pain, mindfulness - Interventional: Consider ESI if inadequate response ``` ## SMART Goals Framework All treatment plans use SMART criteria for goal-setting: - **Specific**: Clear, well-defined outcome (not vague) - **Measurable**: Quantifiable metrics or observable behaviors - **Achievable**: Realistic given patient capabilities and resources - **Relevant**: Aligned with patient priorities and values - **Time-bound**: Specific timeframe for achievement ### Examples **Good SMART Goals**: - Reduce HbA1c from 8.5% to <7% within 3 months - Walk independently 150 feet with assistive device by 8 weeks - Decrease PHQ-9 depression score from 18 to <10 in 8 weeks - Achieve knee flexion >90 degrees by postoperative day 14 - Reduce pain from 7/10 to ≤4/10 within 6 weeks **Poor Goals** (not SMART): - "Feel better" (not specific or measurable) - "Improve diabetes" (not specific or time-bound) - "Get stronger" (not measurable) - "Return to normal" (vague, not specific) ## Workflow Examples ### Standard Treatment Plan Workflow 1. **Assess patient** - Complete history, physical, diagnostic testing 2. **Select template** - Choose appropriate template for clinical context 3. **Generate template** - `python generate_template.py --type [type]` 4. **Customize plan** - Fill in patient-specific information (de-identified) 5. **Set SMART goals** - Define measurable short and long-term goals 6. **Specify interventions** - Evidence-based pharmacological and non-pharmacological 7. **Create timeline** - Schedule appointments, milestones, reassessments 8. **Define monitoring** - Outcome measures, assessment frequency 9. **Validate completeness** - `python check_completeness.py plan.tex` 10. **Quality check** - `python validate_treatment_plan.py plan.tex` 11. **Review quality checklist** - Compare to `quality_checklist.md` 12. **Generate PDF** - `pdflatex plan.tex` 13. **Review with patient** - Shared decision-making, confirm understanding 14. **Implement and document** - Execute plan, track progress in clinical notes 15. **Reassess and modify** - Adjust plan based on outcomes ### Multidisciplinary Care Plan Workflow 1. **Identify team members** - PCP, specialists, therapists, case manager 2. **Create base plan** - Generate template for primary condition 3. **Add specialty sections** - Integrate consultant recommendations 4. **Coordinate goals** - Ensure alignment across disciplines 5. **Define communication** - Team meeting schedule, documentation sharing 6. **Assign responsibilities** - Clarify who manages each intervention 7. **Create care timeline** - Coordinate appointments across providers 8. **Share plan** - Distribute to all team members and patient 9. **Track collectively** - Shared monitoring and outcome tracking 10. **Regular team review** - Adjust plan collaboratively ## Best Practices ### Patient-Centered Care ✓ Involve patients in goal-setting and decision-making ✓ Respect cultural beliefs and language preferences ✓ Address health literacy with appropriate language ✓ Align plan with patient values and life circumstances ✓ Support patient activation and self-management ### Evidence-Based Practice ✓ Follow current clinical practice guidelines ✓ Use interventions with proven efficacy ✓ Incorporate quality measures (HEDIS, CMS) ✓ Avoid low-value or ineffective interventions ✓ Update plans based on emerging evidence ### Regulatory Compliance ✓ De-identify per HIPAA Safe Harbor method (18 identifiers) ✓ Document medical necessity for billing support ✓ Include informed consent documentation ✓ Sign and date all treatment plans ✓ Maintain professional documentation standards ### Quality Documentation ✓ Complete all required sections ✓ Use clear, professional medical language ✓ Include specific, measurable goals ✓ Specify exact medications (dose, route, frequency) ✓ Define monitoring parameters and frequency ✓ Address safety and risk mitigation ### Care Coordination ✓ Communicate plan to entire care team ✓ Define roles and responsibilities ✓ Coordinate across care settings ✓ Integrate specialist recommendations ✓ Plan for care transitions ## Integration with Other Skills ### Clinical Reports - **SOAP Notes**: Document treatment plan implementation and progress - **H&P Documents**: Initial assessment informs treatment planning - **Discharge Summaries**: Summarize treatment plan execution - **Progress Notes**: Track goal achievement and plan modifications ### Scientific Writing - **Citation Management**: Reference clinical practice guidelines - **Literature Review**: Understand evidence base for interventions - **Research Lookup**: Find current treatment recommendations ### Research - **Research Grants**: Treatment protocols for clinical trials - **Clinical Trial Reports**: Document trial interventions ## Clinical Practice Guidelines Treatment plans should align with evidence-based guidelines: ### General Medicine - American Diabetes Association (ADA) Standards of Care - ACC/AHA Cardiovascular Guidelines - GOLD COPD Guidelines - JNC-8 Hypertension Guidelines - KDIGO Chronic Kidney Disease Guidelines ### Rehabilitation - APTA Physical Therapy Clinical Practice Guidelines - AOTA Occupational Therapy Practice Guidelines - AHA/AACVPR Cardiac Rehabilitation Guidelines - Stroke Rehabilitation Best Practices ### Mental Health - APA (American Psychiatric Association) Practice Guidelines - VA/DoD Clinical Practice Guidelines for Mental Health - NICE Guidelines (UK) - Evidence-based psychotherapy protocols (CBT, DBT, ACT) ### Pain Management - CDC Opioid Prescribing Guidelines - AAPM (American Academy of Pain Medicine) Guidelines - WHO Analgesic Ladder - Multimodal Analgesia Best Practices ### Perioperative Care - ERAS (Enhanced Recovery After Surgery) Society Guidelines - ASA Perioperative Guidelines - SCIP (Surgical Care Improvement Project) Measures ## Professional Standards ### Documentation Requirements - Complete and accurate patient information - Clear diagnosis with appropriate ICD-10 coding - Evidence-based interventions - Measurable goals and outcomes - Defined monitoring and follow-up - Provider signature, credentials, and date ### Medical Necessity Treatment plans must demonstrate: - Medical appropriateness of interventions - Alignment with diagnosis and severity - Evidence supporting treatment choices - Expected outcomes and benefit - Frequency and duration justification ### Legal Considerations - Informed consent documentation - Patient understanding and agreement - Risk disclosure and mitigation - Professional liability protection - Compliance with state/federal regulations ## Support and Resources ### Getting Help 1. **Check reference files** - Comprehensive guidance in `references/` directory 2. **Review templates** - See example structures in `assets/` directory 3. **Run validation scripts** - Identify issues with automated tools 4. **Consult SKILL.md** - Detailed documentation and best practices 5. **Review quality checklist** - Ensure all quality criteria met ### External Resources - Clinical practice guidelines from specialty societies - UpToDate and DynaMed for treatment recommendations - AHRQ Effective Health Care Program - Cochrane Library for intervention evidence - CMS Quality Measures and HEDIS specifications - HEDIS (Healthcare Effectiveness Data and Information Set) ### Professional Organizations - American Medical Association (AMA) - American Academy of Family Physicians (AAFP) - Specialty society guidelines (ADA, ACC, AHA, APA, etc.) - Joint Commission standards - Centers for Medicare & Medicaid Services (CMS) ## Frequently Asked Questions ### How do I choose the right template? Match the template to your primary clinical focus: - **Chronic medical conditions** → general_medical or chronic_disease - **Post-surgery or injury** → rehabilitation or perioperative - **Psychiatric conditions** → mental_health - **Pain as primary issue** → pain_management ### What if my patient has multiple conditions? Use the `chronic_disease_management_plan.tex` template for complex multimorbidity, or choose the template for the primary condition and add sections for comorbidities. ### How often should treatment plans be updated? - **Initial creation**: At diagnosis or treatment initiation - **Regular updates**: Every 3-6 months for chronic conditions - **Significant changes**: When goals are met or treatment is modified - **Annual review**: Minimum for all chronic disease plans ### Can I modify the LaTeX templates? Yes! Templates are designed to be customized. Modify sections, add specialty-specific content, or adjust formatting to meet your needs. ### How do I ensure HIPAA compliance? - Remove all 18 HIPAA identifiers (see Safe Harbor method) - Use age ranges instead of exact ages (e.g., "60-65" not "63") - Remove specific dates, use relative timelines - Omit geographic identifiers smaller than state - Use `check_deidentification.py` script from clinical-reports skill ### What if validation scripts find issues? Review the specific issues identified, consult reference files for guidance, and revise the plan accordingly. Common issues include: - Missing required sections - Goals not meeting SMART criteria - Insufficient monitoring parameters - Incomplete medication information ## License Part of the Claude Scientific Writer project. See main LICENSE file. --- For detailed documentation, see `SKILL.md`. For issues or questions, consult the comprehensive reference files in the `references/` directory.