Ngo Long, Latham Nancy K, Jette Alan M, Soukup Jane, Iezzoni Lisa I
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Am J Phys Med Rehabil. 2009 Apr;88(4):308-21. doi: 10.1097/PHM.0b013e318198a791.
To examine the use of physical therapy and occupational therapy among Medicare beneficiaries nationwide before and after the 1997 Balanced Budget Act, which introduced prospective payment for rehabilitation services.
We analyzed responses from the longitudinal Medicare Current Beneficiary Survey, merged with Medicare claims, to track physical therapy and occupational therapy rates and intensity (units of service) from 1994 through 2001. This observational study focused on elderly and disabled Medicare beneficiaries within five conditions: stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis, and lower-limb mobility problems. We used cubic smoothing spline functions to describe trends in service intensity over time and generalized estimating equations to assess changes in service intensity.
Controlling for demographic characteristics, adjusted mean level of physical therapy and occupational therapy intensity rose significantly between 1994 and 2001 for all five conditions. Service intensity leveled off in 1999 for occupational therapy and 2000 for physical therapy. With few exceptions, physical therapy and occupational therapy intensity was not significantly associated with patients' demographic characteristics.
Medicare beneficiaries with conditions that can potentially benefit from physical therapy or occupational therapy or both continued to get these services at similar-and sometimes increasing-intensity during years after passage of the Balanced Budget Act.
考察1997年《平衡预算法案》（该法案引入了康复服务的前瞻性支付）前后全国医疗保险受益人中物理治疗和职业治疗的使用情况。
我们分析了纵向的医疗保险当前受益人调查的回复，并与医疗保险理赔数据合并，以追踪1994年至2001年期间物理治疗和职业治疗的使用率及强度（服务单位）。这项观察性研究聚焦于患有以下五种疾病的老年和残疾医疗保险受益人：中风、急性心肌梗死、慢性阻塞性肺疾病、关节炎以及下肢行动不便问题。我们使用三次平滑样条函数来描述服务强度随时间的变化趋势，并使用广义估计方程来评估服务强度的变化。
在控制了人口统计学特征后，所有五种疾病的物理治疗和职业治疗强度的调整后平均水平在1994年至2001年间均显著上升。职业治疗的服务强度在1999年趋于平稳，物理治疗的服务强度在2000年趋于平稳。除少数例外情况外，物理治疗和职业治疗强度与患者的人口统计学特征无显著关联。
患有可能从物理治疗或职业治疗或两者中受益疾病的医疗保险受益人，在《平衡预算法案》通过后的几年里，继续以相似的强度（有时强度还会增加）接受这些服务。
