Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA.
J Occup Rehabil. 2013 Sep;23(3):347-60. doi: 10.1007/s10926-012-9412-y.
There is a paucity of data describing the relationship between practice setting and the delivery of physical rehabilitation to injured workers.
To determine differences in the number of visits, the number of treatment units, and the proportion of billing for physical agents over an episode of care between different practice settings' providing physical rehabilitation to patients receiving workers' compensation for a musculoskeletal problem.
A large administrative database was evaluated retrospectively. Practice settings were classified as physician office, corporate physical therapy clinic, occupational medicine clinic, hospital-based outpatient clinic, or private physical therapy practice.
70,306 subjects (72.7 % male; mean age = 44.6, SD = 11.8 years) were included in this study. Corporate physical therapy clinics had the highest mean values for total visits (13.1, SD = 12.7) and for total units (66.8, SD = 85.5), and the lowest mean values for proportion of physical agents during the episode of care (.22, SD = .18). Occupational medicine clinics had the lowest mean values for total visits (6.8, SD = 7.9) and for total units (30.4, SD = 36.5), and the highest mean value for proportion of physical agents during the episode of care (.41, SD = .22). When controlling for ICD-9-CM codes, body-part treated, surgical status, and geographical region there were small changes in effect size; however, the significance and directionality of differences between practice settings were not changed.
There were significant differences in billing for physical rehabilitation services between practice settings for patients receiving workers' compensation. Corporate physical therapy clinics billed for more total visits and total units over an episode of care than did other practice settings; however they also billed for a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.
关于实践环境与向受伤工人提供物理康复服务之间的关系，相关数据十分匮乏。
确定在为接受工人赔偿的肌肉骨骼问题患者提供物理康复服务时，不同实践环境的就诊次数、治疗单元数量以及在治疗过程中开具物理治疗师服务的比例存在差异。
对大型行政数据库进行回顾性评估。实践环境被分为医生办公室、企业物理治疗诊所、职业医学诊所、医院门诊和私人物理治疗诊所。
本研究共纳入 70306 名患者（72.7%为男性；平均年龄为 44.6 岁，标准差为 11.8 岁）。企业物理治疗诊所的就诊次数（13.1，标准差为 12.7）和治疗单元总数（66.8，标准差为 85.5）均值最高，治疗过程中开具物理治疗师服务的比例（0.22，标准差为 0.18）最低。职业医学诊所的就诊次数（6.8，标准差为 7.9）和治疗单元总数（30.4，标准差为 36.5）均值最低，治疗过程中开具物理治疗师服务的比例（0.41，标准差为 0.22）最高。在控制 ICD-9-CM 编码、治疗部位、手术情况和地理位置后，效应大小略有变化；然而，不同实践环境之间的差异的显著性和方向性没有改变。
接受工人赔偿的患者在物理康复服务计费方面，不同实践环境之间存在显著差异。企业物理治疗诊所的就诊次数和治疗单元总数均高于其他实践环境，但开具物理治疗师服务的比例较低，表明其更倾向于使用那些有循证指南支持的干预措施（运动疗法和手法治疗），而不是其他实践环境。
