Department of Physical Therapy, School of Health Sciences and Practice, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595 (USA).
Department of Physical Therapy, Mercy College, Dobbs Ferry, New York.
Phys Ther. 2020 Aug 31;100(9):1502-1515. doi: 10.1093/ptj/pzaa082.
Factors predicting physical therapy utilization for lower back pain (LBP) remain unclear, limiting the development of value-based initiatives. The purpose of this study was to identify important factors that impact the number of physical therapist visits per episode of care for US adults with nonspecific LBP.
This study was a retrospective observational cohort study of a clinical dataset derived from 80 clinics of a single physical therapy provider organization. Research variables were categorized at the individual (patient) level and the organization (therapist, clinic) level. A hierarchical regression model was designed to identify factors influencing the number of physical therapist visits per episode of care.
Higher out-of-pocket payments per visit, receipt of "active" physical therapy, longer average visit length, earlier use of physical therapy, and sex of the therapist (male) were found to predict fewer visits per episode of care. Percent change of function, prior receipt of physical therapy by the same provider organization, self-discharge from physical therapy, level of starting function, and therapist certification were found to predict more visits. Of the variance in number of visits, 8.0% was attributable to the health care organization.
Individual factors, such as higher out-of-pocket payment, have a significant impact on reducing visits per episode of care and should be considered when developing value-based initiatives to optimize clinical and utilization outcomes.
Payers use consumer-directed healthcare to reduce costs by discouraging utilization of low value services and encouraging use of low-cost providers. LBP is a costly condition for which physical therapy is a high-value treatment. This study shows that non-need factors predict the number of physical therapy visits per episode of care for patients with nonspecific LBP. Insurance benefit plans with lower out-of-pocket payments for physical therapy and higher reimbursement for active physical therapist interventions may facilitate appropriate utilization of high-value treatment for LBP.
预测下腰痛（LBP）物理治疗利用的因素仍不清楚，这限制了基于价值的计划的制定。本研究的目的是确定影响美国非特异性 LBP 成人每次护理期间物理治疗师就诊次数的重要因素。
这是一项回顾性观察性队列研究，研究对象来自单一物理治疗提供者组织的 80 个诊所的临床数据集。研究变量分为个体（患者）和组织（治疗师、诊所）两个层面。设计了一个层次回归模型，以确定影响每次护理期间物理治疗师就诊次数的因素。
每次就诊的自付费用较高、接受“主动”物理治疗、平均就诊时间较长、较早使用物理治疗以及治疗师的性别（男性）被发现可预测每次就诊的就诊次数减少。功能的百分比变化、同一提供者组织先前接受的物理治疗、物理治疗的自我出院、起始功能水平和治疗师认证被发现可预测更多的就诊次数。就诊次数的方差中，有 8.0%归因于医疗保健组织。
个体因素，如较高的自付费用，对减少每次就诊的就诊次数有重大影响，在制定基于价值的计划以优化临床和利用结果时应予以考虑。
支付者使用消费者导向的医疗保健来降低成本，方法是减少对低价值服务的利用，并鼓励使用低成本提供者。LBP 是一种昂贵的疾病，物理治疗是一种高价值的治疗方法。本研究表明，非需求因素预测了非特异性 LBP 患者每次护理期间物理治疗就诊次数。物理治疗自付费用较低、主动物理治疗师干预措施报销较高的保险福利计划可能有助于为 LBP 提供适当的高价值治疗。
