急诊科就诊与物理治疗师干预开始之间的时间：医疗保健利用和成本。
Time Between an Emergency Department Visit and Initiation of Physical Therapist Intervention: Health Care Utilization and Costs.
机构信息
Department of Physical Therapy and Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108 (USA).
Department of Physical Therapy and Athletic Training, University of Utah.
出版信息
Phys Ther. 2020 Sep 28;100(10):1782-1792. doi: 10.1093/ptj/pzaa100.
OBJECTIVE
The aim of this study was to examine the association between the length of time between an emergency department (ED) visit and the subsequent initiation of physical therapist intervention for low back pain (LBP) on 1-year LBP-related health care utilization (ie, surgery, advanced imaging, injections, long-term opioid use, ED visits) and costs.
METHODS
This retrospective cohort study focused on individuals who consulted the ED for an initial visit for LBP. Claims from a single statewide, all-payers database were used. LBP-related health care use and costs for the 12 months after the ED visit were extracted. Poisson and general linear models weighted with inverse probability treatment weights were used to compare the outcomes of patients who attended physical therapy early or delayed after the ED visit.
RESULTS
Compared with the delayed physical therapy group (n = 94), the early physical therapy group (n = 171) had a lower risk of receiving lumbar surgery (relative risk [RR] = 0.47, 95% CI = 0.26-0.86) and advanced imaging (RR = 0.72, 95% CI = 0.55-0.95), and they were less likely to have long-term opioid use (RR = 0.45, 95% CI = 0.28-0.76). The early physical therapy group incurred lower costs (mean = $3,806, 95% CI = $1,998-$4,184) than those in the delayed physical therapy group (mean = $8,689, 95% CI = $4,653-$12,727).
CONCLUSION
Early physical therapy following an ED visit was associated with a reduced risk of using some types of health care and reduced health care costs in the 12 months following the ED visit.
IMPACT STATEMENT
The ED is an entry point into the health care system for patients with LBP. Until now, the impact of the length of time between an ED visit and physical therapy for LBP has not been well understood. This study shows that swift initiation of physical therapy following an ED visit for LBP is associated with lower LBP-related health utilization for some important outcomes and lower LBP-related health care costs.
目的
本研究旨在探讨急诊科（ED）就诊与随后开始物理治疗之间的时间间隔与腰痛（LBP）相关的 1 年医疗保健利用（即手术、高级影像学检查、注射、长期阿片类药物使用、ED 就诊）和成本之间的关联。
方法
本回顾性队列研究聚焦于因首次就诊 ED 治疗 LBP 的个体。使用来自一个全州范围内的所有支付者数据库的索赔数据。提取 ED 就诊后 12 个月内与 LBP 相关的医疗保健使用和成本。使用具有逆概率治疗权重的泊松和广义线性模型来比较 ED 就诊后早期或延迟接受物理治疗的患者的结局。
结果
与延迟物理治疗组（n=94）相比，早期物理治疗组（n=171）接受腰椎手术（相对风险 [RR] =0.47，95%CI=0.26-0.86）和高级影像学检查（RR=0.72，95%CI=0.55-0.95）的风险较低，且长期使用阿片类药物的可能性较小（RR=0.45，95%CI=0.28-0.76）。早期物理治疗组的成本较低（平均值=3806 美元，95%CI=1998 美元-4184 美元），而延迟物理治疗组的成本较高（平均值=8689 美元，95%CI=4653 美元-12727 美元）。
结论
ED 就诊后早期进行物理治疗与 ED 就诊后 12 个月内某些类型的医疗保健利用风险降低和医疗保健成本降低相关。
意义
ED 是 LBP 患者进入医疗保健系统的入口点。到目前为止，ED 就诊与 LBP 物理治疗之间的时间间隔对 LBP 的影响尚未得到很好的理解。本研究表明，ED 就诊后迅速开始 LBP 物理治疗与某些重要结局的 LBP 相关医疗保健利用率降低和 LBP 相关医疗保健成本降低相关。
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