Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL.
Arch Phys Med Rehabil. 2024 Jan;105(1):125-130. doi: 10.1016/j.apmr.2023.08.017. Epub 2023 Sep 3.
To evaluate the effectiveness of clinical decision support for reducing misallocation of physical therapy (PT) consults.
A prospective quasi-experimental study. Between October 2018 and November 2021, routinely documented data on functional status and physical therapy referrals were collected from electronic medical records.
Hospital Medicine and General Internal Medicine service lines at a large quaternary academic medical center.
20,810 adult patients hospitalized on any of the included treatment (hospital medicine) or control (general internal medicine) service lines.
The primary outcome was "change in proportion of misallocated PT consults" measured as likelihood of PT consults for patients admitted with high functional mobility scores. Changes in the primary outcome from the pre-intervention to post-intervention period were compared in the control and treatment groups using propensity score-weighted difference-in-differences multivariable logit regression adjusting for clinically relevant covariates.
The intervention period was measured for 20 months and consisted of a clinical decision support tool embedded in the daily note templates for hospital medicine providers. The tool provided education on patient mobility scores and their relation to need for PT consult. The tool was rolled out without any further announcements or education.
Our cohort included 20,810 unique admissions (mean age 58.9, 55% women, 83% Black). Post-intervention, the likelihood of PT referrals for patients with high baseline mobility (AM-PAC >18) decreased by 7.3% (P<.001) for the treatment group compared with control, adjusted for age, sex, race, ethnicity, length-of-stay, and mobility change.
Mobility score-based clinical decision support can decrease unneeded PT consults in the inpatient setting. This could help allocate therapy time for at-risk patients while also having a positive effect on health care systems.
评估临床决策支持在减少物理治疗（PT）会诊分配不当方面的效果。
前瞻性准实验研究。在 2018 年 10 月至 2021 年 11 月期间，从电子病历中收集了关于功能状态和物理治疗转介的常规记录数据。
一家大型四级学术医疗中心的医院医学和普通内科服务线。
20810 名成年患者，入住包括治疗（医院医学）或对照（普通内科）服务线的任何一条。
主要结局是“PT 会诊分配不当比例的变化”，测量标准为高功能移动性评分患者的 PT 会诊可能性。通过倾向评分加权差分差异多变量逻辑回归，调整临床相关协变量，比较对照组和治疗组从干预前到干预后的主要结局变化。
干预期为 20 个月，包括嵌入医院医学提供者日常记录模板中的临床决策支持工具。该工具提供了关于患者移动性评分及其与 PT 会诊需求关系的教育。该工具推出时没有任何进一步的公告或教育。
我们的队列包括 20810 名独特的入院患者（平均年龄 58.9 岁，55%为女性，83%为黑人）。干预后，与对照组相比，基线移动性较高（AM-PAC>18）的患者接受 PT 转介的可能性降低了 7.3%（P<.001），调整了年龄、性别、种族、民族、住院时间和移动性变化。
基于移动性评分的临床决策支持可以减少住院环境中不必要的 PT 会诊。这有助于为高危患者分配治疗时间，同时对医疗保健系统产生积极影响。
