Jewell D, Mick S, Wan T, Riddle D; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 1690.
Virginia Commonwealth University, Physical Therapy, PO Box 980224, Richmond, VA 23298-0224 Tel. 804.828.0234 Fax 804.828.8111
RESEARCH OBJECTIVE: Variation in physical therapy services (PTPV) has been observed but research is limited. Proposed explanations for variation in hospital utilization include physician practice style, medical resource supply and community socioeconomic status. The purposes of this study are to: 1) determine to what extent variation occurs in the physical therapy (PT) management of one orthopedic condition; 2) examine the causal relationship between PTPV and practitioner, organizational, and community characteristics; and 3) explore the impact of PTPV on selected clinical outcomes. STUDY DESIGN: We use factor analysis to reduce 60 PT treatment options into meaningful intervention categories for analysis. Treatment variation is defined as deviation above the average factor score within each intervention category. The latent constructs PT Practice Style, Rehabilitation Resource Availability, Community Socioeconomic Status, PTPV, and Risk Adjusted Physical Function are validated by confirmatory factor analysis. A causal model comprised of these five constructs is tested at the provider and clinic level, with clinics nested within counties to account for contextual effects, using multilevel modeling. We included patient and PT characteristics, as well as clinic ownership and payer mix, as mediating factors in the model. POPULATION STUDIED: Adult patients (n=1,195; mean (sd) age = 55.4 (12.4) years) with one complete episode of PT care for the diagnosis adhesive capsulitis of the shoulder from January 1, 1998 December 31, 2000 are studied. We selected this condition because it typically has an idiopathic onset and an unpredictable recovery timeframe. Patients were treated by 256 PTs (mean (sd) years of experience = 8.1 (7.0)) in 145 outpatient PT clinics unequally distributed across the 4 US Census Bureau regions. Counties in which the PT clinics are located are comprised predominantly of individuals who are white, employed, high school graduates living in households with incomes above the poverty line. Patient, PT and clinic data are provided by Focus On Therapeutic Outcomes, Incorporated, a private, for-profit medical rehabilitation outcomes management company. Data for county-level socioeconomic indicators are obtained from the US Census Bureau. PRINCIPAL FINDINGS: Postural Correction, Joint Mobility, Pain Reduction, Spasm Reduction, Flexibility and Exercise are the intervention categories identified for adhesive capsulitis. Variation in PT interventions for adhesive capsulitis ranges from 15-217%. PT Practice Style is a significant predictor of PTPV (r=.15) at the practitioner level of analysis; however, Community Socioeconomic Status is the only significant predictor (r=.33) when the data are aggregated to the clinic level. Higher practice variation appears to result in lower Risk Adjusted Physical Function at the PT level of analysis (r=.14). CONCLUSIONS: These findings confirm the existence of PTPV in the management of patients with adhesive capsulitis. Greater treatment variation may result in poorer risk-adjusted clinical outcomes for patients with this condition, suggesting that efforts to reduce PTPV may improve quality of care. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Future study of practice variation would benefit from inquiry into allied health care services as well as multi-level analysis of potential sources in order to target remediation strategies appropriately.
Publication Types:
Keywords:
- Adult
- Biomedical Research
- Bursitis
- Humans
- Income
- Joints
- Models, Theoretical
- Physical Therapy Modalities
- Poverty
- Research
- Shoulder
- Shoulder Joint
- Shoulder Pain
- Treatment Outcome
- methods
- hsrmtgs
UI: 103624724
From Meeting Abstracts