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The effect of patient, provider and financing regulations on the intensity of ambulatory physical therapy episodes: a multilevel analysis based on routinely available data.

Halfon P, Eggli Y, Morel Y, Taffé P - BMC Health Serv Res (2015)

Bottom Line: We sought to quantify the contribution of patients and providers to these differences and examine how effective Swiss regulations are (nine-session ceiling per prescription and bonus for first treatments).Regulations were the most powerful factors.Moreover, further research is needed on the determinants of patient demand.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, Biopole 2, Route de la Corniche 10, 1010, Lausanne, Switzerland. patricia.halfon@chuv.ch.

ABSTRACT

Background: Many studies have found considerable variations in the resource intensity of physical therapy episodes. Although they have identified several patient- and provider-related factors, few studies have examined their relative explanatory power. We sought to quantify the contribution of patients and providers to these differences and examine how effective Swiss regulations are (nine-session ceiling per prescription and bonus for first treatments).

Methods: Our sample consisted of 87,866 first physical therapy episodes performed by 3,365 physiotherapists based on referrals by 6,131 physicians. We modeled the number of visits per episode using a multilevel log linear regression with crossed random effects for physiotherapists and physicians and with fixed effects for cantons. The three-level explanatory variables were patient, physiotherapist and physician characteristics.

Results: The median number of sessions was nine (interquartile range 6-13). Physical therapy use increased with age, women, higher health care costs, lower deductibles, surgery and specific conditions. Use rose with the share of nine-session episodes among physiotherapists or physicians, but fell with the share of new treatments. Geographical area had no influence. Most of the variance was explained at the patient level, but the available factors explained only 4% thereof. Physiotherapists and physicians explained only 6% and 5% respectively of the variance, although the available factors explained most of this variance. Regulations were the most powerful factors.

Conclusion: Against the backdrop of abundant physical therapy supply, Swiss financial regulations did not restrict utilization. Given that patient-related factors explained most of the variance, this group should be subject to closer scrutiny. Moreover, further research is needed on the determinants of patient demand.

No MeSH data available.


Related in: MedlinePlus

Definition of studied episodes.
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Fig2: Definition of studied episodes.

Mentions: The outcome variable was the number of physical therapy sessions per treatment episode. An episode began with the first session of a new treatment (identified by a specific fee position) and encompassed all sessions provided by a physiotherapist following a patient referral by a physician. To count as an episode, the gap between consecutive visits had to be less than six months and no new treatment had been undertaken. The unit of observation was thus the specific encounter between the patient and the physician/physiotherapist. To eliminate incomplete observations with potentially truncated information on the number of sessions, we excluded episodes that involved appointments between 1 July and 31 December 2006. Figure 2 clarifies the criteria we used to delineate the episodes of physical therapy care that we were to study. All studied episodes (numbered 1, 2 and 6.2 in Figure 2) began in 2005 (January 1 to December 31, 2005), involved follow-ups of two years, and featured no sessions during the second semester of 2006. We excluded episodes beginning in 2006 (numbered 5 in Figure 2; not part of the studied population), without follow-up in 2006 (numbered 4 in Figure 2; possibly right truncated) or with a last session during the second semester of 2006 (numbered 3; possibly right truncated because the episode may have involved additional sessions in 2007). We also excluded episodes that did not entail a first session (episode 6.1, left truncated). Patients might have multiple episodes (episodes 7.1 and 7.2), if a specific fee marked the beginning of a new episode (allowed for a condition involving a new body site whatever time elapsed between two consecutive visits to the same physiotherapist), or if the patient switched to another physiotherapist or was referred by another physician.Figure 2


The effect of patient, provider and financing regulations on the intensity of ambulatory physical therapy episodes: a multilevel analysis based on routinely available data.

Halfon P, Eggli Y, Morel Y, Taffé P - BMC Health Serv Res (2015)

Definition of studied episodes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4325958&req=5

Fig2: Definition of studied episodes.
Mentions: The outcome variable was the number of physical therapy sessions per treatment episode. An episode began with the first session of a new treatment (identified by a specific fee position) and encompassed all sessions provided by a physiotherapist following a patient referral by a physician. To count as an episode, the gap between consecutive visits had to be less than six months and no new treatment had been undertaken. The unit of observation was thus the specific encounter between the patient and the physician/physiotherapist. To eliminate incomplete observations with potentially truncated information on the number of sessions, we excluded episodes that involved appointments between 1 July and 31 December 2006. Figure 2 clarifies the criteria we used to delineate the episodes of physical therapy care that we were to study. All studied episodes (numbered 1, 2 and 6.2 in Figure 2) began in 2005 (January 1 to December 31, 2005), involved follow-ups of two years, and featured no sessions during the second semester of 2006. We excluded episodes beginning in 2006 (numbered 5 in Figure 2; not part of the studied population), without follow-up in 2006 (numbered 4 in Figure 2; possibly right truncated) or with a last session during the second semester of 2006 (numbered 3; possibly right truncated because the episode may have involved additional sessions in 2007). We also excluded episodes that did not entail a first session (episode 6.1, left truncated). Patients might have multiple episodes (episodes 7.1 and 7.2), if a specific fee marked the beginning of a new episode (allowed for a condition involving a new body site whatever time elapsed between two consecutive visits to the same physiotherapist), or if the patient switched to another physiotherapist or was referred by another physician.Figure 2

Bottom Line: We sought to quantify the contribution of patients and providers to these differences and examine how effective Swiss regulations are (nine-session ceiling per prescription and bonus for first treatments).Regulations were the most powerful factors.Moreover, further research is needed on the determinants of patient demand.

View Article: PubMed Central - PubMed

Affiliation: Institute of Social and Preventive Medicine (IUMSP), University Hospital Center and Faculty of Biology and Medicine, Biopole 2, Route de la Corniche 10, 1010, Lausanne, Switzerland. patricia.halfon@chuv.ch.

ABSTRACT

Background: Many studies have found considerable variations in the resource intensity of physical therapy episodes. Although they have identified several patient- and provider-related factors, few studies have examined their relative explanatory power. We sought to quantify the contribution of patients and providers to these differences and examine how effective Swiss regulations are (nine-session ceiling per prescription and bonus for first treatments).

Methods: Our sample consisted of 87,866 first physical therapy episodes performed by 3,365 physiotherapists based on referrals by 6,131 physicians. We modeled the number of visits per episode using a multilevel log linear regression with crossed random effects for physiotherapists and physicians and with fixed effects for cantons. The three-level explanatory variables were patient, physiotherapist and physician characteristics.

Results: The median number of sessions was nine (interquartile range 6-13). Physical therapy use increased with age, women, higher health care costs, lower deductibles, surgery and specific conditions. Use rose with the share of nine-session episodes among physiotherapists or physicians, but fell with the share of new treatments. Geographical area had no influence. Most of the variance was explained at the patient level, but the available factors explained only 4% thereof. Physiotherapists and physicians explained only 6% and 5% respectively of the variance, although the available factors explained most of this variance. Regulations were the most powerful factors.

Conclusion: Against the backdrop of abundant physical therapy supply, Swiss financial regulations did not restrict utilization. Given that patient-related factors explained most of the variance, this group should be subject to closer scrutiny. Moreover, further research is needed on the determinants of patient demand.

No MeSH data available.


Related in: MedlinePlus