Article
Functioning of patients with musculoskeletal conditions drives resource utilisation by physical therapists in the acute hospital
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Authors
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Eva Grill
- Institut für Gesundheits- und Rehabilitationswissenschaften, Ludwig-Maximilians-Universität München, München
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Erika O. Huber
- Rheumaklinik und Institut für Physikalische Medizin, Universitätsspital Zürich, Zürich
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Gerold Stucki
- Klinik für Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, München
| Published: | September 6, 2007 |
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Outline
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Background: Physical therapists’ (PT) interventions in the acute hospital contribute to improved functional patient outcomes. Nevertheless, PT interventions are being challenged because new hospital reimbursement systems require a rationale for resource allocation. PT resource use is known to vary across settings, health conditions, and functional status. However, current studies have not examined PT resources specifically; they are limited with respect to the systems used to assess functioning and the amount of variance of resource use explained.
The International Classification of Functioning, Disability and Health (ICF) is an option for predicting PT resources since it is valid and reliable when used by PTs, and applicable across all conditions and health professions. Objective of this study was to examine whether an ICF based assessment of functioning in patients with musculoskeletal conditions explains PT resource use in the acute hospital.
Methods: Prospective cohort study in patients with musculoskeletal conditions from a representative sample of 23 primary, secondary and tertiary care hospitals in Switzerland. The outcome was measured as total time of PT intervention during the inpatient stay. Generalised linear mixed models were used to identify the factors associated with PT intervention time.
Results: 234 patients (mean age 56.1 years, 50.0% female) had on average 364.2 minutes of PT intervention time (median 272.5, 95% CI 320.9-407.5). There was significant variation across hospital sites. About 30% of variation in the total sample could be explained by site. Type of hospital (primary and secondary care) and speciality (physical medicine and rehabilitation) were variables associated with increased intervention time on the hospital level. Single body functions, body structures and activity categories accounted for 36% of variation within hospitals.
Conclusions: The PT resource use is associated with patients’ functioning parameters at admission to the hospital. Any prospective payment system should take patients’ functioning into consideration when developing standards for PT resource funding.
