title: Implications of practice setting on clinical outcomes and efficiency of care in the delivery of physical therapy services.
abstract: METHODS
  Retrospective analysis of episodes of care.
  
  
  OBJECTIVE
  To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services.
  
  
  BACKGROUND
  Many patients with musculoskeletal conditions benefit from care provided by physical therapists. The majority of physical therapists deliver services in either a private practice setting or in a hospital outpatient setting. There have not been any recent studies comparing whether clinical outcomes or efficiency of care differ based on practice setting.
  
  
  METHODS
  Practices that use the Focus On Therapeutic Outcomes, Inc system were surveyed to determine the specific type of setting in which outcomes were collected in patients with musculoskeletal impairments. Patient outcome data over 12 months (2011-2012) were extracted from the database and analyzed to identify differences in the functional status achieved and the efficiency of the care delivery process between private practices and hospital outpatient settings.
  
  
  RESULTS
  The data suggest that patients experience more efficient care when receiving physical therapy in hospital outpatient settings compared to private practice settings, as demonstrated by 3.1 points of greater improvement in functional status over 2.9 fewer physical therapy visits. However, the difference in improvement between settings is less than the minimum clinically important difference of 9 points in functional status outcome score.
  
  
  CONCLUSIONS
  In this cohort, our data suggest that more efficient care was delivered in the hospital outpatient setting compared to the private practice setting. However, we cannot conclude that care delivered in the hospital setting is more cost-effective, because it is possible that any difference in efficiency of care favoring the hospital outpatient setting is more than offset by higher costs of care.
authors.affiliation: US Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, TX.
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Harman
authors.forename: Jason R
authors.initials: JR
authors.lastname: Rodeghero
authors.forename: Maggie
authors.initials: M
authors.lastname: Horn
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care; D017598:Efficiency, Organizational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D011331:Private Practice / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: cost; health services research; hospital; private practice; rehabilitation