Clinical Outcomes, Utilization, and Charges in Persons With Neck Pain Receiving Guideline Adherent Physical Therapy.
In efforts to decrease practice variation, clinical practice guidelines for neck pain have been published. The purpose of this study was to determine the effect of receiving guideline adherent physical therapy (PT) on clinical outcomes, health care utilization, and charges for health care services in patients with neck pain. A retrospective review of 298 patients with neck pain receiving PT from 2008 to 2011 was performed. Clinical outcomes, utilization, and charges were compared between patients who received guideline adherent care and nonadherent care. Patients in the adherent care group experienced a lower percentage improvement in pain score compared to nonadherent care group (p = .01), but groups did not significantly differ on percentage improvement in disability (p = .32). However, patients receiving adherent care had an average 3.6 fewer PT visits (p < .001) and less charges for PT (p < .001). Additionally, patients receiving adherent care had 7.3 fewer visits to other health care providers (p < .001), one less prescription medication (p = .02) and 43% fewer diagnostic images (p = .02) but did not differ in their charges to other health care providers (p = .68) during the calendar year of undergoing PT. Although receiving guideline adherent care demonstrated positive effects on health care utilization and financial outcomes, there appears to be a trade-off with clinical outcomes.
School of Physical Therapy, Langston University, Langston, OK, USA mhorn21@phhp.ufl.edu.
Maggie E
ME
Horn
Intermountain Healthcare, Salt Lake City, UT, USA.
Gerard P
GP
Brennan
Department of Physical Therapy, University of Florida, Gainesville, FL, USA.|Brooks Rehabilitation, Jacksonville, FL, USA.
Steven Z
SZ
George
Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
Jeffrey S
JS
Harman
Department of Physical Therapy, University of Florida, Gainesville, FL, USA.
Mark D
MD
Bishop
D005260:Female; D019983:Guideline Adherence; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D019547:Neck Pain / Q000191:economics / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000191:economics / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
clinical outcomes; clinical practice guidelines; costs; health care utilization; neck pain; physical therapy