Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions.
Prevalence and predictors of no-shows to physical therapy for musculoskeletal conditions.
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DOI：
10.1371/journal.pone.0251336
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
George SZ
中科院分区：
文献类型：
--
作者：
Bhavsar NA;Doerfler SM;Giczewska A;Alhanti B;Lutz A;Thigpen CA;George SZ
慢性疼痛影响着5000万美国人，通常使用物理疗法等非药物方法进行治疗。为寻求肌肉骨骼疾病物理治疗护理的个人开发一个缺席预测模型有几个好处，包括在不增加现有提供者池的情况下提高劳动力效率，提供遵循指南的护理，以及确定可能受益于远程医疗的人。本文的目的是量化全国寻求理疗护理的患者缺席的发生率，并确定预测患者在寻求理疗护理时是否会缺席的个人和组织因素。回顾性队列研究。美国境内的商业物理治疗提供商，在26个州拥有828家诊所。2016年1月1日至2017年12月31日期间，寻求非药物治疗肌肉骨骼疾病的青少年和成人患者(年龄范围：14-117岁)(n=542,685)。排除标准是不被认为是MSK条件或身高、体重或体重指数值不太可能的主要主诉。这项研究包括444,995人。肌肉骨骼疾病的缺勤率和患者缺勤的预测因素。在我们的人群中，73%的人至少错过了一次给定的理疗护理课程的预约。我们的模型对缺席有适度的区分(c-统计：0.72，所有预约；0.73，前7次预约)，并经过很好的校准，预测和观察到的缺席与良好的一致性。预测缺勤率较高的变量包括保险类型、吸烟状况、较高的BMI、以及更多的先前取消，即就诊和安排日期之间的时间，以及当前和上次就诊之间的时间。在寻求物理治疗师对肌肉骨骼疾病的护理时，缺席的比例很高，这突显了一种低效，如果得不到解决，可能会限制遵循指导方针的护理的提供，这些护理主张及早使用非药物治疗来治疗肌肉骨骼疾病，并导致错失利用远程保健提供物理治疗的机会。
Chronic pain affects 50 million Americans and is often treated with non-pharmacologic approaches like physical therapy. Developing a no-show prediction model for individuals seeking physical therapy care for musculoskeletal conditions has several benefits including enhancement of workforce efficiency without growing the existing provider pool, delivering guideline adherent care, and identifying those that may benefit from telehealth. The objective of this paper was to quantify the national prevalence of no-shows for patients seeking physical therapy care and to identify individual and organizational factors predicting whether a patient will be a no-show when seeking physical therapy care. Retrospective cohort study. Commercial provider of physical therapy within the United States with 828 clinics across 26 states. Adolescent and adult patients (age cutoffs: 14–117 years) seeking non-pharmacological treatment for musculoskeletal conditions from January 1, 2016, to December 31, 2017 (n = 542,685). Exclusion criteria were a primary complaint not considered an MSK condition or improbable values for height, weight, or body mass index values. The study included 444,995 individuals. Prevalence of no-shows for musculoskeletal conditions and predictors of patient no-show. In our population, 73% missed at least 1 appointment for a given physical therapy care episode. Our model had moderate discrimination for no-shows (c-statistic:0.72, all appointments; 0.73, first 7 appointments) and was well calibrated, with predicted and observed no-shows in good agreement. Variables predicting higher no-show rates included insurance type; smoking-status; higher BMI; and more prior cancellations, time between visit and scheduling date, and between current and previous visit. The high prevalence of no-shows when seeking care for musculoskeletal conditions from physical therapists highlights an inefficiency that, unaddressed, could limit delivery of guideline-adherent care that advocates for earlier use of non-pharmacological treatments for musculoskeletal conditions and result in missed opportunities for using telehealth to deliver physical therapy.
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