Did the 1997 Balanced Budget Act reduce use of physical and occupational therapy services?
Did the 1997 Balanced Budget Act reduce use of physical and occupational therapy services?
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DOI：
10.1016/j.apmr.2008.02.010
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发表时间：
2008-05-01
影响因子：
4.3
通讯作者：
Iezzoni, Lisa L.
中科院分区：
文献类型：
--
作者：
Latham, Nancy K.;Jette, Alan M.;Iezzoni, Lisa L.
目的：调查1997年平衡预算法案通过后，物理治疗（PT）和职业治疗（OT）服务的使用是否减少。设计：来自全国代表性医疗保险当前受益人调查（MCBS）的数据与医疗保险索赔数据合并。我们对1995年（n= 7978）、1999年（n=7863）和2001年（n=7973）的数据进行了横断面分析。所有分析都使用MCBS抽样权重来提供估计，这些估计可以推广到具有5种常见疾病的医疗保险人群。环境：熟练护理设施（snf）、家庭保健机构、住院康复设施（irf）和门诊康复设施。参与者：在每个研究年份参加MCBS调查的医疗保险受益人，并且患有以下一种或多种疾病：急性中风，急性心肌梗死，慢性阻塞性肺病，关节炎或退行性关节疾病，或活动能力问题。干预措施：不适用。主要结果测量：符合我们纳入标准的患者在每种情况下接受PT或OT的百分比，以及每种情况下接受PT和OT的总单位。结果：多变量logistic回归显示，在三个时间点上，从家庭健康机构接受PT或OT治疗的符合纳入标准的人群比例无统计学差异。对于snf， 1995 - 1999年（OR = 1.42, 95%可信区间[CI]， 1.19-1.69）和1995 - 2001年（OR = 1.69, 95% CI, 1.39-2.05）接受PT的几率均有统计学意义。用于IRF和门诊设置。在1995年至2001年期间观察到显著增加（OR = 1.71, OR = 1.27）。分别)。从1995年到2001年，观察到门诊康复设置的IRF和门诊康复设置有统计学上显著的增加。在1995年至1999年和1995年至2001年期间，SNF的增长在统计上是显著的。从1995年到2001年，除了体外循环治疗外，所有机构接受的平均总PT和OT单位也有所增加。结论：尽管BBA要求限制急症后护理支出，但这项具有全国代表性的研究显示，在所有情况下，患有5种常见诊断的医疗保险受益人接受PT和/或OT的百分比没有减少，1995年至2001年间，除了irf，接受PT和/或OT服务的单位没有减少。这项研究表明，提供PT和OT服务并没有下降的人的条件，康复设施往往是临床指征。
Objective: To investigate whether use of physical therapy (PT) and occupational therapy (OT) services decreased after the passage of the 1997 Balanced Budget Act (BBA).Design: Data from the nationally representative Medicare Current Beneficiary Survey (MCBS) were merged with Medicare claims data. We conducted cross-sectional analyses of data from 1995 n=7978), 1999 (n=7863), and 2001 (n=7973). All allalyses used MCBS sampling weights to provide estimates that call be generalized to the Medicare population with 5 common conditions.Settings: Skilled nursing facilities (SNFs), home health agencies, inpatient rehabilitation facilities (IRFs), and outpatient rehabilitation settings.Participants: Medicare beneficiaries who participated in the MCBS survey in each of the Study years and had I or more of the following conditions: acute stroke, acute myocardial infarction, chronic obstructive pulmonary disease, arthritis or degenerative joint disease, or mobility problems.Interventions: Not applicable.Main Outcome Measures: Percentage of persons meeting our inclusion criteria who received PT or OT in each setting, and total units of PT and OT received in each setting.Results: Multivariable logistic regression revealed no statistically significant differences in the proportion of people who Met our inclusion criteria who Used PT or OT from home health agencies across the 3 time points. For SNFs, all increase in (lie odds of receiving, PT was statistically significant from 1995 to 1999 (odds ratio [OR] = 1.42 95% confidence interval [CI], 1.19-1.69) and 1995 to 2001 (OR = 1.69; 95% CI, 1.39-2.05). For IRF and outpatient settings. a significant increase was observed between 1995 and 2001 (OR = 1.71, OR = 1.27. respectively). For OT, a statisticalty significant increase was observed for IRF and outpatient rehabilitation settings from 1995 to 2001. For SNF, the increase was statistically significant front 1995 to 1999 and 1995 to 2001. Mean total PT and OT Units received also increased across all settings from 1995 to 2001 except for IRFs.Conclusions: Despite BBA mandates restricting postacute care expenditures, this nationally representative study showed no decreases in the percentage of Medicare beneficiaries with 5 common diagnoses receiving PT and/or OT across all settings and no decreases ill units of PT and/or OT services received between 1995 and 2001 except for those in IRFs. This study suggests that the delivery of PT and OT services did not decline among persons with conditions for which rehabilitation set-vices are often clinically indicated.