Health Serv Res 47:633-654.
Center for Public Health Statistics, University of Iowa, Iowa City, IA, USA
OBJECTIVE: To compare patient profiles and health care use for physician-referred and self-referred episodes of outpatient physical therapy (PT).
DATA SOURCE: Five years (2003-2007) of private health insurance claims data, from a Midwest insurer, on beneficiaries aged 18-64.
STUDY DESIGN: Retrospective analyses of health care use of physician-referred (N = 45,210) and self-referred (N = 17,497) ambulatory PT episodes of care was conducted, adjusting for age, gender, diagnosis, case mix, and year.
DATA COLLECTION/EXTRACTION: Physical therapy episodes began with the physical therapist initial evaluation and ended on the last date of service before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of PT.
PRINCIPAL FINDINGS: The self-referred group was slightly younger, but the two groups were very similar in regard to diagnosis and case mix. Self-referred episodes had fewer PT visits (86 percent of physician-referred) and lower allowable amounts ($0.87 for every $1.00), after covariate adjustment, but did not differ in related health care utilization after PT.
CONCLUSIONS: Health care use during PT episodes was lower for those who self-referred, after adjusting for key variables, but did not differ after the PT episode.
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