Fritz J.1, Magel J.1, Cohee K.2, Meier W.2
1University of Utah, Physical Therapy and Athletic Training, Salt Lake City, United States, 2University of Utah, Physical Therapy, Salt Lake City, United States
Background: Many patients with low back pain entering healthcare receive care that is disorganized and guideline-discordant. Often physical therapy is provided after imaging or specialist consultation has occurred, contrary to guideline recommendations. We identified these issues in our healthcare system. Patients with low back pain often accessed care or were referred to specialist physicians first, then waited to receive physical therapy care in our system. We hypothesized that creating a process for earlier access to Physical Therapy (PT) prior to specialist consultation could reduce waiting times for patients, reduce unnecessary tests and procedures and improve patient-centered outcomes.
Purpose: Report our strategy for implementing an alternative care pathway involving rapid access to PT for patients with low back pain prior to specialist consultation. Acceptability to patients, utilization of imaging and injection procedures, and patient-reported outcomes are reported.
Methods: A team including physicians and physical therapists convened to develop an alternative care pathway. Patients with low back pain calling the scheduling center for an initial specialist physician consultation for low back pain with insurance that reimbursed PT without physician referral, were eligible for inclusion. A screening script was developed for schedulers to determine eligibility. Eligible patients were offered the opportunity to begin PT within 72 hours instead of waiting for a physician consultation. All patients, regardless of eligibility or acceptance, were scheduled with a physician. Through our systems electronic health record, we tracked acceptance of rapid PT among eligible patients. For those accepting rapid PT, the timing and number of PT visits were recorded. For all patients we tracked the utilization of imaging (x-rays or MRI) or epidural injection procedures occurring within 90 days of scheduling. were provided. Patient-centered outcomes were collected using the PROMIS physical function computer-adapted test.
Results: From January to May, 2016, 432 patients with low back pain called to schedule a specialist consultation, of which 112 (25.9%) were offered rapid PT. Sixty-eight of 112 accepted (60.7%). Mean age of the entire sample (n=432) was 50.5 years (SD = 17.2) and 62.2% were female. Patients attending rapid PT averaged 46.9 years old (SD = 18.0) and 51.9% were female. Patients attended a mean 4.9 PT visits (SD = 2.8). PROMIS physical function scores improved from 41.9 (+7.0) at initial PT visit to 47.0 (+7.9) at discharge. Among patients attending rapid PT, 63.0% did not attend their physician specialist consultation after PT. Among patients attending rapid PT, 1 received an MRI and 1 received an epidural injection within 90 days. Among those not attending rapid PT, utilization rates for MRI and injection were 16.9% and 20.8% respectively.
Conclusion(s): Implementation of new care pathways requires collaboration. We were able to create a process for improving rapid access to OT in our healthcare system. Rapid access to physical therapy was acceptable to a majority of eligible patients and outcomes are encouraging for both reducing utilization and improving outcomes.
Implications: Efforts to improve care pathways within healthcare systems with physical therapy utilized earlier may provide opportunities to improve outcomes and reduce costs.
Funding acknowledgements: No funding was received for this project
Topic: Musculoskeletal: spine
Ethics approval: Exempt approval from University of Utah Institutional Review Board
All authors, affiliations and abstracts have been published as submitted.
