Date Presented 04/04/19
National Ambulatory Medical Care Survey OT referral data provides objective description of the patients referred to OT: 29% had a musculoskeletal condition and 42% had a history of injury. This data can be used when planning a primary-care OT practice and supports further outpatient OT utilization research beyond patients who are currently being referred to OT.
Primary Author and Speaker: Anne Fleischer
Contributing Authors: Alan Fleischer
PURPOSE: Occupational therapy (OT) has described its role within primary care and challenges to integrating OT into primary care practices (Halle, Mroz, Fogelberg, & Leland, 2018; Leland, Fogelberg, Halle, & Mroz, 2016). One barrier is the ambulatory care physician’s (ACP) understanding of what diagnoses may be associated with functional impairments that OTs can treat. We sought to describe ACP OT referral patterns. Recently, the National Ambulatory Medical Care Survey (NAMCS) ("Ambulatory Health Care Data," 2017) has added OT referrals to collected data. By analyzing this data, OT will be able to create an informed plan to integrate OT within primary care and provide support for future Health Service utilization research.
DESIGN: Cross-sectional survey.
METHOD: Data from 2014-2015 NAMCS were compiled and analyzed to characterize ACP visits in which OT was referred. Patient demographics, insurance, history of new or old injury, diagnosis, recent inpatient admission, reason for referral, physician’s specialty area, provision of patient educational materials, and physician practice incentives were analyzed. Using SAS University Edition, data were analyzed using SURVEY weights and all hypothesis testing was performed with chi-square. Descriptive statistics were used to describe referral patterns.
RESULTS: Referrals to OT were not significantly different based on demographics and insurance; except for patients with worker’s compensation insurance who were significantly more likely to be referred (p < .0001). Those with unknown health insurance were significantly less likely to be referred (p < .006). Patients were more likely to be referred if they were recently discharged from the hospital (p = .02), had a new or old injury (p <.0001) or received injury prevention information during the visit (p =.002). However, those who received health education were not more likely to be referred (p =.01). The highest proportion of referrals by specialty was orthopedic surgery (43%), general and family practice (10%), pediatrics (7%) and neurology (5%). When analyzing categories of ACP, surgical practices more likely to refer than primary care or medical (p = .003). Post-operative visits followed by new problem or routine visits for a chronic problem were more likely to be referred than pre-operative visits, chronic condition flare up or preventive care. ACP incentives related to productivity (p = .9), quality (preventive) care (p = .3), and patient satisfaction (p = .4) were not associated with either referring or not referring to OT. Forty-two percent of the referrals used ICD-9 injury codes and 29% were ICD-9 musculoskeletal codes. Remaining 29% included developmental, neurologic and general medical ICD-9 codes.
CONCLUSION: These data reflect that there are no overt biases related to demographics (sex, race, age) or physician incentives, which influence referrals to OT. Therefore, interventions to minimize biases do not appear to be a priority. ACP currently utilizes OT for their patients who have musculoskeletal disorders, or history of injury and hospitalization more than other conditions as demonstrated by referring 71% of their patients for these conditions. Future research should focus on why ACP practices do not refer more patients within other diagnosis categories. Do these patterns reflect reimbursement by insurance for certain categories of diagnoses, lack of knowledge of the benefit of OT for other conditions or a combination of both factors?
IMPACT STATEMENT: Analyzed NAMCS OT Ambulatory Health Care data about referrals to OT provides objective information to use to integrate OT within primary care and supports further outpatient OT utilization research beyond patients with musculoskeletal conditions and history of injury.
References
Amulatory Health Care Data. (2017). Retrieved from https://www.cdc.gov/nchs/ahcd/rdc_data.htm
Halle, A. D., Mroz, T. M., Fogelberg, D. J., & Leland, N. E. (2018). Occupational Therapy and Primary Care: Updates and Trends. American Journal of Occupational Therapy, 72(3), 7203090010p7203090011-7203090010p7203090016. doi:10.5014/ajot.2018.723001
Leland, N. E., Fogelberg, D. J., Halle, A. D., & Mroz, T. M. (2016). Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform. American Journal of Occupational Therapy, 71(1), 7101090010p7101090011-7101090010p7101090016. doi:10.5014/ajot.2017.711001
