Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy

摘要

The purpose of this study was to characterize the intervention type delivered to individuals with cerebral palsy (CP) in a pediatric outpatient medical setting and to identify factors associated with the total amount of service within each type. Four hundred and twenty-five individuals with CP (1-33 years) Gross Motor Function Classification System (GMFCS): Level I (n = 152); II (n = 63); III (n = 55); IV (n = 80); and V (n = 75). Billing code data was extracted retrospectively from 2008 medical records and categorized to reflect four types: body structures and function (BSF), activity (ACT), environment (ENV), and examination (EXAM). Age at first visit, type of insurance at first visit and GMFCS level was also collected. The majority (47%) of the PT delivered was categorized as activity based units, 25% as body structure and function, 21% as environment, and 7% as examination. Significant differences were found in: total BSF therapy units among GMFCS (p = 0.008) and insurance type (p < 0.001), ACT units among GMFCS (p < 0.001), age groups (p < 0.001), and insurance type (p = 0.008), and ENV units among GMFCS (p = 0.04). The amount of variability (R-2) explained by the model for each category BSF, ACT, and ENV was 0.09 (p < 0.0001), 0.15 (p < 0.0001) and 0.02 (p = 0.04), respectively. Variations in amount of services received among types of intervention are associated with child and environmental characteristics. Low R-2 values indicate the need to collect information on other factors that influence service delivery. Data that are standardized and reliably collected should be validated and compared across institutions to support larger studies of service delivery patterns.