Determinants of Physical Therapy Referral for Peripheral Vestibular Disorders
Pamela M. Dunlap, Charles J. George, Lauren Terhorst, Kathleen M. McTigue, Janet K. FreburgerAbstract
Objective
To identify patient‐ and provider‐level determinants of PT referrals for peripheral vestibular disorders.
Study Design
Retrospective cohort study using electronic health record data.
Setting
A large health system in western Pennsylvania.
Methods
We included individuals 18 years of age or older with a new encounter for a peripheral vestibular disorder between 1/1/2017 and 6/30/2022. The primary outcome was PT referral. Exposures included patient age, gender, race, insurance, urbanization, area deprivation index (ADI), Elixhauser comorbidity index, peripheral vestibular diagnosis, provider type, and specialty.
Results
We included 20,468 individuals (mean [SD] age 59 [13] years and 69.3% female) with an incident peripheral vestibular disorder visit with 21.7% having a referral to PT. In adjusted models, patients more likely to receive a PT referral were 70 years of age or older (OR = 1.23, 95% CI: 1.04‐1.45) versus <50 years of age, female (OR = 1.18, 95% CI: 1.07‐1.3), have Medicaid (OR = 1.20, 95% CI: 1.04‐1.39) versus commercial insurance, benign paroxysmal positional vertigo (OR = 1.88, 95% CI: 1.57‐2.26) versus other peripheral vestibular diagnoses, and 3+ comorbidities (OR = 1.22, 95% CI: 1.07‐1.38) versus no comorbidities. Neurology was more likely to refer (OR = 6.10, 95% CI: 2.56‐14.58), and emergency medicine was less likely to refer to PT (OR = 0.18, 95% CI: 0.08‐0.39) compared to otolaryngology.
Conclusion
This study identified patient‐ and provider‐level determinants of PT referrals for use when identifying strategies to equitably improve PT referrals in health systems.