A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy

Health Serv Res. 2012 Apr;47(2):633-54. doi: 10.1111/j.1475-6773.2011.01324.x. Epub 2011 Sep 23.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Ambulatory Care / statistics & numerical data
  • Cross-Sectional Studies
  • Delivery of Health Care / statistics & numerical data
  • Diagnosis-Related Groups
  • Female
  • Humans
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Physical Therapy Modalities / statistics & numerical data*
  • Propensity Score
  • Referral and Consultation / statistics & numerical data*
  • Self Care / statistics & numerical data
  • Sex Factors
  • Young Adult