外周前庭疾病物理治疗转诊的决定因素
Determinants of Physical Therapy Referral for Peripheral Vestibular Disorders.
文献信息
| PMID | 42808647 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Pamela M Dunlap |
| 作者单位 | Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. |
| 期刊 | Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery |
| SCI 分区 | Q1 |
| IF | 2.9 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
目的： 识别外周前庭疾病物理治疗（PT）转诊的患者层面和提供者层面的决定因素。
研究设计： 使用电子健康记录数据的回顾性队列研究。
地点： 宾夕法尼亚州西部的一个大型卫生系统。
方法： 我们纳入了2017年1月1日至2022年6月30日期间因外周前庭疾病新就诊的18岁及以上个体。主要结局是PT转诊。暴露因素包括患者年龄、性别、种族、保险、城市化程度、区域剥夺指数（ADI）、Elixhauser合并症指数、外周前庭诊断、提供者类型和专科。
结果： 我们纳入了20,468名个体（平均[标准差]年龄59[13]岁，69.3%为女性），这些个体有一次新发外周前庭疾病就诊，其中21.7%转诊至PT。在调整模型中，更可能接受PT转诊的患者为70岁及以上（OR=1.23，95% CI：1.04-1.45）对比<50岁、女性（OR=1.18，95% CI：1.07-1.3）、有Medicaid（OR=1.20，95% CI：1.04-1.39）对比商业保险、良性阵发性位置性眩晕（OR=1.88，95% CI：1.57-2.26）对比其他外周前庭诊断，以及3种及以上合并症（OR=1.22，95% CI：1.07-1.38）对比无合并症。与耳鼻喉科相比，神经内科更可能转诊（OR=6.10，95% CI：2.56-14.58），急诊医学更不可能转诊至PT（OR=0.18，95% CI：0.08-0.39）。
结论： 本研究识别了PT转诊的患者层面和提供者层面的决定因素，可用于确定在卫生系统中公平改善PT转诊的策略。
英文摘要
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.