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News from APTA

	Health Services Research Agenda for Physical Therapy

 
On October 6–7, 2005, several APTA members and staff met to develop a series of health policy research questions. This meeting was, in part, a response to a recommendation by the Medicare Payment Advisory Commission (MedPAC) to retain the requirement for referral to a physical therapist for patients receiving Medicare due to concerns about utilization and costs. In addition to staff, the participants included Elizabeth Coulson, PT; Laurita Hack, PT, DPT, MBA, PhD, FAPTA; Michael Johnson, PT, MS, OCS; Joanne Kerwin, PT; and Patricia Sinnott, PT, PhD, MPH. Sharon Arnold, PhD, representing Academy Health, the nation’s foremost health services research association, also was present.

The meeting was an excellent first step in generating appropriate research questions, with discussions centering around thecontrastbetween the value of information generated from well-designed studies published in peer-reviewed journals and the information that is often used by policy makers. After a presentation from staff describing how APTA’s initiatives are taking place within the health policy environment, panel members discussed the relative merits of both sources of information and considered two strategies that would allow both types of information to be used beneficially.

First, a number of researchable questions were identified that cut across the areas comprising health services research—human resources, access, cost, and quality. Within the human resources domain, the questions typically dealt with a description of providers of physical therapy services, such as physical therapist students, physical therapist assistants, potential competitive providers of physical therapy services, and physical therapists themselves.

Questions about access focused on utilization rates for physical therapy services. The need to determine the current utilization rate was identified. Use of physical therapy across a person’s lifetime and the identification of any disparities based on race/ethnicity, sex, or geographic location that may exist also were identified as important questions. These access questions are especially important because MedPAC expressed concerns about utilization of services in their report.

Cost issues also are important because, historically, there has not been a great deal of emphasis placed on cost-effectiveness studies. Outcomes traditionally have been analyzed in clinical terms, and, to a certain extent, the cost component has been neglected. The panel emphasized that outcomes research must address economic issues such as cost.

Quality issues are perhaps the most difficult to assess at this time. Appropriate outcomes and "best practices" within physical therapy have yet to be determined. In the current regulatory environment, assessment of quality is needed. At the federal level, there has been a call in Congress to reimburse health care services using a "pay for performance" system. However, researchers debate whether such a system should be developed. Research on quality of care will facilitate an operational definition of the term "pay for performance."

The panel members also developed a second recommendation, one that was not anticipated at the start of the meeting. The meeting participants believed that APTA should generate a series of policy briefs or perspectives on relevant public health issues that fall within the 4 domains of health services research that affect physical therapy. The idea of these briefs moved the discussion from a focus on research to one on policy.

The importance of policy briefings has been articulated by the late John Eisenberg, MD, the former Director of the Agency for Healthcare Research and Quality (AHRQ). Dr Eisenberg admonished health services researchers to recognize that their responsibilities did not end when their research was published in a peer-reviewed journal. Eisenberg believed that a study would have maximum value if its importance could be understood by congressional staffers in the period of time between the beginning and end of the line in the House or Senate cafeteria, a test he dubbed the "cafeteria line test." The policy briefings developed by APTA will resemble the "cafeteria line" descriptions. They will be succinct pieces that will demonstrate the unique contribution that physical therapy can bring to a wide range of health care issues.

The briefings will deal with a wide range of topics, from the physical therapy workforce to clinical topics in which physical therapists play a vital role, such as balance and falls prevention and physical activity across the age spectrum.

The meeting laid a foundation for future work, but it was only a first step. Meetings of the group will continue. In fact, the group will be expanded to include non–physical therapists as well. In addition, the group’s work will be shared with APTA components, such as the Section on Health Policy and Administration, to increase feedback on what has been, and will continue to be, a vital area for the profession.

Consult this column in future issues of Physical Therapy for reports on progress toward establishment of the coalition.

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This Article Full Text (PDF) Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Search for Related Content Related Collections Health Services Research Physical Therapist Practice: Other Social Bookmarking                      What's this?