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Patient Safety and Quality

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Use of physical therapist assistants in place of physical therapists may result in lower quality of rehabilitation care

Substituting less expensive support personnel for more highly skilled providers is a growing trend in health care. However, use of physical therapist assistants (PTAs) and therapy aides in place of licensed physical therapists (PTs) may reduce the efficiency and quality of care in outpatient rehabilitation, concludes a new study. Researchers found that high PTA use (more than 50 percent of the time during the treatment episode) and use of therapy aides were each independently associated with more visits per treatment episode and lower functional health upon discharge from treatment.

State regulations requiring full-time on-site PTA supervision were associated with better functional health status of rehabilitation patients. State regulations regarding physical therapy reevaluation, PT/PTA ratio, and PTA licensure did not affect patient outcomes. These findings suggest that use of care extenders such as PTAs and therapy aides in place of PTs is associated with more costly and lower quality care delivery in outpatient rehabilitation. Regulations that specify PTA supervision adopted at the State or institutional level could potentially lead to improved care outcomes, note the researchers.

They analyzed a sample of 63,900 patients from 38 States drawn from 395 clinics that participated in the Focus on Therapeutic Outcomes Inc. database in 2000 and 2001. They examined the relationship between State regulations of physical therapists and high PTA use, number of visits, and patient self-reported functional status. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00011).

See "State regulation and the delivery of physical therapy services," by Linda Resnik, Ph.D., P.T., O.C.S., Zhanlian Feng, Ph.D., and Dennis L. Hart, Ph.D., P.T., in the August 2006 HSR: Health Services Research 41(4), pp. 1296-1316.

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