Continuity in the Provider of Home-Based Physical Therapy Services and Its Implications for Outcomes of Patients

Background A growing body of research suggests that greater continuity of health care is positively associated with improved outcomes of patients. However, few studies have examined this issue in the context of physical therapy. Objective The purpose of this study was to evaluate whether the level of continuity in the provider (provider continuity) of physical therapy services was related to outcomes in a population of patients receiving home health care. Design This was a retrospective observational study. Methods Clinical and administrative records were retrieved for a population of adult patients receiving physical therapy services from a large, urban, not-for-profit certified home health care agency in 2009. Descriptive and multivariable analyses were used to examine how the level of provider continuity, calculated by use of a formula that models dispersion in contact between the patient and the providers of physical therapy services, varied across characteristics and outcomes of patients. Results Logistic regression analyses indicated that patients with lower levels of provider continuity had significantly higher odds of hospitalization (odds ratio [OR]=2.06, 95% confidence interval [CI]=1.90–2.23) and lower odds of improvements in the number of activity limitations (OR=0.85, 95% CI=0.80–0.92) and in the severity of activity limitations (OR=0.85, 95% CI=0.78–0.93) between the beginning and the end of the home health care episode. Limitations Baseline clinical characteristics associated with continuity of care suggest some level of indication bias. Outcome measures for activities of daily living were limited to patients who were not hospitalized during their home health stay. Conclusions These findings build upon research suggesting that continuity in the patient-provider relationship is an important determinant of outcomes of patients.