ATI Evidence-based Guide Investigating Clinical Services

Musculoskeletal (MSK) conditions are prevalent1 and contribute substantially to healthcare utilization and cost. Physical therapy is a non-surgical, non-pharmacological intervention that can be clinically effective and cost-effective for many MSK presentations, with a large proportion of patients improving without requiring escalation of care. In the context of evolving reimbursement and value-based care pressures, it is increasingly important to understand the clinical effectiveness, utilization patterns, and value implications of PT as delivered in routine outpatient practice. (1-6)

To address these priorities, investigators from ATI and the University of South Carolina are interested in evaluating how standard-of-care outpatient rehabilitation is delivered and how variation in care delivery mechanisms relates to clinical outcomes, service utilization, and value. In this retrospective study, we will conduct secondary analyses of existing standard-of-care documentation within ATI's PT EMR, without altering clinical care or interacting with patients. Care delivery mechanisms of interest include, but are not limited to: (1) delivery mode (in-clinic, telehealth, remote therapeutic moderating (RTM), and hybrid models when documented); (2) use of care extenders (PTAs/Technicians) when identifiable in documentation; (3) specialty service lines and provider qualifications (e.g., Women's Health, Hand Therapy, Vestibular Therapy, Work Comp/Work Hardening, advanced training/certifications); and (4) types of interventions delivered (e.g., exercise therapy, manual therapy, therapeutic modalities), as documented as part of routine care. (7-9)

ATI is a large national outpatient MSK provider delivering physical and occupational therapy services. Investigators have previously used ATI clinical outcomes resources (e.g., the ATI EMR) to characterize care patterns, evaluate outcomes and measurement properties, and explore predictors of utilization behaviors such as canceled visits. The present protocol extends this work by leveraging existing standard-of-care EMR documentation to evaluate patient characteristics, interventions delivered, utilization management patterns, and clinical and objective/functional outcomes in routine outpatient care, producing evidence to inform clinical effectiveness, quality improvement, implementation efforts, and policy-relevant value questions. (4,10-13)

This study is a retrospective cohort study existing standard-of-care documentation from the ATI physical therapy EMR (including routinely collected clinical measures, objective/functional measures, and patient-reported outcomes) for patients receiving physical or occupational therapy beginning January 1, 2016. All interventions referenced in the dataset represent usual care delivered as part of clinical practice and were not assigned for research purposes.