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A Single-Number Value Metric Integrating Quality and Cost in Outpatient Physical Therapy
Bryan Bourcier1, Thomas Ruediger2, Christine Walck3
1AdventHealth Innovation Tower, 265 E Rollins St, Orlando, FL, 32804, United States.
Importance:
As health care transitions toward value-based care, outpatient physical therapy lacks a practical metric that objectively integrates quality of care and cost into a single measure of clinical value.
Objective:
The objective was to develop a single-number value metric (VM) integrating clinical effectiveness, patient experience, and cost efficiency in outpatient physical therapy and to determine its concordance with blinded manager assessments of therapist value.
Design:
This was a retrospective observational cohort study.
Setting:
The study was conducted at 8 outpatient physical therapy clinics within a single health care system, including freestanding ambulatory clinics and hospital-based outpatient departments.
Participants:
The study included twelve licensed physical therapists and 2400 outpatient episodes of care.
Intervention(S) Or Exposure(S):
Therapist-level patient-reported outcome measure (PROM) improvement, clinic-level Net Promoter Score (NPS), and financial data were combined to calculate a single-number VM. Blinded clinical managers independently ranked therapists according to perceived value.
Main Outcome(S) And Measure(S):
VM scores were calculated for each therapist. Concordance between VM rankings and blinded manager rankings was assessed using Spearman rank correlation coefficient.
Results:
VM scores ranged from 1.39 to 4.76 (median = 2.39; interquartile range = 1.99-3.13). Across 2400 episodes of care, 72.8% of PROM changes met or exceeded published minimal clinically important difference thresholds. Among ambulatory therapists, VM rankings demonstrated a strong inverse correlation with manager rankings (Spearman ρ = -0.82). Among hospital-based therapists, VM rankings demonstrated perfect inverse agreement with manager rankings (Spearman ρ = -1.00).
Conclusions:
The proposed VM integrates clinical effectiveness, patient experience, and cost efficiency into a feasible, single-number measure of value in outpatient physical therapy. VM scores were strongly aligned with blinded managerial assessments of therapist value.
Relevance:
The VM offers a potential framework for evaluating clinical value in outpatient physical therapy and supporting the transition from volume-based to value-based care.
