Saving money by integrating physiotherapists in the emergency department: Mission possible?
Bibliographic record
Abstract
Context. Emergency department (ED) overcrowding is a complex phenomenon. One solution proposed to improve patient flow in the ED is the addition of physiotherapists to manage musculoskeletal disorders (MSKD). To our knowledge, no North American study has looked at the costs of this new care model compared to usual care provided by emergency physicians (EP). Objective. Compare the average cost of an ED visit between three ED care models. Study Design and Analysis. Cost study based on randomized clinical trial data (NCT04009369). Costs incurred for the management of participants through the three care models were calculated using Time-Driven Activity-Based Costing, in which the time invested with a patient determines care costs. Setting. ED of the CHU de Québec – Université Laval (Quebec, Canada). Population Studied. Persons aged 18 to 80 presenting to the ED with a minor MSKD (n=78). Intervention. Three ED care models were compared: 1) management by a PT and an EP; 2) management by an EP according to usual care; and 3) management by a PT. Outcome Measures. Mean cost of an ED visit for a MSKD. Generalized linear models with Gamma distributions and log links were used to assess whether there was a significant difference in mean ED visit costs between the three care models. A probabilistic budget impact sub analysis comparing the costs of implementing the two new care models for 10,000 patients was also carried out (reference cost: usual care by an EP, Canadian payer system perspective, 10,000 random samples of 10,000 patients). Results. Mean ED visit cost for PT and EP management was $278.55 (2018 $CAD, Min-Max: 97.64-1,389.94), compared with $267.86 for EP management (62.46-1,490.85), resulting in a non-significant absolute difference of $11.67/patient between models (p=.78). The average cost of management by a PT was $193.87 (62.46-678.47), representing an average saving of $70.96/patient compared to EP management. Implementing management by a PT and an EP would cost the healthcare system an average of $107,335.31 more per 10,000 patients (95% CI: 48,416.05-165,953.41), whereas management by a PT would save the health system an average of $739,467.20 (689,476.88-789,717.02). Conclusions. This study is a first step towards a better understanding of the costs associated with care models integrating physiotherapists in the ED for patients presenting with a MSKD. These innovative care models may have the potential to help reduce healthcare costs in the ED.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.014 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".