Determinants of Physical Therapy Referral for Peripheral Vestibular Disorders

OBJECTIVE: To identify patient- and provider-level determinants of PT referrals for peripheral vestibular disorders. STUDY DESIGN: Retrospective cohort study using electronic health record data. SETTING: A large health system in western Pennsylvania. METHODS: We included individuals 18 years of age or older with a new encounter for a peripheral vestibular disorder between 1/1/2017 and 6/30/2022. The primary outcome was PT referral. Exposures included patient age, gender, race, insurance, urbanization, area deprivation index (ADI), Elixhauser comorbidity index, peripheral vestibular diagnosis, provider type, and specialty. RESULTS: We included 20,468 individuals (mean [SD] age 59 [13] years and 69.3% female) with an incident peripheral vestibular disorder visit with 21.7% having a referral to PT. In adjusted models, patients more likely to receive a PT referral were 70 years of age or older (OR = 1.23, 95% CI: 1.04-1.45) versus <50 years of age, female (OR = 1.18, 95% CI: 1.07-1.3), have Medicaid (OR = 1.20, 95% CI: 1.04-1.39) versus commercial insurance, benign paroxysmal positional vertigo (OR = 1.88, 95% CI: 1.57-2.26) versus other peripheral vestibular diagnoses, and 3+ comorbidities (OR = 1.22, 95% CI: 1.07-1.38) versus no comorbidities. Neurology was more likely to refer (OR = 6.10, 95% CI: 2.56-14.58), and emergency medicine was less likely to refer to PT (OR = 0.18, 95% CI: 0.08-0.39) compared to otolaryngology. CONCLUSION: This study identified patient- and provider-level determinants of PT referrals for use when identifying strategies to equitably improve PT referrals in health systems.