Patient and health-system factors associated with scheduling and completion of outpatient physical therapy referral: a retrospective cohort study

Background Demand for outpatient physical therapy (PT) increasingly exceeds capacity, yet little is known about which referrals result in scheduling and completed visits or whether conversion differs by patient characteristics. Using the Andersen Behavioral Model, we examined factors associated with within-system appointment scheduling and first-​visit completion after PT referral. Methods This retrospective cohort study used electronic health record data on 80,130 outpatient PT referrals among 46,603 patients aged 18–90 years in a large urban academic health system (July 2022 through February 2025). Covariates were grouped into predisposing, enabling, and need domains. Primary outcomes were appointment scheduling within 90 days and first-visit completion within 120 days of referral. Secondary outcomes were days from referral to scheduling and to first completed visit reaching each milestone. Generalized estimating equations accounted for within-patient referral clustering. Results Overall, 41.5% of referrals were scheduled within 90 days and 35.1% resulted in a completed first visit within 120 days. Among referrals reaching each milestone, median time to scheduling was 5 days (IQR, 1–14), and to first visit was 29 days (IQR, 17–45). After adjustment, lower odds of both outcomes were seen in Black or African American patients (OR, 0.77 and 0.71, respectively), Hispanic patients (OR, 0.93 and 0.91) relative to the weighted cohort mean, and in Medi-Cal enrollees (OR, 0.91 and 0.87), and patients with non-English language preference (OR, 0.74 and 0.76). New (vs. established) referral entry status was associated with lower odds of appointment scheduling (OR, 0.83; 95% CI, 0.80–0.86) and completion (OR, 0.86; 95% CI, 0.83–0.89). Among scheduled referrals, pelvic health, and neurologic referrals took 31%-52% longer to schedule than orthopedic referrals. Conclusion Fewer than half of outpatient PT referrals were scheduled within 90 days in the study health system. Differences by race and ethnicity, language preference, and insurance type remained after adjustment, and referral entry status was independently associated with both outcomes. Because care received outside the system was not captured, these findings identify potential candidate targets for prospective, equity-focused evaluation of referral and scheduling processes.