One-year Health Care Utilization Following Physical Therapist Evaluation in a Veterans Affairs Emergency Department

IMPORTANCE: Emergency department (ED) care for musculoskeletal pain is associated with higher healthcare utilization compared to other entry points into the healthcare system. ED physical therapists are associated with decreased healthcare utilization in the ED; however, long-term healthcare utilization after the ED visit is understudied. OBJECTIVE: The objective was to study the association between an ED physical therapist visit and 1-year physical therapist visit utilization and total musculoskeletal healthcare utilization. DESIGN: This study used a retrospective cohort design. SETTING AND PARTICIPANTS: This study included Veterans presenting to a single Veterans Health Administration ED with a primary diagnosis of musculoskeletal pain. Intervention(s) or Exposure(s): Veterans who saw an ED physical therapist (EDPT group) from October 2022 to September 2023 were randomly sampled and age, sex, and ICD-10 ED primary diagnosis code matched to veterans without an ED physical therapist visit. MAIN OUTCOME(S) AND MEASURE(S): The primary outcome was 1-year physical therapist visits after initial ED visit. Secondary outcomes included: 1-year utilization of physician specialty care visits, advanced imaging (magnetic resonance imaging and computed tomography), high-risk prescription (opioids, benzodiazepines, skeletal muscle relaxants), and ED return visit for the initial ED diagnosis. RESULTS: Physical therapist visits did not differ between groups (mean [SD]: EDPT = 2.89 [5.02] versus matched control = 2.69 [5.15]). EDPT was associated with lower rates of physician specialty visits (rate ratio: 0.52 [0.33-0.81]) and lower odds of specialist referral (odds ratio: 0.32 [0.16-0.63]) and advanced imaging (odds ratio 0.41 [0.21-0.84]). EDPT was not significantly associated with high-risk medication prescriptions or return visits to the ED. CONCLUSIONS AND RELEVANCE: EDPT was significantly associated with reduced specialist services and advanced imaging during the year after the initial ED visit. These findings support physical therapists in the ED as a strategy that may reduce unnecessary healthcare utilization for Veterans with musculoskeletal pain.