Impact of risk adjustment on provider ranking for patients with low back pain receiving physical therapy

Daniel Deutscher*, Mark W. Werneke, Deanna Hayes, Jerome E. Mioduski, Karon F. Cook, Julie M. Fritz, Linda J. Woodhouse, Paul W. Stratford

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


BACKGROUND: The impact of risk adjustment on clinic quality ranking for patients treated in physical therapy outpatient clinics is unknown. U OBJECTIVES: To compare clinic ranking, based on unadjusted versus risk-adjusted outcomes for patients with low back pain (LBP) who are treated in physical therapy outpatient clinics. U METHODS: This retrospective cohort study involved a secondary analysis of data from adult patients with LBP treated in outpatient physical therapy clinics from 2014 to 2016. Patients with complete outcomes data at admission and discharge were included to develop the risk-adjustment model. Clinics with complete outcomes data for at least 50% of patients and at least 10 complete episodes of care per clinician per year were included for ranking assessment. The R2 shrinkage and predictive ratio were used to assess overfitting. Agreement between unadjusted and adjusted rankings was assessed with percentile ranking by deciles or 3 distinct quality ranks based on uncertainty assessment. U RESULTS: The primary sample included 414 125 patients (mean ± SD age, 57 ± 17 years; 60% women) treated by 12 569 clinicians from 3048 clinics from all US states; 82% of patients from 2107 clinics were included in the ranking assessment. The R2 shrinkage was less than 1%, with a predictive ratio of 1. Risk adjustment impacted ranking for 70% or 31% of clinics, based on decile or 3 distinct quality levels, respectively. U CONCLUSION: Important changes in ranking were found after adjusting for basic patient characteristics of those admitted to physical therapy for treatment of LBP. Risk-adjustment profiling is necessary to more accurately reflect quality of care when treating patients with LBP.

Original languageEnglish (US)
Pages (from-to)637-648
Number of pages12
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number8
StatePublished - Aug 2018


  • Functional status
  • Patient-reported outcome measures
  • Physical therapy
  • Provider ranking
  • Risk adjustment

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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