An Explanatory Model for the Relationship Between Physical Therapists' Self-perceptions of Value and Care Prioritization Decisions in the Acute Hospital

Abstract

Purpose: The aim of the study was to understand how acute care physical therapists' perceptions of the value of physical therapy inform their decisions regarding which patients to treat. Methods: This was a qualitative study using a grounded theory approach. Data were collected using semistructured interviews with a purposive sample of acute hospital physical therapists in the United States. Interview transcriptions were analyzed to derive codes and identify an explanatory model. Results: Participants included 16 physical therapists from 4 hospital systems. Their descriptions indicate that care prioritization is influenced by a self-perception of value informed by both patient- and system-driven thinking. Patient-driven thinking prioritizes factors considered most important to individual patients (eg, improved functional independence). System-driven thinking prioritizes factors most important to the health system (eg, a certain patient population or productivity expectation). The relative contribution of system- and patient-driven thinking in prioritization decisions was variable from one participant to another. Conclusions: In addition to the perceived value of physical therapy for individual patients, acute hospital physical therapists integrate organization-level factors into prioritization decisions. Future research should seek to understand how this may influence practice variation and identify practice patterns that simultaneously optimize outcomes considered important by both patients and organizations.