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Titre : | Prevalence and Predictors of Ambulatory Care Physicians? Documentation of Mobility Limitations in Older Adults (2023) |
Auteurs : | Valerie Shuman ; Jennifer S. Brach ; Jonathan F. Bean ; Janet K. Freburger |
Type de document : | Article |
Dans : | Archives of Physical Medicine and Rehabilitation (Vol. 104, n° 5, 2023) |
Article en page(s) : | p. 719-727 |
Note générale : | https://doi.org/10.1016/j.apmr.2022.11.018 |
Langues: | Anglais |
Descripteurs : |
HE Vinci Documentation ; Médecins ; Médecins de premier recours ; Mobilité réduite ; Réadaptation ; Sujet âgé |
Résumé : | Objective To determine how often physicians document mobility limitations in visits with older adults, and which patient, physician, and practice characteristics associate with documented mobility limitations. Design We completed a cross-sectional analysis of National Ambulatory Medical Care Surveys, years 2012-2016. Multivariate analyses were conducted to identify patient, physician, and practice-level factors associated with mobility limitation documentation. Setting Ambulatory care visits. Participants We analyzed visits with adults 65 years and older. Final sample size represented 1.3 billion weighted visits. Intervention Not applicable. Main Outcome Measure We defined the presence/absence of a mobility limitation by whether any International Classification of Diseases (ICD)-9 or ICD-10 code related to mobility limitations, injury codes, or the patient's ?reasons for visit? were documented in the visits. Results The overall prevalence of mobility limitation documentation was 2.4%. The most common codes were falls-related. Patient-level factors more likely to be associated with mobility limitation documentation were visits by individuals over 85 years of age, relative to 65-69 years, (odds ratio 2.32, 95% confidence interval 1.76-3.07]; with a comorbid diagnosis of arthritis (odds ratio 1.35, 1.18-2.01); and with a comorbid diagnosis of cerebrovascular disease (odds ratio 1.60, 1.13-2.26). Patient-level factors less likely to be associated with mobility limitation documentation were visits by men (odds ratio 0.80, 0.64-0.99); individuals with a cancer diagnosis (odds ratio 0.76, 0.58-0.99); and by individuals seeking care for a chronic problem (relative to a new problem [odds ratio 0.36, 0.29-0.44]). Physician-level factors associated with an increased likelihood of mobility limitation documentation were visits to neurologists (odds ratios 4.48, 2.41-8.32) and orthopedists (odds ratio 2.67, 1.49-4.79) compared with primary care physicians. At the practice-level, mobility documentation varied based on the percentage of practice revenue from Medicare. Conclusions Mobility limitations are under-documented and may be primarily captured when changes in function are overt. |
Disponible en ligne : | Oui |
En ligne : | https://login.ezproxy.vinci.be/login?url=https://www.sciencedirect.com/science/article/pii/S0003999323000503 |