Prevalence and Predictors of Ambulatory Care Physicians' Documentation of Mobility Limitations in Older Adults.
Valerie Shuman, Jennifer S Brach, Jonathan F Bean and 1 others
PMID 36731767WHAT IT FOUND
Mobility limitations were documented in only 2% of ambulatory visits by adults 65 and older.
Documentation was more likely in patients over 85, with arthritis or cerebrovascular disease, or when physical therapy, home health, or equipment was ordered.
Key findings
01Only 2% of 64,892 visits by adults 65 and older included mobility limitation-related documentation.
02Documentation was more likely for visits by patients over 85 and visits involving arthritis or cerebrovascular disease, and less likely for visits by males, patients with cancer, and visits not for a new problem.
03Documentation was more likely when visits included a neurologic examination, injury prevention counseling, or orders for physical therapy, home health care, or durable medical equipment, and with neurologists, orthopedists, or osteopathic physicians; cardiologists and other physicians were associated with less documentation.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The outcome is physician documentation, not measured mobility limitation, so undocumented problems and information from earlier visits are not captured. Mobility limitations were identified using broad administrative codes and patient reasons for visit, and no validation studies exist for the codes used beyond the impaired mobility code. Only 1,430 of 64,892 actual visits had mobility limitation documentation, and some estimates had standard errors above 30%, so they are imprecise. Race and ethnicity were imputed for 25.6% of visits, and Medicare revenue was missing for 14.2%; missing-data categories were themselves significant predictors, so their influence is hard to interpret. The ICD-9 to ICD-10 transition occurred in 2016 and may have affected findings, although the authors found no significant difference between 2012-2015 and 2016. Physiatrists and geriatricians were grouped with primary care, so their separate role in documentation cannot be assessed.
Declared interests
The article is marked as supported by non-U.S. government and N.I.H. extramural research funding. No author conflict-of-interest declaration is included in the supplied text.
The easy way to misread this
Do not read 2% as the share of older adults with mobility limitations. It is the share of visits with mobility limitation-related documentation, and the paper notes self-reported mobility limitation prevalence ranges from 24% to 47%.