Using the value-based care paradigm to compare physical therapy access to care models in cervical spine radiculopathy: a case report.

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Background: The efficiency and effectiveness of multiple physical therapy care delivery models can be measured using the value-based care paradigm. Entering physical therapy through direct access can decrease health-care utilization and improve patient outcomes. Limited evidence exists which compares direct access physical therapy to referral using the value-based care paradigm specific to cervical spine radiculopathy. Case Description: The patient was a 39-year-old woman who presented to physical therapy through physician referral with the diagnoses of acute cervical radiculopathy. The patient was evaluated, provided guideline adherent treatment and discharged with a home exercise program. Sixteen months from being discharged, the same patient returned through direct access due to an acute onset of cervical spine symptoms and was evaluated and provided treatment that same morning. Outcomes: Direct access physical therapy saved the patient and third-party payer $434.30 and $3264.75 respectively. A 5×'s higher efficiency per visit and a 6.2×'s higher value in reducing disability was demonstrated when the patient accessed physical therapy directly. Physician referral and direct access entry pathways demonstrated neck disability index improvements of 6% and 16%, respectively. Discussion: This case report describes a clinical example of previous research that demonstrates improved cost efficiency, outcomes, and increased value with a patient who presented to physical therapy with cervical radiculopathy through two different access to care models. The results of this case demonstrate a clinical example of the use of the value-based care paradigm in comparing value and efficiency of two access to care models in a patient with cervical radiculopathy without other neurological deficits.





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Ramirez, Michelle M, and Gerard P Brennan (2020). Using the value-based care paradigm to compare physical therapy access to care models in cervical spine radiculopathy: a case report. Physiotherapy theory and practice, 36(12). pp. 1476–1484. 10.1080/09593985.2019.1579878 Retrieved from

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Michelle Ramirez


Dr. Michelle M. Ramirez is currently pursuing her Ph.D. at Duke University School of Medicine in Population Health Sciences with a concentration in musculoskeletal epidemiology, health services research and patient-reported outcomes. She is a residency trained physical therapist and a Board Certified Orthopaedic Clinical Specialist with over 12 years of clinical experience as a physical therapist and health system leader. During part of her time as a clinician, she served as a Primary Osteoarthritis Provider within Duke's Joint Health Program specializing in the treatment of patients with knee and hip osteoarthritis. She has broad research interests in comparative effectiveness, epidemiologic methods and study design. Her research involves using epidemiological and comparative effectiveness methods in the study of knee injuries, post-operative outcomes, knee osteoarthritis and total knee arthroplasty. Her Graduate Research Assistantship is funded by the Duke University Total Joint Arthroplasty Learning Health Unit in Duke's Department of Orthopedic Surgery and her research is funded by the Foundation for Physical Therapy Research. She is a member of the Society for Epidemiologic Research, the American Physical Therapy Association, American College of Rheumatology, a published author and has presented at multiple state and national conferences.

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