Smith J T, Price C, Stevens P M, Masters K S, Young M
Primary Children's Medical Center, Salt Lake City, Utah, USA.
J Pediatr Orthop. 1999 Jul-Aug;19(4):553-5. doi: 10.1097/00004694-199907000-00027.
In the current climate of health care reform, there is a perception that overspecialization is responsible for increased medical costs. Few studies support the premise that high-quality surgical subspecialization improves the cost effectiveness of care. The purpose of this study was to compare hospital utilization and charges between a pediatric hospital staffed by pediatric orthopedic subspecialists and a community hospital system for the care of closed femur fractures and slipped capital femoral epiphysis (SCFE) in a pediatric population. We reviewed hospital charges and length-of-stay (LOS) data for all children treated for closed femoral shaft fractures and SCFE between 1992 and 1994 within the Intermountain Health Care System (IHC). Within the IHC, there are 23 community hospitals and one children's hospital (PCMC). Patients were matched for age and injury severity. Four of six orthopedic surgeons at PCMC are pediatric orthopedists, but none of the community orthopedists has subspecialty training in pediatric orthopedics. For closed femoral shaft fractures (n = 334), the average hospital charges were less (PCMC, $4,943/Other IHC, $9,031), and length of stay was shorter (PCMC, 2.81 days/Other IHC, 8.91 days) when the child was treated at the children's hospital by pediatric orthopedic subspecialists. For SCFE (n = 63), the average hospital charges were less (PCMC, $2,824/Other IHC, $3,544) and the length of stay was shorter (PCMC, 1.13 days/Other IHC, 1.64 days) at the children's hospital. These data suggest that hospital utilization and charges were significantly decreased if the care was provided by pediatric orthopedic subspecialists in a children's hospital.
在当前医疗保健改革的大环境下，人们认为过度专业化是医疗成本增加的原因。很少有研究支持高质量的外科亚专业能提高医疗成本效益这一前提。本研究的目的是比较一家由小儿骨科亚专科医生坐诊的儿童医院和一个社区医院系统在治疗小儿闭合性股骨干骨折和股骨头骨骺滑脱（SCFE）时的医院利用率和收费情况。我们回顾了1992年至1994年期间在山间医疗保健系统（IHC）内接受闭合性股骨干骨折和SCFE治疗的所有儿童的医院收费和住院时间（LOS）数据。在IHC内，有23家社区医院和一家儿童医院（PCMC）。患者按年龄和损伤严重程度进行匹配。PCMC的六位骨科医生中有四位是小儿骨科医生，但社区骨科医生中没有一位接受过小儿骨科亚专业培训。对于闭合性股骨干骨折（n = 334），当患儿在儿童医院由小儿骨科亚专科医生治疗时，平均医院收费较低（PCMC为4943美元/其他IHC医院为9031美元），住院时间较短（PCMC为2.81天/其他IHC医院为8.91天）。对于SCFE（n = 63），儿童医院的平均医院收费较低（PCMC为2824美元/其他IHC医院为3544美元），住院时间较短（PCMC为1.13天/其他IHC医院为1.64天）。这些数据表明，如果由儿童医院的小儿骨科亚专科医生提供治疗，医院利用率和收费会显著降低。
