Hawker G A, Wright J G, Coyte P C, Williams J I, Harvey B, Glazier R, Wilkins A, Badley E M
Faculty of Medicine, University of Toronto, Ontario, Canada.
Med Care. 2001 Mar;39(3):206-16. doi: 10.1097/00005650-200103000-00002.
Area variation in the use of surgical interventions such as arthroplasty is viewed as concerning and inappropriate.
To determine whether area arthroplasty rates reflect patient-related demand factors, we estimated the need for and the willingness to undergo arthroplasty in a high- and a low-use area of Ontario, Canada.
Population-based mail and telephone survey.
All adults aged > or =55 years in a high (n = 21,925) and low (n = 26,293) arthroplasty use area.
We determined arthritis severity and comorbidity with questionnaires, established the presence of arthritis with examination and radiographs, and evaluated willingness to have arthroplasty with interviews. Potential arthroplasty need was defined as severe arthritis, no absolute contraindication for surgery, and evidence of arthritis on examination and radiographs. Estimates of need were then adjusted for patients' willingness to undergo arthroplasty.
Response rates were 72.0% for questionnaires and interviews. The potential need for arthroplasty was 36.3/1,000 respondents in the high-rate area compared with 28.5/1,000 in the low-rate area (P <0.0001). Among individuals with potential need, only 14.9% in the high-rate area and 8.5% in the low-rate area were definitely willing to undergo arthroplasty (P = 0.03), yielding adjusted estimates of need of 5.4/1,000 and 2.4/1,000 in the high- and low-rate areas, respectively.
Demonstrable need and willingness were greater in the high-rate area, suggesting these factors explain in part the observed geographic rate variations for this procedure. Among those with severe arthritis, no more than 15% were definitely willing to undergo arthroplasty, emphasizing the importance of considering both patients' preferences and surgical indications when evaluating need and appropriateness of rates for surgery.
诸如关节成形术等外科手术干预措施在使用上的地区差异被视为令人担忧且不适当的。
为了确定地区关节成形术使用率是否反映了与患者相关的需求因素，我们估计了加拿大安大略省高使用率地区和低使用率地区对关节成形术的需求以及接受该手术的意愿。
基于人群的邮件和电话调查。
加拿大安大略省关节成形术高使用率地区（n = 21,925）和低使用率地区（n = 26,293）中所有年龄≥55岁的成年人。
我们通过问卷确定关节炎严重程度和合并症，通过检查和X光片确定关节炎的存在，并通过访谈评估接受关节成形术的意愿。潜在的关节成形术需求被定义为患有严重关节炎、无绝对手术禁忌症且检查和X光片有患关节炎的证据。然后根据患者接受关节成形术的意愿对需求估计值进行调整。
问卷和访谈的回复率为72.0%。高使用率地区每1000名受访者中关节成形术的潜在需求为36.3例，而低使用率地区为28.5例（P <0.0001）。在有潜在需求的个体中，高使用率地区只有14.9%、低使用率地区只有8.5%明确愿意接受关节成形术（P = 0.03），调整后的高使用率地区和低使用率地区需求估计值分别为每1000人中有5.4例和2.4例。
高使用率地区可证明的需求和意愿更高，表明这些因素部分解释了该手术观察到的地区使用率差异。在患有严重关节炎的人群中，不超过15%明确愿意接受关节成形术，这强调了在评估手术需求和使用率的合理性时考虑患者偏好和手术适应症的重要性。
