Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, Ohio.
J Arthroplasty. 2014 Jul;29(7):1345-9. doi: 10.1016/j.arth.2014.02.020. Epub 2014 Feb 26.
While price capitation strategies may help to control total hip (THA) and knee arthroplasty (TKA) implant costs, its effect on premium implant selection is unclear. Primary THA and TKA cases 6 months before and after capitated pricing implementation were retrospectively identified. After exclusions, 716 THA and 981 TKA from a large academic hospital and 2 midsize private practice community hospitals were reviewed. Academic hospital surgeons increased premium THA implant usage (66.5% to 70.6%; P = 0.28), while community surgeons selected fewer premium implants (36.4%) compared to academic surgeons, with no practice change (P = 0.95). Conversely, premium TKA implant usage significantly increased (73.4% to 89.4%; P < 0.001) for academic surgeons. Community surgeons used premium TKA implants at greater rates in both periods, with all cases having ≥1 premium criterion.
虽然价格上限支付策略可能有助于控制全髋关节置换术（THA）和膝关节置换术（TKA）植入物的总成本，但它对优质植入物选择的影响尚不清楚。本研究回顾性分析了实施上限定价前后 6 个月的主要 THA 和 TKA 病例。排除标准后，对一家大型学术医院和 2 家中型私立社区医院的 716 例 THA 和 981 例 TKA 进行了分析。与学术医院的外科医生相比，社区医院的外科医生选择的优质植入物更少（36.4%对 66.5%；P = 0.28），但没有手术变化（P = 0.95）。相反，学术医院的优质 TKA 植入物使用率显著增加（73.4%至 89.4%；P < 0.001）。在这两个时期，社区医院的外科医生都更倾向于使用优质 TKA 植入物，所有病例都至少符合 1 个优质标准。
