Jancuska Jeffrey, Adrados Murillo, Hutzler Lorraine, Bosco Joseph
*Department of Orthopaedic Surgery and Hospital for Joint Diseases†New York University School of Medicine, New York, NY.
Spine (Phila Pa 1976). 2016 Jan;41(2):153-8. doi: 10.1097/BRS.0000000000001150.
A retrospective review of an administrative database.
The purpose of this study is to determine the current extent of regionalization by mapping lumbar spine procedures according to hospital and patient zip code, as well as examine the rate of growth of lumbar spine procedures performed at high-, medium-, and low-volume institutions in New York State.
The association between hospital and spine surgeon volume and improved patient outcomes is well established. There is no study investigating the actual process of patient migration to high-volume hospitals.
New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,695 lumbar spine surgery patients from 2005 to 2014. The data included the patients' zip code, hospital of operation, and year of discharge. The volume of lumbar spine surgery in New York State was mapped according to patient and hospital 3-digit zip code. New York State hospitals were categorized as low, medium, and high volume and descriptive statistics were used to determine trends in changes in hospital volume.
Lumbar spine surgery recipients are widely distributed throughout the state. Procedures are regionalized on a select few metropolitan centers. The total number of procedures grew 2.5% over the entire 10-year-period. High-volume hospital caseload increased 50%, from 7253 procedures in 2005 to 10,915 procedures in 2014. The number of procedures at medium and low-volume hospitals decreased 30% and 13%, respectively.
Despite any concerted effort aimed at moving orthopedic patients to high-volume hospitals, migration to high-volume centers occurred. Public interest in quality outcomes and cost, as well as financial incentives among medical centers to increase market share, potentially influence the migration of patients to high-volume centers. Further regionalization has the potential to exacerbate the current level of disparities among patient populations at low and high-volume hospitals.
对一个管理数据库进行回顾性研究。
本研究的目的是通过根据医院和患者邮政编码绘制腰椎手术分布图来确定当前区域化的程度，并研究纽约州高、中、低手术量机构进行的腰椎手术的增长率。
医院和脊柱外科医生手术量与改善患者预后之间的关联已得到充分证实。尚无研究调查患者向高手术量医院迁移的实际过程。
使用纽约州全州规划与研究合作系统（SPARCS）的管理数据，识别出2005年至2014年期间的228,695例腰椎手术患者。数据包括患者的邮政编码、手术医院和出院年份。根据患者和医院的三位邮政编码绘制纽约州腰椎手术量分布图。纽约州的医院被分为低、中、高手术量三类，并使用描述性统计来确定医院手术量变化的趋势。
接受腰椎手术的患者广泛分布于全州。手术集中在少数几个大都市中心。在整个10年期间，手术总数增长了2.5%。高手术量医院的病例数增加了50%，从2005年的7253例手术增加到2014年的10,915例手术。中、低手术量医院的手术数量分别减少了30%和13%。
尽管有将骨科患者转移至高手术量医院的协同努力，但患者仍向高手术量中心迁移。公众对治疗效果和成本的关注，以及医疗中心之间增加市场份额的经济激励措施，可能影响患者向高手术量中心的迁移。进一步的区域化可能会加剧目前低、高手术量医院患者群体之间的差距水平。
3级。
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