Galloway Joseph D, Voss Frank R
Department of General Surgery, Medical University of South Carolina, Charleston, SC, USA.
Department of Orthopaedic Surgery, University of South Carolina, Columbia, SC, USA; Practice Management Committee, American Association of Hip and Knee Surgeons (AAHKS).
Arthroplast Today. 2016 Aug 27;2(3):133-136. doi: 10.1016/j.artd.2016.03.003. eCollection 2016 Sep.
In medicine today, there is a trend toward increasing transparency. Higher quality and better value are being sought, and one of the methods being used is publicly reported health care outcomes. However, there is a problem that comes from our loss of anonymity. Physicians who are being individually watched have to choose between doing what is best for the patient and doing what would look good when it is publicly reported. Often this might mean choosing not to treat a particularly sick patient who is unlikely to have a good outcome. Adjusting outcomes to account for risk factors should be a way to prevent this effect, but these methods need to be studied more. The current performance measures being released are based on administrative claims data, and to date, much of that information is not properly risk adjusted. To ensure that the increasing transparency reveals an accurate picture, it is critical that the complexity of care provided by surgeons be carefully documented. Therefore, we propose accurate coding of patients' comorbidities during hospitalization for total knee arthroplasty and total hip arthroplasty, and we have included a chart detailing our recommendations of the specific diagnostic codes that are most important.
在当今医学领域，存在一种透明度不断提高的趋势。人们追求更高的质量和更好的价值，所采用的方法之一就是公开报告医疗保健结果。然而，我们失去匿名性带来了一个问题。被单独关注的医生必须在为患者做最有益的事情和做在公开报告时看起来不错的事情之间做出选择。通常这可能意味着选择不治疗预后不太好的重病患者。调整结果以考虑风险因素应该是防止这种影响的一种方法，但这些方法需要更多研究。目前发布的绩效指标是基于行政索赔数据，到目前为止，其中许多信息并未进行适当的风险调整。为确保透明度的提高能呈现准确的情况，仔细记录外科医生所提供护理的复杂性至关重要。因此，我们建议在全膝关节置换术和全髋关节置换术住院期间准确编码患者的合并症，并且我们附上了一个图表，详细列出了我们认为最重要的特定诊断代码的建议。
