Boylan Matthew R, Perfetti Dean C, Naziri Qais, Maheshwari Aditya V, Paulino Carl B, Mont Michael A
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York.
J Arthroplasty. 2017 Sep;32(9S):S124-S127. doi: 10.1016/j.arth.2017.03.003. Epub 2017 Mar 14.
Although resident physicians play a vital role in the US health care system, they are believed to create inefficiencies in the delivery of care. Under the regional component of the Comprehensive Care for Joint Replacement model, teaching hospitals are forced to compete on efficiency and outcomes with nonteaching hospitals.
We identified 86,021 patients undergoing elective primary total hip arthroplasty in New York State between January 1, 2009, and September 30, 2014. Outcomes included length and cost of the index admission, disposition, and 90-day readmission. Mixed-effects regression models compared teaching vs nonteaching orthopedic hospitals after adjusting for patient demographics, comorbidities, hospital, surgeon, and year of surgery.
Patients undergoing surgery at teaching hospitals had longer lengths of stay (β = 3.2%; P < .001) and higher costs of admission (β = 13.6%; P < .001). There were no differences in disposition status (odds ratio = 1.03; P = .779). The risk of 90-day readmission was lower for teaching hospitals (odds ratio = 0.89; P = .001).
Primary total hip arthroplasty at teaching orthopedic hospitals is characterized by greater utilization of health care resources during the index admission. This suggests that teaching hospitals may be adversely affected by reimbursement tied to competition on economic and clinical metrics. Although a certain level of inefficiency is inherent during the learning process, these policies may hinder learning opportunities for residents in the clinical setting.
尽管住院医师在美国医疗保健系统中发挥着至关重要的作用，但人们认为他们会导致医疗服务效率低下。在全髋关节置换综合护理模式的区域组成部分下，教学医院被迫在效率和治疗结果方面与非教学医院竞争。
我们确定了2009年1月1日至2014年9月30日期间在纽约州接受择期初次全髋关节置换术的86021名患者。结果包括首次入院的时长和费用、出院情况以及90天再入院情况。在对患者人口统计学、合并症、医院、外科医生和手术年份进行调整后，采用混合效应回归模型比较了教学骨科医院与非教学骨科医院。
在教学医院接受手术的患者住院时间更长（β = 3.2%；P <.001），入院费用更高（β = 13.6%；P <.001）。出院情况没有差异（优势比 = 1.03；P =.779）。教学医院90天再入院的风险较低（优势比 = 0.89；P =.001）。
教学骨科医院的初次全髋关节置换术的特点是在首次入院期间对医疗资源的利用更多。这表明教学医院可能会受到与经济和临床指标竞争相关的报销政策的不利影响。尽管在学习过程中必然存在一定程度的效率低下，但这些政策可能会阻碍住院医师在临床环境中的学习机会。
