Modi Parth K, Kaufman Samuel R, Borza Tudor, Oliphant Bryant W, Ryan Andrew M, Miller David C, Shahinian Vahakn B, Ellimoottil Chad, Hollenbeck Brent K
1 University of Michigan, Ann Arbor, MI, USA.
Surg Innov. 2019 Apr;26(2):227-233. doi: 10.1177/1553350618816594. Epub 2018 Nov 30.
To evaluate the effect of Accountable Care Organizations (ACOs) on the use of vertebroplasty and arthroscopic partial meniscectomy, 2 procedures for which randomized controlled trials suggest similar outcomes to sham surgery and therefore may provide low value. Medicare Shared Savings Program ACOs aim to improve quality and decrease health care spending. Reducing the use of potentially low-value procedures can accomplish both of these goals.
We performed a retrospective cohort study of patients who underwent potentially low-value orthopedic procedures (vertebroplasty and partial meniscectomy) and a control (hip fracture) from 2010 to 2015 using a 20% sample of national Medicare claims. We performed an interrupted time-series analysis using linear spline models to evaluate the count of each procedure per 1000 patients, stratified by ACO participation.
We identified 76 256 patients who underwent arthroscopic partial meniscectomy, 44 539 patients who underwent vertebroplasty, and 50 760 patients who underwent hip fracture admission. Arthroscopic partial meniscectomy rates decreased, vertebroplasty rates remained stable, and hip fracture rates increased for both groups during the study period, with similar trends among ACO and non-ACO patients. After January 1, 2013, ACO and non-ACO populations had similar trends for vertebroplasty (ACO incidence rate ratio [IRR] = 1.15 [1.08-1.23] vs non-ACO IRR = 1.11 [1.05-1.16]), meniscectomy (ACO IRR = 1.06 [1.01-1.12] vs non-ACO IRR = 1.03 [0.99-1.07]), and hip fracture (ACO IRR = 1.08 [1.01-1.14] vs non-ACO IRR = 1.08 [1.03-1.13]).
ACOs were not associated with a reduction in the frequency of vertebroplasty and arthroscopic partial meniscectomy.
评估责任医疗组织（ACO）对椎体成形术和关节镜下半月板部分切除术使用情况的影响，这两种手术的随机对照试验表明其结果与假手术相似，因此可能价值不高。医疗保险共享节约计划ACO旨在提高质量并降低医疗保健支出。减少潜在低价值手术的使用可以实现这两个目标。
我们使用全国医疗保险索赔的20%样本，对2010年至2015年期间接受潜在低价值骨科手术（椎体成形术和半月板部分切除术）的患者以及对照组（髋部骨折）进行了一项回顾性队列研究。我们使用线性样条模型进行中断时间序列分析，以评估每1000名患者中每种手术的例数，并按ACO参与情况进行分层。
我们确定了76256例接受关节镜下半月板部分切除术的患者、44539例接受椎体成形术的患者以及50760例因髋部骨折入院的患者。在研究期间，两组的关节镜下半月板部分切除术发生率均下降，椎体成形术发生率保持稳定，髋部骨折发生率上升，ACO患者和非ACO患者的趋势相似。2013年1月1日之后，ACO人群和非ACO人群在椎体成形术（ACO发病率比[IRR]=1.15[1.08 - 1.23]，非ACO人群IRR = 1.11[1.05 - 1.16]）、半月板切除术（ACO IRR = 1.06[1.01 - 1.12]，非ACO人群IRR = 1.03[0.99 - 1.07]）和髋部骨折（ACO IRR = 1.08[1.01 - 1.14]，非ACO人群IRR = 1.08[1.03 - 1.13]）方面具有相似趋势。
ACO与椎体成形术和关节镜下半月板部分切除术的频率降低无关。
