Navarro Sergio M, Frankel William C, Haeberle Heather S, Billow Damien G, Ramkumar Prem N
Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.
Hip Int. 2020 May;30(3):347-353. doi: 10.1177/1120700019837130. Epub 2019 Mar 26.
Studies have shown high-volume surgeons and hospitals deliver higher value care. The aims of this study were to establish meaningful thresholds defining high-volume surgeons and hospitals performing hip fracture surgery and to examine the relative market share of hip fracture cases using these surgeon and hospital strata.
We performed a retrospective cohort study in a database of 103,935 patients undergoing hip fracture repair. We generated stratum-specific likelihood ratio (SSLR) models of a receiver operating characteristic (ROC) curve using length of stay (LOS) and cost value metrics. Volume thresholds predictive of decreased LOS and costs for surgeons and hospitals were identified.
Analysis of annual surgeon hip fracture volume produced two volume categories for LOS and cost: 0-30 (low) and 31+ (high). Analysis of LOS by annual hospital hip fracture volume produced strata at: 0-59 (low), 60-146 (medium), and 147 or more (high). Analysis of cost by annual hospital volume produced strata at: 0-125 (low) and 126+ (high). LOS and cost both decreased significantly (< 0.05) in progressively higher volume categories. Low-volume surgeons performed the majority of hip fracture cases, although they were performed at medium- or high-volume centres.
This study demonstrates a direct relationship between volume and value, translating to improvement in hip fracture care delivery for both surgeons and hospitals. Higher volume hospitals while lower volume surgeons perform the majority of hip fracture cases, suggesting optimisation opportunities. However, systems-based practices at the hospital level likely drive value to a greater extent than individual surgeons.
研究表明，手术量大的外科医生和医院能提供更高价值的医疗服务。本研究的目的是确定有意义的阈值，以界定进行髋部骨折手术的高手术量外科医生和医院，并使用这些外科医生和医院分层来检查髋部骨折病例的相对市场份额。
我们在一个包含103935例接受髋部骨折修复患者的数据库中进行了一项回顾性队列研究。我们使用住院时间（LOS）和成本价值指标生成了受试者工作特征（ROC）曲线的分层特定似然比（SSLR）模型。确定了预测外科医生和医院住院时间和成本降低的手术量阈值。
对年度外科医生髋部骨折手术量的分析产生了两个关于住院时间和成本的手术量类别：0 - 30例（低）和31例及以上（高）。按年度医院髋部骨折手术量分析住院时间产生的分层为：0 - 59例（低）、60 - （中）和147例及以上（高）。按年度医院手术量分析成本产生的分层为：0 - 125例（低）和126例及以上（高）。住院时间和成本在手术量逐渐增加的类别中均显著降低（<0.05）。低手术量的外科医生实施了大多数髋部骨折手术，尽管这些手术是在中高手术量的中心进行的。
本研究表明手术量与价值之间存在直接关系，这转化为外科医生和医院在髋部骨折护理服务方面的改善。虽然低手术量的外科医生实施了大多数髋部骨折手术，但高手术量的医院表明存在优化机会。然而，医院层面基于系统的实践可能比个体外科医生在更大程度上推动价值提升。
