Li Lambert, Bokshan Steven L, Mehta Shayna R, Owens Brett D
Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA.
Orthop J Sports Med. 2019 Jun 10;7(6):2325967119850503. doi: 10.1177/2325967119850503. eCollection 2019 Jun.
Surgeon caseload has been shown to affect both health and economic outcomes in arthroscopic rotator cuff repair. Although previous studies have investigated disparities in access to care, little is known about disparities between low- and high-volume surgeons and facilities.
To identify where disparities may exist regarding access to high-volume surgeons and facilities.
Cross-sectional study.
Univariate analysis was performed to analyze differences in the caseload between low- and high-volume surgeons and facilities. Cutoff values were set at 50 cases per year for high-volume surgeons and 125 cases annually for high-volume facilities. Multiple linear regression was then used to develop a cost model incorporating all variables significant under univariate analysis. We collected 18,616 cases with Current Procedural Terminology code 29827 ("arthroscopic rotator cuff repair") from the 2014 Florida State Ambulatory Surgery and Services Databases.
A greater proportion of the caseload for low-volume surgeons and facilities was composed of patients who were of lower socioeconomic status, had government-subsidized insurance, or lived in areas with low-income ZIP codes. Low-volume surgeons and facilities also had higher total charges, higher postoperative admission rates, and lower distal clavicle excision rates ( < .001). In our cost model, a low facility volume significantly increased costs. Subacromial decompression, postoperative admission, distal clavicle excision, male sex, and government-subsidized insurance were all significant factors for increased costs in multivariate cost analysis.
There are disparities in access to high-volume surgeons and facilities for patients undergoing arthroscopic rotator cuff repair in Florida. Patients with a lower socioeconomic status, government-subsidized insurance, and low income all faced decreased access to these high-volume groups. High-volume surgeons and facilities were associated with lower total charges, higher rates of distal clavicle excision, and lower readmission rates. Low-volume facilities added a significant amount of cost, even when controlling for all other significant variables. It is important for providers to be aware of these disparities and work to address them in their own practices.
已有研究表明，外科医生的病例量会影响关节镜下肩袖修复的健康和经济结果。尽管此前的研究调查了医疗服务可及性方面的差异，但对于低手术量和高手术量的外科医生及医疗机构之间的差异却知之甚少。
确定在获得高手术量外科医生和医疗机构服务方面可能存在的差异。
横断面研究。
进行单因素分析，以分析低手术量和高手术量的外科医生及医疗机构之间病例量的差异。高手术量外科医生的病例量阈值设定为每年50例，高手术量医疗机构的病例量阈值设定为每年125例。然后使用多元线性回归建立一个成本模型，纳入单因素分析中所有显著的变量。我们从2014年佛罗里达州门诊手术和服务数据库中收集了18616例当前手术操作术语编码为29827（“关节镜下肩袖修复”）的病例。
低手术量的外科医生和医疗机构的病例中，社会经济地位较低、拥有政府补贴保险或居住在低收入邮政编码地区的患者所占比例更大。低手术量的外科医生和医疗机构的总费用更高、术后住院率更高、锁骨远端切除率更低（P<0.001）。在我们的成本模型中，医疗机构手术量低会显著增加成本。在多因素成本分析中，肩峰下减压、术后住院、锁骨远端切除、男性性别和政府补贴保险都是成本增加的显著因素。
在佛罗里达州，接受关节镜下肩袖修复的患者在获得高手术量外科医生和医疗机构服务方面存在差异。社会经济地位较低、拥有政府补贴保险和低收入的患者获得这些高手术量群体服务的机会都减少。高手术量的外科医生和医疗机构与较低的总费用、较高的锁骨远端切除率和较低的再入院率相关。即使在控制了所有其他显著变量的情况下，低手术量的医疗机构也会增加大量成本。医疗服务提供者意识到这些差异并在自身实践中努力解决这些差异非常重要。
