Meirick Thomas, Shah Apurva S, Dolan Lori A, Weinstein Stuart L
The University of Iowa Hospitals and Clinics, Department of Orthopaedics and Rehabilitation, Iowa City, IA USA.
Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA USA.
Iowa Orthop J. 2019;39(1):57-61.
Adolescent idiopathic scoliosis (AIS) has been associated with unnecessary referrals, but the provider and patient costs associated with these referrals remain unknown. The purpose of this study was to determine the prevalence and associated costs of unnecessary referrals for AIS in a university hospital-based orthopaedic clinic. These data are required to estimate the cost-efficacy of scoliosis screening programs.
We accessed the electronic medical records of all patients referred during 2013-2014 with suspected AIS. Spine radiographs were reviewed to determine whether the referral was "unnecessary," defined as a Cobb angle <20 degrees. Patient and provider costs were estimated. Patient costs included transportation expenses and parental lost wages. Provider costs included orthopaedic evaluation, diagnostic imaging, and overhead. Transportation costs were based on actual driving distances and the Internal Revenue Service standard mileage rate. Parental lost wages and the cost of evaluation by an orthopaedic surgeon were calculated with time-driven activity-based costing. Diagnostic imaging costs were calculated with a traditional activity-based costing methodology.
Three hundred thirty-seven patients were included. The prevalence of unnecessary referrals was 39% (n=131). 17% of patients had a Cobb angle <10 degrees and 22% had a Cobb angle between 10-20 degrees. Males were more likely to be referred unnecessarily than females, 49% to 35% (p=0.02) as were non-Caucasians (54% vs. 37%, p=0.04). No difference was noted related to source of insurance (private or public, p=0.18). The average total cost of an unnecessary referral was $782.13 USD, including $231.07 in patient costs and $551.06 in provider costs.
Nearly 40% of all referrals for AIS were deemed unnecessary. The average cost of an unnecessary referral is approximately $780, imposing significant costs on both patients and the healthcare system. III.
青少年特发性脊柱侧凸（AIS）与不必要的转诊有关，但这些转诊所涉及的医疗服务提供者和患者的费用仍不清楚。本研究的目的是确定在一家大学医院的骨科诊所中，AIS不必要转诊的患病率及相关费用。这些数据对于评估脊柱侧凸筛查项目的成本效益是必需的。
我们查阅了2013 - 2014年期间所有因疑似AIS而被转诊患者的电子病历。对脊柱X光片进行复查，以确定转诊是否“不必要”，定义为Cobb角<20度。估算了患者和医疗服务提供者的费用。患者费用包括交通费用和父母的误工工资。医疗服务提供者的费用包括骨科评估、诊断成像和管理费用。交通费用基于实际驾驶距离和美国国税局的标准里程费率。父母的误工工资和骨科医生的评估费用采用基于时间驱动的作业成本法计算。诊断成像费用采用传统的作业成本法计算。
共纳入337例患者。不必要转诊的患病率为39%（n = 131）。17%的患者Cobb角<10度，22%的患者Cobb角在10 - 20度之间。男性比女性更易被不必要转诊，分别为49%和35%（p = 0.02），非白种人也是如此（54%对37%，p = 0.04）。在保险来源方面未发现差异（私人或公共保险，p = 0.18）。一次不必要转诊的平均总成本为782.13美元，其中患者费用231.07美元，医疗服务提供者费用551.06美元。
所有AIS转诊中近40%被认为是不必要的。一次不必要转诊的平均费用约为780美元，给患者和医疗系统都带来了巨大成本。III.
