Gorman Tiffany L, S Albersheim Melissa, Parikh Harsh R, Flagstad Ilexa R, Okelana A Bandele, Vang Sandy, Johal Herman, Cunningham Brian P
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
Division of Orthopaedics, McMaster University, Hamilton, Ontario, CA.
J Orthop Trauma. 2019 Nov;33 Suppl 7:S21-S25. doi: 10.1097/BOT.0000000000001622.
With value-based payment models on the horizon, this study was designed to examine the perceptions of value-based care among orthopaedic traumatologists and how they influence their practice.
Systems-based survey study.
Orthopaedic Trauma Association (OTA) research surveys.
OTA members.
Thirty-eight-question surveys focusing on 5 areas related to value-based care: understanding value, assessing interest, barriers, perceptions around implementing value-based strategies, and policy.
Of 1106 OTA members, 252 members responded for a response rate of 22.7%. Consideration around cost was not different between hospital, academic, and private practice settings (P = 0.47). Previous reported experience in finance increased the amount surgical decision-making was influenced by cost (P < 0.01), along with reported understanding of implant costs (P < 0.01). Over half of the respondents (59.4%) believed value-based payments are coming to orthopaedic trauma. The vast majority (88.5%) believed bundled payments would be unsuccessful or only partially successful. With respect to barriers, a third of respondents (34.7%) indicated accurate cost data prevented the implementation of programs that track and maximize value, another third (31.5%) attributed it to a limited ability to collect patient-reported outcomes, and the rest (33.8%) were split between lack of institutional interest and access to funding.
Our study indicated the understanding of value in orthopaedic trauma is limited and practice integration is rare. Reported experience in finance was the only factor associated with increased consideration of value-based care in practice. Our results highlight the need for increased exposure and resources to changing health care policy, specifically for orthopaedic traumatologists.
Level V. See Instructions for Authors for a complete description of levels of evidence.
鉴于基于价值的支付模式即将出现，本研究旨在调查骨科创伤外科医生对基于价值的医疗的看法及其对他们临床实践的影响。
基于系统的调查研究。
骨科创伤协会（OTA）研究调查。
OTA成员。
38个问题的调查问卷，聚焦于与基于价值的医疗相关的5个领域：理解价值、评估兴趣、障碍、对实施基于价值策略的看法以及政策。
1106名OTA成员中，252名成员回复，回复率为22.7%。医院、学术和私人执业环境在成本考量方面无差异（P = 0.47）。先前报告的财务经验增加了手术决策受成本影响的程度（P < 0.01），以及对植入物成本的了解程度（P < 0.01）。超过一半的受访者（59.4%）认为基于价值的支付即将应用于骨科创伤领域。绝大多数（88.5%）认为捆绑支付将不会成功或仅部分成功。关于障碍，三分之一的受访者（34.7%）表示准确的成本数据阻碍了追踪和最大化价值的项目实施，另有三分之一（31.5%）将其归因于收集患者报告结局的能力有限，其余（33.8%）则在缺乏机构兴趣和资金获取之间存在分歧。
我们的研究表明，骨科创伤领域对价值的理解有限，实践整合很少见。报告的财务经验是与临床实践中更多考虑基于价值的医疗相关的唯一因素。我们的结果凸显了增加对不断变化的医疗政策的接触和资源投入的必要性，特别是针对骨科创伤外科医生。
V级。有关证据水平的完整描述，请参阅作者指南。
