VOICES Health Policy Research Center, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA.
Department of Health Research and Policy, Stanford University, Stanford, CA.
J Hand Surg Am. 2020 Apr;45(4):289-297.e1. doi: 10.1016/j.jhsa.2019.09.008. Epub 2019 Nov 19.
The use of routine physical therapy (PT) and occupational therapy (OT) after certain hand procedures, such as carpal tunnel release, remains controversial. The objective of this study was to evaluate baseline use, the change in use, variation in prescribing patterns by region, and costs for PT/OT after common hand procedures.
Outpatient administrative claims data from patients who underwent procedures for carpal tunnel syndrome, trigger finger, carpometacarpal arthritis, de Quervain tenosynovitis, wrist ganglion cyst, and distal radius fracture were abstracted from the Truven Health MarketScan database from 2007 to 2015. The incidence of therapy and total reimbursement of therapy per patient were collected for each procedure over a 90-day postoperative observational period. Trends in use of therapy over time were described with average compound annual growth rates (CAGRs), a way of quantifying average growth over a specified observation period. Variations in the incidence of PT/OT use across 4 census regions were assessed.
The incidence of 90-day utilization of PT and OT after hand procedures was 14.0% and increased for all procedures during the observation period with an average CAGR of 8.3%. Cost per therapy visit was relatively stable when adjusted for inflation, with an average CAGR of 0.63%. Patients in the northeast had a significantly higher incidence of PT/OT use than those in the south and west for all procedures except carpometacarpal arthritis.
Use of PT and OT has increased over time after common hand procedures. Geographical variation in the utilization rate of these services is substantial. Limiting unwarranted variation of care is a health policy strategy for increasing value of care.
TYPE OF STUDY/LEVEL OF EVIDENCE: Outcomes Research II.
在某些手部手术后，如腕管松解术，常规物理治疗（PT）和职业治疗（OT）的应用仍存在争议。本研究的目的是评估常见手部手术后 PT/OT 的基线应用、应用变化、区域间处方模式的差异以及治疗费用。
从 2007 年至 2015 年，从 Truven Health MarketScan 数据库中提取接受腕管综合征、扳机指、腕掌关节炎、De Quervain 腱鞘炎、腕关节腱鞘囊肿和桡骨远端骨折手术患者的门诊管理索赔数据。在术后 90 天观察期内，每例患者的治疗发生率和治疗总报销额。描述了随着时间的推移治疗使用的趋势，采用平均复合年增长率（CAGR），这是一种量化特定观察期内平均增长率的方法。评估了 4 个普查区域之间治疗使用的发生率差异。
手部手术后 90 天内接受 PT 和 OT 的发生率为 14.0%，在观察期间，所有手术的使用率均有所增加，平均 CAGR 为 8.3%。经通胀调整后，每次治疗访问的成本相对稳定，平均 CAGR 为 0.63%。除腕掌关节炎外，东北部患者在所有手术中接受 PT/OT 的比例明显高于南部和西部。
常见手部手术后，PT 和 OT 的使用随着时间的推移而增加。这些服务利用率的地域差异很大。限制护理的不必要差异是提高护理价值的医疗政策策略。
研究类型/证据水平：结局研究 II。
