From the Department of Orthopaedic Surgery, Foot and Ankle Center, Brigham and Women's Hospital, Boston, MA.
J Am Acad Orthop Surg. 2020 Aug 15;28(16):e729-e734. doi: 10.5435/JAAOS-D-19-00487.
Patient-reported outcome measures (PROMs) are used to assess performance and value. The type of health insurance coverage may influence outcomes scores. The goal of this study was to determine if the type of insurance coverage is associated with the trends in PROMs within an orthopaedic cohort.
We reviewed the electronic medical records of 10,745 adult foot and ankle patients who completed PROMs questionnaires from 2015 to 2017. Patients completed the Foot and Ankle Ability Measure, PROMIS Global-Mental, PROMIS Global-Physical, and PROMIS Physical Function Short Form 10a. Descriptive analyses, analysis of variance, and Tukey HSD (honest significant difference) post hoc analyses were conducted.
Patients with commercial insurance consistently had the highest outcomes scores, whereas those with Workers Comp/Motor Vehicle and Medicaid had the lowest. PROMs of patients with commercial insurance were statistically significantly higher than the pooled scores of all other patients. Markedly poorer scores were also seen for Workers Comp/Motor Vehicle and Medicaid. In addition, these differences in PROMs for Workers Comp/Motor Vehicle and Medicaid exceeded the minimal clinically important differences. Patients with Medicare or Free Care had generally lower scores than the pooled averages, but these results were not statistically significant.
PROMs scores vary between the patients with different insurance types in an orthopaedic foot and ankle cohort. These data suggest that patient insurance type may affect patient-reported outcomes.
Level III, Retrospective Cohort.
患者报告的结果测量（PROMs）用于评估绩效和价值。健康保险的覆盖类型可能会影响结果评分。本研究的目的是确定保险类型是否与骨科队列中 PROM 趋势相关。
我们回顾了 2015 年至 2017 年期间完成 PROMs 问卷的 10745 例成年足踝患者的电子病历。患者完成了足踝能力量表、PROMIS 全球心理量表、PROMIS 全球身体量表和 PROMIS 身体功能简短 10a 量表。进行了描述性分析、方差分析和 Tukey HSD（诚实显著差异）事后分析。
商业保险患者的结果评分始终最高，而工人赔偿/机动车保险和医疗补助患者的评分最低。商业保险患者的 PROM 评分明显高于所有其他患者的汇总评分。工人赔偿/机动车保险和医疗补助患者的 PROM 评分也明显较差。此外，工人赔偿/机动车保险和医疗补助患者的这些 PROM 差异超过了最小临床重要差异。 Medicare 或免费护理患者的评分通常低于汇总平均值，但这些结果没有统计学意义。
在骨科足踝队列中，不同保险类型的患者的 PROMs 评分存在差异。这些数据表明，患者的保险类型可能会影响患者报告的结果。
三级，回顾性队列。
