From the Department of Orthopaedic Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX (Dr. Gregory, Mr. Wayne, Mr. Kozemchak, and Dr. Warth), University of Texas Rio Grande Valley School of Medicine, Brownsville, TX (Mr. Wayne), the Department of Orthopaedic Surgery, University of Louisville, Louisville, KY (Dr. Miller), and Memorial Hermann Hospital, Ironman Sports Medicine Institute; Houston, TX (Dr. Bailey).
J Am Acad Orthop Surg. 2021 Feb 1;29(3):e143-e153. doi: 10.5435/JAAOS-D-20-00035.
Managing costs and improving access to care are two important goals of healthcare policy. The purposes of this study were to (1) evaluate the changes in distribution of total shoulder arthroplasty (TSA) cases in the state of Texas from 2010 to 2015 and (2) to evaluate patient access to TSA surgery centers as measured by driving miles.
Inpatient (IP) and outpatient (OP) records were obtained from 2010 to 2015 from the Texas Department of State Health Services. All primary elective anatomic or reverse TSAs for patients with Texas-based home residence zip codes were included. Driving miles between patient zip codes and their chosen TSA surgery centers were estimated, and the results were compared between IP (high-volume [HV-IP] or low-volume [LV-IP]) and OP centers. Paired student t-tests, multivariate regressions, and mixed-model analysis of variance (ANOVA) were performed for volume comparisons, interactions between TSA centers types, and yearly trend data, respectively.
Between 2010 and 2015, a total of 21,092 TSA procedures were performed across 321 surgery centers in the state of Texas (19,629 IP [93.1%] and 1,463 OP [6.9%]). During this time, the cumulative volume of IP TSA per 100,000 Texas residents increased by 109.1%, whereas the cumulative volume of OP TSA increased by 143.7%. Approximately 85.5% of included patients resided within 50 miles of any TSA surgery center; however, only 47.0% of the total Texas population resided within 50 miles of any TSA surgery center. This relationship remained true at every time point irrespective of their volume designations (OP, IP, HV-IP, and LV-IP).
Despite the overall increase in TSA volume over time, the majority all TSA utilization in the state of Texas occurred in patients who resided within 50 miles of a TSA center. Increasing volume seems to reflect concentration of care into HV-IP and OP centers. Strategies to improve access to TSA care for underserved areas should be considered.
Level II.
管理成本和改善医疗服务可及性是医疗政策的两个重要目标。本研究的目的是：(1)评估德克萨斯州全肩关节置换术（TSA）病例的分布在 2010 年至 2015 年间的变化；(2)通过驾驶英里数评估患者接受 TSA 手术中心的机会。
从 2010 年至 2015 年，从德克萨斯州卫生部获得了住院（IP）和门诊（OP）记录。所有基于德克萨斯州住址邮编的原发性择期解剖或反向 TSA 患者均被纳入研究。估计患者邮编与所选 TSA 手术中心之间的驾驶英里数，并对 IP（高容量 [HV-IP] 或低容量 [LV-IP]）和 OP 中心之间的结果进行比较。分别进行了体积比较的配对学生 t 检验、多元回归和混合模型方差分析（ANOVA），以及 TSA 中心类型之间的交互作用和逐年趋势数据。
2010 年至 2015 年间，德克萨斯州共有 321 个手术中心共进行了 21092 例 TSA 手术（19629 例 IP [93.1%] 和 1463 例 OP [6.9%]）。在此期间，每 10 万德克萨斯州居民的 IP TSA 累计量增加了 109.1%，而 OP TSA 的累计量增加了 143.7%。大约 85.5%的纳入患者居住在距离任何 TSA 手术中心 50 英里以内的地方；然而，只有 47.0%的德克萨斯州总人口居住在距离任何 TSA 手术中心 50 英里以内的地方。无论他们的容量指定（OP、IP、HV-IP 和 LV-IP）如何，这种关系在每个时间点都是真实存在的。
尽管 TSA 数量总体上随时间增加，但该州所有 TSA 使用率都发生在居住在 TSA 中心 50 英里以内的患者中。容量的增加似乎反映了 HV-IP 和 OP 中心的集中护理。应考虑制定改善服务不足地区接受 TSA 治疗机会的策略。
II 级。
