Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, Ariz.
Division of Vascular Surgery, Department of Surgery, University of Arizona, Tucson, Ariz.
J Vasc Surg. 2022 Jan;75(1):296-300. doi: 10.1016/j.jvs.2021.07.126. Epub 2021 Jul 24.
OBJECTIVE/BACKGROUND: Over the past decade, multidisciplinary "toe and flow" programs have gained great popularity, with proven benefits in limb salvage. Many vascular surgeons have incorporated podiatrists into their practices. The viability of this practice model requires close partnership, hospital support, and financial sustainability. We intend to examine the economic values of podiatrists in a busy safety-net hospital in the Southwest United States.
An administrative database that captured monthly operating room (OR) cases, clinic encounters, in-patient volume, and total work relative value units (wRVUs) in an established limb salvage program in a tertiary referral center were examined. The practice has a diverse patient population with >30% of minority patients. During a period of 3 years, there was a significant change in the number of podiatrists (from 1 to 4) within the program, whereas the clinical full-time employees for vascular surgeons remained relatively stable.
The limb salvage program experienced >100% of growth in total OR volumes, clinic encounters, and total wRVUs over a period of 4 years. A total of 35,591 patients were evaluated in a multidisciplinary limb salvage clinic, and 5535 procedures were performed. The initial growth of clinic volume and operative volume (P < .01) were attributed by the addition of vascular surgeons in year one. However, recruitment of podiatrists to the program significantly increased clinic and OR volume by an additional 60% and >40%, respectively (P < .01) in the past 3 years. With equal number of surgeons, podiatry contributed 40% of total wRVUs generated by the entire program in 2019. Despite the fact that that most of the foot and ankle procedures that were regularly performed by vascular surgeons were shifted to the podiatrists, vascular surgeons continued to experience an incremental increase in operative volume and >10% of increase in wRVUs.
This study shows that the value of close collaboration between podiatry and vascular in a limb salvage program extends beyond a patient's clinical outcome. A financial advantage of including podiatrists in a vascular surgery practice is clearly demonstrated.
目的/背景：在过去的十年中，多学科的“足部和血流”项目广受欢迎，已被证明对肢体保全有益。许多血管外科医生已将足病医生纳入其治疗团队。这种实践模式的可行性需要密切的合作、医院的支持和财务的可持续性。我们旨在研究在美国西南部一家繁忙的医疗保障医院中足病医生的经济价值。
我们检查了一个在三级转诊中心建立的肢体保全项目的每月手术室（OR）病例、诊所就诊、住院量和总工作相对价值单位（wRVU）的行政数据库。该实践具有多元化的患者群体，少数民族患者占比超过 30%。在 3 年期间，该项目中的足病医生数量（从 1 名增加到 4 名）发生了显著变化，而血管外科医生的临床全职员工相对稳定。
在 4 年期间，肢体保全项目的总 OR 量、诊所就诊量和总 wRVU 增长超过 100%。共有 35591 名患者在多学科肢体保全诊所接受了评估，共进行了 5535 次手术。第一年新增血管外科医生使诊所和手术量出现了最初的增长（P<.01）。然而，在过去 3 年中，足病医生加入该项目使诊所和 OR 量分别增加了 60%和 40%以上（P<.01）。在外科医生人数相同的情况下，足病科在 2019 年贡献了整个项目总 wRVU 的 40%。尽管大多数由血管外科医生常规进行的足踝手术已转移至足病医生，但血管外科医生的手术量仍继续增加，wRVU 增加了 10%以上。
本研究表明，在肢体保全项目中，足病学与血管学之间的密切合作的价值不仅体现在患者的临床结果上。将足病医生纳入血管外科学术实践具有明显的经济优势。
