Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
TRIA Orthopaedic Institute, Bloomington, MN, USA.
J Shoulder Elbow Surg. 2022 Jan;31(1):72-80. doi: 10.1016/j.jse.2021.07.004. Epub 2021 Aug 11.
Rotator cuff repair (RCR) is one of the most common elective orthopedic procedures, with predictable indications, techniques, and outcomes. As a result, this surgical procedure is an ideal choice for studying value. The purpose of this study was to perform patient-level value analysis (PLVA) within the setting of RCR over the 1-year episode of care.
Included patients (N = 396) underwent RCR between 2009 and 2016 at a single outpatient orthopedic surgery center. The episode of care was defined as 1-year following surgery. The Western Ontario Rotator Cuff index was collected at both the initial preoperative baseline assessment and the 1-year postoperative mark. The total cost of care was determined using time-driven activity-based costing (TDABC). Both PLVA and provider-level value analysis were performed.
The average TDABC cost of care was derived at $5413.78 ± $727.41 (95% confidence interval, $5341.92-$5485.64). At the patient level, arthroscopic isolated supraspinatus tears yielded the highest value coefficient (0.82; analysis-of-variance F test, P = .01). There was a poor correlation between the change in the 1-year Western Ontario Rotator Cuff score and the TDABC cost of care (r = 0.03). Provider-level value analysis demonstrated significant variation between the 8 providers evaluated (P < .01).
RCR is one of the most common orthopedic procedures, yet the correlations between cost of care and patient outcomes are unknown. PLVA quantifies the ratio of functional improvement to the TDABC-estimated cost of care at the patient level. This is the first study to apply PLVA over the first-year episode of care. With health care transitioning toward value-based delivery, PLVA offers a quantitative tool to measure the value of individual patient care delivery over the entire episode of care.
肩袖修复术（RCR）是最常见的择期骨科手术之一，具有明确的适应证、技术和结果。因此，该手术是研究价值的理想选择。本研究的目的是在 RCR 的 1 年治疗期间内进行患者水平价值分析（PLVA）。
纳入的 396 例患者于 2009 年至 2016 年在一家单门诊骨科手术中心接受 RCR。治疗期间定义为术后 1 年。Western Ontario Rotator Cuff 指数分别在术前基线评估和术后 1 年标记时收集。使用时间驱动的活动基础成本核算（TDABC）确定总护理成本。进行了 PLVA 和提供者水平价值分析。
平均 TDABC 护理成本为 5413.78 ± 727.41 美元（95%置信区间，5341.92-5485.64）。在患者水平上，关节镜下单纯冈上肌腱撕裂产生的价值系数最高（0.82；方差分析 F 检验，P =.01）。1 年 Western Ontario Rotator Cuff 评分的变化与 TDABC 护理成本之间相关性较差（r = 0.03）。提供者水平价值分析显示，评估的 8 个提供者之间存在显著差异（P <.01）。
RCR 是最常见的骨科手术之一，但护理成本与患者结果之间的相关性尚不清楚。PLVA 在患者水平上量化了功能改善与 TDABC 估计的护理成本之间的比值。这是第一项在 1 年治疗期间内应用 PLVA 的研究。随着医疗保健向基于价值的交付模式转变，PLVA 提供了一种定量工具，可以衡量整个治疗期间单个患者护理交付的价值。
