Health Policy and Management, University of California Berkeley School of Public Health, Berkeley, California, USA
Health Systems Administration, Georgetown University, Washington, Columbia, USA.
BMJ Open. 2021 Nov 26;11(11):e053121. doi: 10.1136/bmjopen-2021-053121.
Musculoskeletal problems like hip and knee osteoarthritis and low-back pain are preference sensitive conditions. Patient engagement strategies (PES), such as shared decision-making and motivational interviewing, can help align patients' preferences with treatment options and potentially reduce spending. We assess the association of physician practice-level adoption of PES with utilisation and spending.
Cross-sectional study in which patients were matched across low, moderate and high levels of PES via coarsened exact matching.
Primary and secondary care in 2190 physician practices.
39 336 hip, 48 362 knee and 67 940 low-back patients who were Medicare beneficiaries were matched to the 2017-2018 National Survey of Healthcare Organizations and Systems.
Total hip replacement (THR), total knee replacement (TKR), 1-2 level posterior lumbar fusion (LF), total annual spending, components of total annual spending.
Total annual spending for patients with musculoskeletal problems did not differ for practices with low versus moderate PES, low versus high PES or moderate versus high PES, but spending was significantly lower in some categories for practices with relatively higher PES adoption. For hospital-owned and health system-owned practices, the ORs of receiving LF were 0.632 (95% CI 0.396 to 1.009) for patients attributed to practices with high PES compared with patients attributed to practices with moderate PES. For independent practices, the odds of receiving THR were 1.403 (95% CI 1.035 to 1.902) for patients attributed to practices with moderate PES compared with patients attributed to practices with low PES.
Practice-level adoption of PES for patients with musculoskeletal problems was generally not associated with total spending. PES, however, may steer patients toward evidence-based treatments. Opportunities for overall spending reduction exist as indicated by the variation in the subcomponents of total spending by PES adoption.
髋关节和膝关节骨关节炎以及下腰痛等肌肉骨骼问题是偏好敏感的情况。患者参与策略（PES），如共同决策和动机访谈，可以帮助将患者的偏好与治疗选择相匹配，并可能降低支出。我们评估了医生实践层面采用 PES 与利用和支出的关联。
通过粗化精确匹配，将患者按 PES 的低、中、高水平进行匹配的横截面研究。
2190 个医生诊所的初级和二级保健。
39336 名髋关节、48362 名膝关节和 67940 名下腰痛患者，他们是医疗保险受益人，与 2017-2018 年全国医疗保健组织和系统调查相匹配。
全髋关节置换术（THR）、全膝关节置换术（TKR）、1-2 级后路腰椎融合术（LF）、总年度支出、总年度支出构成。
在具有低、中、高 PES 的实践中，患有肌肉骨骼问题的患者的总年度支出没有差异，但在某些类别中，具有相对较高 PES 采用率的实践的支出明显较低。对于医院所有和卫生系统所有的实践，与归因于具有中等 PES 的实践的患者相比，归因于具有高 PES 的实践的患者接受 LF 的 OR 为 0.632（95%CI 0.396 至 1.009）。对于独立实践，与归因于具有低 PES 的实践的患者相比，归因于具有中等 PES 的实践的患者接受 THR 的几率为 1.403（95%CI 1.035 至 1.902）。
患有肌肉骨骼问题的患者的 PES 实践层面采用通常与总支出无关。然而，PES 可能会引导患者选择基于证据的治疗方法。正如 PES 采用的总支出子成分的变化所表明的那样，存在着降低总支出的机会。
