Harvard Combined Orthopaedic Residency Program, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
J Clin Neurosci. 2022 Sep;103:180-187. doi: 10.1016/j.jocn.2022.07.015. Epub 2022 Jul 28.
Patient-reported outcome measures (PROMs) are increasingly recognized as a key component of healthcare value, allowing comparison of therapeutic impact across different specialties. Prior literature suggests that insurance type may be associated with differing baseline PROMs among patients with degenerative conditions, including lumbar stenosis and hip arthritis. This association, however, has not been investigated for adult spinal deformity (ASD).
Baseline PROMs were reviewed from 207 patients with ASD presenting for treatment between 2015 and 2019. The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a), PROMIS Global-Mental, PROMIS Global-Physical, and visual analogue scale (VAS) for back and leg pain were assessed. Negative binomial regression was used to determine the impact of sociodemographic factors, including insurance type, on severity of symptoms and degree of disability at baseline.
Mean age of the study population was 62.2 +/- 15 years, with 61.8 % male prevalence. The Medicaid population had a greater proportion of Hispanic and non-English speaking patients, compared to commercially insured patients. Medicaid insured patients had significantly greater VAS low back pain scores compared with commercially insured individuals (IRR 1.535, 95 % CI 1.122-2.101, p = 0.007).
Medicaid insured patients demonstrated worse baseline PROMs at presentation with ASD, as compared to commercially insured or Medicare patients. Stakeholders across spine care delivery should elucidate the etiology of baseline disparities in ASD patients, as they may result from health system asymmetries. In an ecosystem moving toward value-driven treatment algorithms, accounting for and addressing these differences will be necessary to provide equitable care for ASD populations.
患者报告的结局测量（PROMs）越来越被认为是医疗保健价值的关键组成部分，它允许在不同专业之间比较治疗效果。先前的文献表明，保险类型可能与退行性疾病（包括腰椎狭窄症和髋关节炎）患者的基线 PROMs 存在差异有关。然而，这种关联尚未在成人脊柱畸形（ASD）中进行研究。
对 2015 年至 2019 年间接受治疗的 207 例 ASD 患者的基线 PROMs 进行了回顾。评估了患者报告的结局测量信息系统（PROMIS）物理功能简短表 10a（PF10a）、PROMIS 全球心理、PROMIS 全球身体以及背部和腿部疼痛的视觉模拟量表（VAS）。使用负二项回归来确定社会人口因素（包括保险类型）对基线时症状严重程度和残疾程度的影响。
研究人群的平均年龄为 62.2±15 岁，男性患病率为 61.8%。与商业保险患者相比，医疗补助患者中西班牙语和非英语患者的比例更高。与商业保险个体相比，医疗补助保险患者的 VAS 腰痛评分显著更高（IRR 1.535，95%CI 1.122-2.101，p=0.007）。
与商业保险或医疗保险患者相比，医疗补助保险患者在 ASD 就诊时表现出更差的基线 PROMs。脊柱护理提供的各个利益相关者应阐明 ASD 患者基线差异的病因，因为这些差异可能源于卫生系统的不对称。在向基于价值的治疗算法转变的环境中，需要考虑并解决这些差异，以便为 ASD 人群提供公平的护理。
