Weiner J P, Steinwachs D M, Frank R G, Schwartz K J
Am J Public Health. 1987 Aug;77(8):987-92. doi: 10.2105/ajph.77.8.987.
We examined the roles of Doctors of Podiatric Medicine (DPMs) and orthopedic surgeons in the provision of foot surgery by analyzing the 1982 computerized claims of over 1.1 million federal employees, retirees, and family members. We found that DPMs provided over 60 per cent of all elective insured foot surgery. Without being able to adjust for the severity of the patient's underlying condition or the appropriateness and outcome of the surgery, the average per procedure charge submitted by an orthopedist was 17 per cent higher than that of a DPM; orthopedists were five times as likely to perform a procedure on an inpatient basis, and admitted patients to a hospital had longer stays; DPMs perform a greater number of procedures per episode, but their overall charges during the average foot surgery episode were 30 per cent lower, primarily because of their lower hospitalization rates. The possible impact of recent changes in health care delivery on the DPM/orthopedist practice comparison are discussed as are several questions regarding the quality and need of the care provided by these two groups.
我们通过分析110多万联邦雇员、退休人员及其家庭成员1982年的计算机化理赔数据，研究了足病医学博士（DPMs）和骨科医生在足部手术提供方面的作用。我们发现，DPMs提供了超过60%的所有选择性参保足部手术。在无法根据患者潜在病情的严重程度或手术的适当性及结果进行调整的情况下，骨科医生提交的每项手术平均收费比DPMs高17%；骨科医生进行住院手术的可能性是DPMs的五倍，且收治的患者住院时间更长；DPMs每次诊疗进行的手术数量更多，但在平均足部手术诊疗期间，他们的总费用低30%，主要是因为他们的住院率较低。讨论了近期医疗服务提供变化对DPM/骨科医生实践比较的可能影响，以及关于这两组提供的护理质量和需求的几个问题。
