Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Mil Med. 2023 Jul 22;188(7-8):e1842-e1846. doi: 10.1093/milmed/usad004.
Retrospective review (level of evidence III).
Surgical care patterns for lumbar disc herniation (LDH), a common musculoskeletal condition of high relevance to the Military Health System (MHS), have not been described or compared across the direct care and purchased care MHS components. This study aimed to describe surgery rates in MHS beneficiaries who were diagnosed with LDH in direct care versus purchased care and to evaluate characteristics associated with the location of surgery. Differences in care patterns for LDH may suggest unexpected variation within the centrally managed MHS.
We described 1-year rates of surgery among beneficiaries who were diagnosed with LDH in direct care versus purchased care. Among beneficiaries who were diagnosed in direct care and had surgery, multivariable logistic regression models were used to identify characteristics associated with surgery location.
We identified 726,638 MHS beneficiaries who were diagnosed with LDH in direct care or purchased care during the 9-year study period. One-year surgery rates were 10.1% in beneficiaries who were diagnosed in direct care versus 11.3% in beneficiaries who were diagnosed in purchased care. Among the 7467 patients who were diagnosed in direct care and had surgery within 1 year, characteristics associated with lower probability of surgery in purchased care versus direct care included diagnosing facility type (hospital with a neurosurgery or spine specialty versus clinic (odds ratio [OR], 0.12 (95% CI, 0.10-0.15)), Navy versus Army (OR, 0.24 (95% CI, 0.21-0.28)), and diagnosing facility specialty (Medical Expense and Performance Reporting System) (surgical care (OR, 0.33 (95% CI, 0.27-0.40)) and orthopedic care (OR, 0.39 (95% CI, 0.33-0.46)) versus primary care. The presence of comorbidities was associated with higher probability of surgery in purchased care versus direct care (OR, 1.20 (95% CI, 1.06-1.36)).
The 1-year rate of surgery for LDH was modestly higher in beneficiaries who were diagnosed in purchased care versus direct care. Among patients who were diagnosed in direct care, several patient-level and facility-level characteristics were associated with receiving surgery in purchased care, suggesting potentially unexpected variation in care utilization across components of the MHS.
回顾性研究（证据水平 III）。
腰椎间盘突出症（LDH）是一种常见的肌肉骨骼疾病，与军事卫生系统（MHS）有很高的相关性，但尚未在直接护理和购买护理 MHS 组件之间对其手术护理模式进行描述或比较。本研究旨在描述直接护理和购买护理中诊断为 LDH 的 MHS 受助人的手术率，并评估与手术部位相关的特征。LDH 护理模式的差异可能表明中央管理的 MHS 中存在意外的变化。
我们描述了在直接护理和购买护理中诊断为 LDH 的受助人的 1 年手术率。在直接护理中诊断并接受手术的受助人中，使用多变量逻辑回归模型确定与手术部位相关的特征。
我们在 9 年的研究期间确定了 726638 名在直接护理或购买护理中诊断为 LDH 的 MHS 受助人。在直接护理中诊断为 LDH 的受助人中，1 年手术率为 10.1%，而在购买护理中诊断为 LDH 的受助人中，1 年手术率为 11.3%。在 7467 名在直接护理中诊断并在 1 年内接受手术的患者中，与购买护理相比，手术可能性较低的特征包括诊断机构类型（具有神经外科或脊柱专业的医院与诊所（比值比[OR]，0.12（95%CI，0.10-0.15）），海军与陆军（OR，0.24（95%CI，0.21-0.28）），和诊断机构的专业（医疗费用和绩效报告系统）（外科护理（OR，0.33（95%CI，0.27-0.40））和骨科护理（OR，0.39（95%CI，0.33-0.46））与初级保健。合并症的存在与购买护理中手术的可能性较高有关（OR，1.20（95%CI，1.06-1.36））。
与直接护理相比，在购买护理中诊断为 LDH 的受助人的 1 年手术率略高。在直接护理中诊断的患者中，一些患者水平和机构水平的特征与在购买护理中接受手术有关，这表明 MHS 各组成部分之间的护理利用可能存在潜在的意外差异。
