种族/民族差异对全膝关节置换术后物理治疗利用的影响。
Racial/Ethnic Disparities in Physical Therapy Utilization After Total Knee Arthroplasty.
机构信息
From the Department of Orthopedics & Rehabilitation, Yale School of Medicine, New Haven, CT.
出版信息
J Am Acad Orthop Surg. 2023 Apr 1;31(7):357-363. doi: 10.5435/JAAOS-D-22-00733. Epub 2023 Jan 27.
BACKGROUND
Total knee arthroplasty (TKA) is a common orthopaedic procedure, after which many patients benefit from physical therapy (PT). However, such services may not be uniformly accessible and used. To that end, disparities in access to care such as PT after interventions may be a factor for those of varying race/ethnicities.
METHODS
TKAs were abstracted from the 2014 to 2016 Standard Analytic Files PearlDiver data set-a large national health administrative data set containing information on more than 60 million Medicare patients. Occurrences of home or outpatient PT within 90 days after TKA were identified. Patient demographic factors were extracted, including age, sex, Elixhauser Comorbidity Index, estimated average household income of patient based on zip code (low average household income [<75k/year] or high average household income [>75k/year]), and patient race/ethnicity (White, Hispanic, Asian, Native American, Black, or Other). Predictive factors for PT utilization were determined and compared with univariate and multivariate analyses.
RESULTS
Of 23,953 TKA patients identified, PT within 90 days after TKA was used by 18,837 (78.8%). Patients self-identified as White (21,824 [91.1%]), Black (1,250 [5.2%]), Hispanic (268 [1.1%]), Asian (241 [1.0%]), Native American (90 [0.4%]), or "Other" (280 [1.2%]) and were of low household income (19,957 [83.3%]) or high household income (3,994 [16.7%]). When controlling for age, sex, and ECI, PT was less likely to be received by those of low household income (relative to high household income OR 0.79) or by those of defined race/ethnicity (relative to White or Black OR 0.81, Native American OR 0.58, Asian OR 0.50, or Hispanic OR 0.44) ( P < 0.05 for each).
DISCUSSION
In a large Medicare data set, disparities in utilization of PT after TKA were identified based on patient's estimated household income and race/ethnicity. Identification of such factors may help facilitate the expansion of care to meet the needs of all groups adequately.
LEVEL OF EVIDENCE
Level III.
背景
全膝关节置换术（TKA）是一种常见的矫形手术，许多患者在术后受益于物理治疗（PT）。然而，这些服务可能无法普遍获得和使用。为此，接受治疗的患者在获得治疗方面可能存在差异，例如手术后接受 PT 的机会，这可能是不同种族/族裔的一个因素。
方法
从 2014 年至 2016 年的标准分析文件 PearlDiver 数据集中提取 TKA 信息-这是一个大型的国家健康管理数据集，包含超过 6000 万 Medicare 患者的信息。确定 TKA 后 90 天内是否在家中或门诊进行 PT。提取患者人口统计学因素，包括年龄、性别、Elixhauser 合并症指数、基于邮政编码的患者家庭平均收入（低家庭平均收入[<75k/年]或高家庭平均收入[>75k/年]）和患者种族/族裔（白种人、西班牙裔、亚洲人、美洲原住民、黑人和其他）。确定 PT 利用的预测因素，并通过单变量和多变量分析进行比较。
结果
在确定的 23953 例 TKA 患者中，有 18837 例（78.8%）在 TKA 后 90 天内接受了 PT。患者自我认定为白人（21824 例[91.1%]）、黑人（1250 例[5.2%]）、西班牙裔（268 例[1.1%]）、亚洲人（241 例[1.0%]）、美洲原住民（90 例[0.4%]）或“其他”（280 例[1.2%]），家庭收入较低（19957 例[83.3%]）或家庭收入较高（3994 例[16.7%]）。在控制年龄、性别和 ECI 后，家庭收入较低（相对于高家庭收入 OR 0.79）或特定种族/族裔（相对于白人或黑人 OR 0.81、美洲原住民 OR 0.58、亚洲人 OR 0.50、西班牙裔 OR 0.44）的患者不太可能接受 PT（每项 P<0.05）。
讨论
在大型 Medicare 数据集中，根据患者估计的家庭收入和种族/族裔，确定了 TKA 后接受 PT 利用方面的差异。确定这些因素可能有助于促进扩大护理范围，以充分满足所有群体的需求。
证据水平
三级。
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