与更常见的骨科运动手术相比，髋关节镜检查中选择非网络内外科医生的比例有所增加。
Increased rate of out-of-network surgeon selection for hip arthroscopy compared to more common orthopedic sports procedures.
作者信息
Rosenberg Ashley M, Tiao Justin, Kantrowitz David, Hoang Timothy, Wang Kevin C, Zubizarreta Nicole, Anthony Shawn G
机构信息
Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1188, New York, NY, 10029, United States.
Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1077, New York, NY, 10029, United States.
出版信息
J Orthop. 2023 Dec 7;50:92-98. doi: 10.1016/j.jor.2023.11.075. eCollection 2024 Apr.
BACKGROUND
Demand for hip arthroscopy (HA) has increased, but shortfalls in HA training may create disparities in care access. This analysis aimed to (1) compare out-of-network (OON) surgeon utilization for HA with that of more common orthopedics sports procedures, including rotator cuff repair (RCR), partial meniscectomy (PM), and anterior cruciate ligament reconstruction (ACLR), (2) compare the HA OON surgeon rate with another less commonly performed procedure, meniscus allograft transplant (MAT), and (3) analyze trends and predictors of OON surgeon utilization.
METHODS
The 2013-2017 IBM MarketScan database identified patients under 65 who underwent HA, RCR, PM, ACLR, or MAT. Demographic differences were determined using standardized differences. Cochran-Armitage tests analyzed trends in OON surgeon utilization. Multivariable logistic regression identified predictors of OON surgeon utilization. Statistical significance was set to p < 0.05 and significant standardized differences were >0.1.
RESULTS
410,487 patients were identified, of which 12,636 patients underwent HA, 87,607 RCR, 233,241 PM, 76,700 ACLR, and 303 MAT. OON surgeon utilization increased for HA, rising from 7.98 % in 2013 to 9.37 % in 2017 (p = 0.026). Compared to RCR, PM, and ACLR, HA was associated with higher likelihood of OON surgeon utilization. Usage of ambulatory surgery centers (ASCs) was predictive of higher OON surgeon rates along with procedure year, insurance plan type, and geographic region. HA performed in an ASC was 13 % less likely to have an OON surgeon (p = 0.047).
CONCLUSION
OON surgeon utilization generally declined but increased for HA. HA was a predictor of OON surgeon status, possibly because HA is a technically complicated procedure with fewer trained in-network providers. Other predictors of OON surgeon status included ASC usage, PPO/EPO plan type, and Northeast geographic region. There is a need to improve access to experienced HA providers-perhaps with prioritization of HA training in residency and fellowship programs-in order to address rising OON surgeon utilization.
背景
髋关节镜检查（HA）的需求有所增加，但HA培训的不足可能导致医疗服务可及性的差异。本分析旨在：（1）比较HA的网络外（OON）外科医生利用率与其他更常见的骨科运动手术，包括肩袖修复（RCR）、半月板部分切除术（PM）和前交叉韧带重建（ACLR）；（2）将HA的OON外科医生比率与另一种较少进行的手术——半月板同种异体移植（MAT）进行比较；（3）分析OON外科医生利用率的趋势和预测因素。
方法
2013 - 2017年IBM MarketScan数据库确定了65岁以下接受HA、RCR、PM、ACLR或MAT的患者。使用标准化差异确定人口统计学差异。 Cochr an - Armitage检验分析OON外科医生利用率的趋势。多变量逻辑回归确定OON外科医生利用率的预测因素。统计学显著性设定为p < 0.05，显著标准化差异>0.1。
结果
共识别出410,487例患者，其中12,636例接受HA，87,607例接受RCR，233,241例接受PM，76,700例接受ACLR，303例接受MAT。HA的OON外科医生利用率有所增加，从2013年的7.98%升至2017年的9.37%（p = 0.026）。与RCR、PM和ACLR相比，HA与更高的OON外科医生利用率相关。门诊手术中心（ASC）的使用情况、手术年份、保险计划类型和地理区域是OON外科医生比率较高的预测因素。在ASC进行的HA手术中，OON外科医生的可能性降低了13%（p = 0.047）。
结论
OON外科医生的总体利用率下降，但HA的利用率上升。HA是OON外科医生状态的一个预测因素，可能是因为HA是一项技术复杂的手术，网络内经过培训的提供者较少。OON外科医生状态的其他预测因素包括ASC的使用情况、PPO/EPO计划类型和东北地区。有必要改善获得经验丰富的HA提供者的机会——或许可以在住院医师和专科培训项目中优先进行HA培训——以应对OON外科医生利用率的上升。
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