评估与膝关节和髋关节置换手术护理成本及结果相关的患者和外科医生特征：一项全国医疗保险队列研究。
Evaluating Patient and Surgeon Characteristics Associated with Care Cost and Outcomes for Knee and Hip Replacement Procedures: A National Medicare Cohort Study.
作者信息
Dun Chen, Rumalla Kranti C, Walsh Christi M, Escobar Carolina
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
出版信息
JB JS Open Access. 2024 Feb 20;9(1). doi: 10.2106/JBJS.OA.23.00088. eCollection 2024 Jan-Mar.
BACKGROUND
The role of physician credentialing has been widely considered in quality and outcome improvement studies. However, the association between surgeon characteristics and health-care costs remains unclear.
METHODS
Our objective was to determine the association of orthopaedic surgeon characteristics with health outcomes and costs, utilizing Medicare data. We used 100% Fee-for-Service Medicare data from 2015 to 2019 to identify all patients ≥65 years of age who underwent 2 common orthopaedic surgical procedures, total hip and knee replacement. After determining whether the patients had been readmitted after discharge from their initial admission for surgery, we computed 3 metrics of total medical expenditure: the costs of the initial surgery admission and 30-day and 180-day episode-based bundles of care. Hierarchical linear regression and logistic regression models were used to evaluate patient and surgeon characteristics associated with care costs and the likelihood of readmission.
RESULTS
We identified 2,269 surgeons who performed total knee replacements on 298,934 patients and 1,426 surgeons who performed total hip replacements on 204,721 patients. Patient characteristics associated with higher initial surgery costs included increasing age, female sex, racial minority status, and a higher Charlson Comorbidity Index. Surgeon characteristics associated with lower readmission rates included practice in the Northeast region and a higher patient volume; having malpractice claims was associated with higher readmission rates.
CONCLUSIONS
A higher volume of patients treated by the orthopaedic surgeon was associated with lower overall costs and readmission rates. Information on surgeons' malpractice claims and annual volume should be made publicly available to assist patients, payer networks, and hospitals in surgeon selection and oversight. These results could also inform the guidelines of physician credentialing organizations.
LEVEL OF EVIDENCE
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
医师资格认证的作用在质量和结果改善研究中已得到广泛探讨。然而，外科医生特征与医疗保健成本之间的关联仍不明确。
方法
我们的目标是利用医疗保险数据确定骨科医生特征与健康结果及成本之间的关联。我们使用了2015年至2019年100%的按服务收费医疗保险数据，以识别所有年龄≥65岁且接受过两种常见骨科手术（全髋关节置换和全膝关节置换）的患者。在确定患者在首次手术入院出院后是否再次入院后，我们计算了三项总医疗支出指标：首次手术入院成本以及基于30天和180天发作的护理套餐成本。采用分层线性回归和逻辑回归模型来评估与护理成本及再次入院可能性相关的患者和医生特征。
结果
我们识别出2269名对298934名患者进行全膝关节置换的外科医生以及1426名对204721名患者进行全髋关节置换的外科医生。与较高首次手术成本相关的患者特征包括年龄增长、女性、少数族裔身份以及较高的Charlson合并症指数。与较低再入院率相关的外科医生特征包括在东北地区执业以及较高的患者量；有医疗事故索赔与较高的再入院率相关。
结论
骨科医生治疗的患者量较大与较低的总体成本和再入院率相关。应公开外科医生的医疗事故索赔信息和年手术量，以协助患者、支付方网络和医院进行外科医生选择和监督。这些结果也可为医师资格认证组织的指南提供参考。
证据水平
预后水平III。有关证据水平的完整描述，请参阅作者指南。
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