Van Boxtel Matthew E, Jauregui Isaias, Valiquette Andrew, Sullivan Connor, Graf Alexander, Hanley Jessica
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI.
J Hand Surg Glob Online. 2024 Feb 23;6(3):333-337. doi: 10.1016/j.jhsg.2024.01.011. eCollection 2024 May.
Social determinants of health disparities have been shown to adversely impact outcomes following distal radius fracture (DRF) treatment. Identifying risk factors for increased hospital use following DRF has been historically difficult; however, it is of utmost concern to orthopedic surgeons to improve outcomes and decrease the total cost of care. The effect of social deprivation following DRF has yet to be fully investigated.
This is a retrospective cohort analysis of a single institution's experience in treating DRF with either an operative or nonsurgical modality between 2005 and 2020. Patient demographic information and health care utilization (hospital readmission, emergency department [ED] visitation, office visits, and telephone use) were collected from within 90 days of treatment. Area Deprivation Index (ADI) national percentiles were recorded. Patients were stratified into terciles based on their relative level of deprivation, and their outcomes were compared. Secondary analyses included stratifying patients based on treatment modality, race, and legal sex.
In total, 2,149 patients were included. The least, intermediate, and most deprived groups consisted of 552, 1,067, and 530 patients, respectively. Risk factors for hospital readmission included higher levels of relative deprivation. Identifying as Black or African American and nonsurgical management were risk factors for increased ED visitation. No differences in rate of hospital readmission, ED visitation, office visitation, or telephone use were seen based on deprivation level.
High levels of social deprivation, treatment modality, race, and legal sex disparities may influence the amount of hospital resource utilization following DRF treatment. Understanding and identifying risk factors for greater resource utilization can help to mitigate inappropriate use and decrease health care costs. We hope to use these findings to guide clinical decision making, educate patient populations, and optimize outcomes following DRF treatment.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
健康差异的社会决定因素已被证明会对桡骨远端骨折(DRF)治疗后的结果产生不利影响。从历史上看,确定DRF后住院使用率增加的风险因素一直很困难;然而,骨科医生最关心的是改善治疗结果并降低护理总成本。DRF后社会剥夺的影响尚未得到充分研究。
这是一项回顾性队列分析,分析了单一机构在2005年至2020年间采用手术或非手术方式治疗DRF的经验。在治疗后90天内收集患者的人口统计学信息和医疗保健利用率(医院再入院、急诊科就诊、门诊就诊和电话使用情况)。记录地区剥夺指数(ADI)全国百分位数。根据患者相对剥夺水平将其分为三分位数,并比较他们的治疗结果。二次分析包括根据治疗方式、种族和法定性别对患者进行分层。
总共纳入了2149名患者。最贫困、中等贫困和最贫困组分别包括552名、1067名和530名患者。医院再入院的风险因素包括相对剥夺程度较高。被认定为黑人或非裔美国人以及非手术治疗是急诊科就诊增加的风险因素。根据剥夺水平,在医院再入院率、急诊科就诊率、门诊就诊率或电话使用率方面未发现差异。
高度的社会剥夺、治疗方式、种族和法定性别差异可能会影响DRF治疗后医院资源的利用量。了解和识别更高资源利用率的风险因素有助于减少不当使用并降低医疗保健成本。我们希望利用这些发现来指导临床决策、教育患者群体并优化DRF治疗后的结果。
研究类型/证据水平:治疗性III级。