Das Rishub K, Bittles Olivia, Thayer Wesley P, Drolet Brian C
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.
Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN.
J Hand Surg Am. 2025 Jan;50(1):27-33. doi: 10.1016/j.jhsa.2024.08.015. Epub 2024 Sep 30.
This study evaluated the prevalence, characteristics, and reimbursement of advanced practice providers, including nurse practitioners and physician assistants, who provide care related to the diagnosis and treatment of diseases and conditions of the hand, wrist, and upper extremities in the United States from 2013 to 2021.
Our analysis was a retrospective cohort study evaluating the diagnostic, procedural, and therapeutic services provided by advanced practice providers from 2013 to 2021 using the Medicare Provider Utilization and Payment Data Public Use Files from the Centers for Medicare and Medicare Services. The reported provider type and billing codes were used to identify health care professionals providing upper-extremity care such as ordering radiographs, applying casts and splints, and performing procedures on the hand, wrist, or other anatomic regions of the upper extremity. Trends over the study period and available data about services provided were analyzed.
From 2013 to 2021, providers of upper-extremity care included 19,525 (64.7%) doctor of medicine or doctor of osteopathic medicine upper-extremity surgeons, 7,612 (25.2%) physician assistants, and 3,042 (10.1%) nurse practitioners. The nonsurgeon providers were more likely to be women and provide care in micropolitan areas with less than 50,000 people compared with upper-extremity surgeons. Overall, the number of advanced practice providers who billed for upper-extremity care increased by 170.9% from 1,965 in 2013 to 5,324 in 2021. Based on these trends, the growth of APPs providing upper-extremity care is expected to continue.
There is a growing prevalence of advanced practice providers in upper-extremity care, and this trend is expected to continue.
With a growing need for upper-extremity care and predicted shortages in the surgeon workforce, the scope of practice and integration of advanced practice providers merits further discussion and evaluation.
本研究评估了2013年至2021年在美国提供与手部、腕部和上肢疾病及病症诊断和治疗相关护理的高级实践提供者（包括执业护士和医师助理）的患病率、特征及报销情况。
我们的分析是一项回顾性队列研究，使用医疗保险和医疗补助服务中心的医疗保险提供者利用和支付数据公共使用文件，评估2013年至2021年高级实践提供者提供的诊断、程序和治疗服务。报告的提供者类型和计费代码用于识别提供上肢护理的医疗保健专业人员，如开具X光片、应用石膏和夹板，以及对手部、腕部或上肢其他解剖区域进行手术。分析了研究期间的趋势以及所提供服务的可用数据。
2013年至2021年，上肢护理提供者包括19525名（64.7%）医学博士或骨病医学博士上肢外科医生、7612名（25.2%）医师助理和3042名（10.1%）执业护士。与上肢外科医生相比，非外科提供者更可能为女性，且在人口少于5万的微型都市地区提供护理。总体而言，开具上肢护理账单的高级实践提供者数量从2013年的1965人增加到2021年的5324人，增长了170.9%。基于这些趋势，预计提供上肢护理的高级实践提供者数量将继续增长。
高级实践提供者在上肢护理中的患病率不断上升，且这一趋势预计将持续。
随着上肢护理需求的不断增加以及预计外科医生劳动力短缺，高级实践提供者的执业范围和整合值得进一步讨论和评估。
