手术前患者报告的结果测量值不应用于指示全膝关节关节整形手术
Ryan M Sutton1, Colin M Baker1, Taylor D'Amore1
1Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
The Journal of arthroplasty
|June 21, 2023
概括
商业保险公司越来越多地使用手术前患者报告的结果测量 (PROM) 来确定全膝关节整形术 (TKA) 的资格. 虽然设置PROM值可以优化结果,但它可能会为可以从TKA中受益的患者创建访问障碍.
科学领域:
- 整形外科手术研究结果研究结果
- 医疗服务研究 医疗服务研究
- 患者报告的结果措施 (PROMs)
背景情况:
- 医疗保险要求质量计划的PROM.
- 商业保险公司现在正在使用手术前的PROM来确定全膝关节整形术 (TKA) 的资格.
- 有关基于PROM分数的潜在TKA拒绝存在担忧,最佳值未知.
研究的目的:
- 根据理论的手术前PROM得分值,评估全膝关节整形术 (TKA) 的结果.
- 评估不同PROM分数截止值对患者改善和获得护理的影响.
主要方法:
- 对25246名初级TKA患者 (2016-2019年) 的回顾性分析.
- 评估假设的手术前膝关节损伤和骨关节炎结局评分为关节置换 (KOOS,JR) 的切断点 (40, 50, 60, 70).
- 在"批准"和"拒绝"手术组之间比较住院并发症,90天再入院,出院处置和1年的最低临床重要差异 (MCID) 成绩.
主要成果:
- 大多数患者在所有测试的PROM值中实现了MCID.
- 经过批准的患者表现出更高的MCID成就率 (P < .001),但也显示出更高的非家庭出院率,为40号,50号和60号值.
- 在批准和拒绝的组之间,住院并发症和90天再入院率相似.
结论:
- 设置TKA资格的术前PROM门可以优化患者的改善.
- 这种政策可能会无意中为那些否则会从TKA中受益的患者创建获得护理障碍.
- 大多数患者在不考虑PROM值的情况下都取得了显著改善,这表明需要仔细考虑符合条件的标准.
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