膝关节全置换后的社会风险和患者报告的结果:对医疗保险政策的影响
Elizabeth C Danielson1, Wenjun Li2, Linda Suleiman3
1Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Health services research
|August 22, 2023
概括
患者层面的社会因素,如种族和收入,会影响膝关节整体置换的结果. 县级社会脆弱性没有显示出相关性,这表明重点关注健康公平的个体患者因素.
科学领域:
- 整形外科手术 整形外科手术
- 医疗保健服务研究 医疗服务研究
- 健康的社会决定因素
背景情况:
- 患者报告的结果 (PROs) 对于评估全膝关节置换 (TKR) 成功至关重要.
- 风险调整模型传统上侧重于临床因素,可能忽视社会决定因素.
- 了解社会风险因素对TKR结果的影响对于健康公平至关重要.
研究的目的:
- 评估县级和患者级的社会风险因素与TKR后的PRO之间的关联.
- 为了确定社会因素是否改善现有的TKR结果的风险调整模型.
主要方法:
- 对接受选择性单边TKR的成年患者进行前性纵向队列研究.
- 数据来自功能和结果研究的整体关节置换队列和社会脆弱性指数的相对有效性的数据合并.
- 对临床和人口统计因素进行调整的分析,在手术后12个月测量疼痛和功能变化.
主要成果:
- 包括种族,教育和收入在内的患者层面的因素与PROs有显著的关联.
- 黑人种族和较低收入与较差的疼痛和功能改善有关.
- 高等教育与功能改善较少相关,而家庭规模显示出不同的影响.
结论:
- 患者层面的社会因素,而不是县级的社会脆弱性,与TKR PROs有关.
- 这些发现强调了解决个人社会决定因素的重要性,以提高TKR结果中的健康公平性.
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