Primary Care Provider Density and Elective Total Joint Replacement Outcomes.

Arthroplasty Today

Nicholas Williams, MPH¹  Collin Brantner, BA²  Said Ibrahim, MD, MPH, MBA²  Linda A. Russell, MD²  Mark P. Figgie, MD²  Lisa A. Mandl, MD, MPH³  Iris Navarro-Millan, MD³  Joseph T. Nguyen, MPH⁴  Anne R. Bass, MD⁴  Jackie Szymonifka, MA⁴  Michael L. Parks, MD⁴  Susan M. Goodman, MD⁴  Bella Mehta, MBBS, MS⁴ 

[1] Corresponding author. 535 East 70th Street, New York, NY 10021, USA. Tel.: [phone].;Department of Medicine, Weill Cornell Medicine, New York, NY, USA;Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA;Department of Medicine, Hospital for Special Surgery, New York, NY, USA;

关键词: Total hip arthroplasty;    Total knee arthroplasty;    Primary care physicians;    Provider density;    WOMAC;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes. Methods: We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years. Using geocoding, we identified the number of PCPs in the patient’s census tract (communities). We used Augmented Inverse Probability Weighting and Cross-validated Targeted Minimum Loss-Based Estimation to compare provider density and outcomes adjusting for potential confounders. Results: Our sample included 3606 TKA and 4295 THA cases. The median number of PCPs in each community was similar for both procedures: TKA 2 (interquartile range 1, 6) and for THA 2 (interquartile range 1, 7). Baseline and 2-year follow-up WOMAC pain, function, and stiffness scores were not statistically significantly different comparing communities with more than median number of PCPs to those with less than median number of PCPs. In sensitivity analyses, adding 1 PCP to a community with zero PCPs would not have statistically significantly improved baseline or 2-year follow-up WOMAC pain, function, and stiffness scores. Conclusions: In this sample of patients who underwent elective TKA or THA for osteoarthritis, we found no statistically significant association between PCP density and pain, function, or stiffness outcomes at baseline or 2 years. Further studies should examine what other provider factors affect access and outcomes in THA and TKA.

【 授权许可】

Unknown