Radiographs and Corticosteroid Injections at a New Patient Visit for Care of Carpal Tunnel Syndrome and Ulnar Neuropathy at the Elbow.

Autor: Kortlever JTP; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States., Dekker AB; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States., Ring D; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States., Vagner GA; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States., Reichel LM; Department of Surgery and Perioperative Care, Dell Medical School-The University of Texas at Austin, Austin, Texas, United States., Schuurman AH; Department of Plastic Surgery and Hand Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, The Netherlands., Coert JH; Department of Plastic Surgery and Hand Surgery, University Medical Center Utrecht-Utrecht University, Utrecht, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of hand and microsurgery [J Hand Microsurg] 2020 Oct 29; Vol. 14 (2), pp. 170-176. Date of Electronic Publication: 2020 Oct 29 (Print Publication: 2022).
DOI: 10.1055/s-0040-1718968
Abstrakt: Introduction  The benefit of radiographs or steroid injection for idiopathic carpal tunnel syndrome (CTS) or ulnar neuropathy at the elbow (UNE) is open to debate. We assessed: (1) Radiographs ordered and injections performed at a new patient visit for patients presenting with either idiopathic CTS or UNE; (2) The estimated payment reduction if we omit these interventions; and (3) Patient age, sex, geographic region, and work status associated with radiographs or injections at a new patient visit for patients presenting with either idiopathic CTS or UNE. Materials and Methods  Using a large database of commercial insurance claims, we identified patients with a new visit for either CTS ( N = 9,522), UNE ( N = 2,507), or both ( N = 962; 8.7%). We identified injections and radiographs, and estimated total payments for these interventions. We created three multivariable logistic regression models for each diagnosis to identify factors associated with the interventions. Results  Nearly one third of patients had radiographs at a new patient visit (30% and 32% for idiopathic CTS and UNE, respectively). Nearly 10% of patients with CTS and 2.6% with UNE received an injection. Both radiographs and injections representing annual minimum payments of over $345,000 and $294,000, respectively. Among people with CTS, radiographs were independently more common in the South and less common in the West. Injection for CTS was associated with younger age; North, Central, and South regions; and retired employment status. For people with UNE, radiographs were independently associated with younger age; South or West region; and retired or working employment status. Injection for UNE was associated with retired employment status. Conclusion  The prevalence of radiographs and injections suggests opportunities for savings, which might benefit clinicians with bundled or capitated payments and patients with large copayments or deductibles. The observed variation may reflect debate about whether these interventions are worthwhile. Level of Evidence  Diagnostic; Retrospective Database Level III study.
Competing Interests: Conflict of Interest D.R. has or may receive payment or benefits from Skeletal Dynamics, Wright Medical for elbow implants, Deputy Editor for Clinical Orthopaedics and Related Research, Universities and Hospitals, Lawyers outside the submitted work. All other authors report no conflict of interest. Note This study was performed at The Dell Medical School–The University of Texas. Ethical Approval This study was exempt from approval of the Institutional Review Board of the University of Texas at Austin. This study has been performed in accordance with the ethical standards in the 1964 Declaration of Helsinki. This study has been performed in accordance with relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA).
(Society of Indian Hand Surgery & Microsurgeons. All rights reserved.)
Databáze: MEDLINE
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