Clinical Outcomes of Orthopedic Surgery Co-Management by Internal Medicine Advanced Practice Clinicians: A Cohort Study.

Autor:	Johnson SA; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City. Electronic address: stacy.a.johnson@hsc.utah.edu., Whipple M; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City., Kendrick DR; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City., Gouttsoul A; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City., Eppich K; Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah School of Medicine, Salt Lake City., Wu C; Study Design and Biostatistics Center, Center for Clinical and Translational Science, University of Utah School of Medicine, Salt Lake City., Rupp AB; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City., Signor EA; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City., Reddy SP; Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2024 Nov; Vol. 137 (11), pp. 1097-1103.e3. Date of Electronic Publication: 2024 Jun 10.
DOI:	10.1016/j.amjmed.2024.05.034
Abstrakt:	Background: Comanagement of orthopedic surgery patients by internal medicine hospitalists is associated with improvements in clinical outcomes including complications, length of stay, and cost. Clinical outcomes of orthopedic comanagement performed solely by internal medicine advanced practice clinicians have not been reported. Our objecyive was to compare clinical outcomes between advanced practice clinician-based comanagement and usual orthopedic care. Methods: This is a retrospective cohort study in patients 18 years or older, hospitalized for orthopedic joint or spine surgery between May 1, 2014 and January 1, 2022. Outcomes assessed were length of stay, intensive care unit (ICU) transfer, return to operating room, in-hospital and 30-day mortality, 30-day readmission, and total direct cost, excluding surgical implants. Generalized boosted regression and propensity score weighting was used to compare clinical outcomes and health care cost between usual care and advanced practice clinician comanagement. Results: Advanced practice clinician comanagement was associated with a 5% reduction in mean length of stay (rate ratio = 0.95, P = .009), decreased odds of returning to the operating room (odds ratio [OR] 0.51, P = .002), and a significant reduction in 30-day mortality (OR 0.32, P = .037) compared with usual orthopedic care in a weighted analysis. Need for ICU transfer was higher with advanced practice clinician comanagement (OR 1.54, P = .009), without significant differences in 30-day readmission or in-hospital mortality. Conclusions: We observed reductions in length of stay, health care costs, return to the operating room, and 30-day mortality with advanced practice clinician comanagement compared with usual orthopedic care. Our findings suggest that advanced practice clinician-based comanagement may represent a safe and cost-effective model for orthopedic comanagement. (Copyright © 2024. Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu