Factors Driving Physician-Hospital Alignment in Orthopaedic Surgery

Background

The relationships between physicians and hospitals are viewed as central to the proposition of delivering high-quality health care at a sustainable cost. Over the last two decades, major changes in the scope, breadth, and complexities of these relationships have emerged. Despite understanding the need for physician-hospital alignment, identification and understanding the incentives and drivers of alignment prove challenging.

Questions/purposes

Our review identifies the primary drivers of physician alignment with hospitals from both the physician and hospital perspectives. Further, we assess the drivers more specific to motivating orthopaedic surgeons to align with hospitals.

Methods

We performed a comprehensive literature review from 1992 to March 2012 to evaluate published studies and opinions on the issues surrounding physician-hospital alignment. Literature searches were performed in both MEDLINE^® and Health Business™ Elite.

Results

Available literature identifies economic and regulatory shifts in health care and cultural factors as primary drivers of physician-hospital alignment. Specific to orthopaedics, factors driving alignment include the profitability of orthopaedic service lines, the expense of implants, and issues surrounding ambulatory surgery centers and other ancillary services.

Conclusions

Evolving healthcare delivery and payment reforms promote increased collaboration between physicians and hospitals. While economic incentives and increasing regulatory demands provide the strongest drivers, cultural changes including physician leadership and changing expectations of work-life balance must be considered when pursuing successful alignment models. Physicians and hospitals view each other as critical to achieving lower-cost, higher-quality health care.     

骨科患者健康教育的有效性调查分析

目的了解骨科患者对健康教育的掌握情况。方法采用自行设计的问卷对1250例骨科患者进行健康教育有效性及健康教育满意度调查。结果健康知识及健康技能完全掌握者分别为250例（20．0％）和500例（40．0％）；患者对健康教育的满意率15．0％～34．0％。结论骨科患者对健康教育有效性及对健康教育满意度较低，医护人员需寻求适合骨科患者的健康教育路径，以提高健康教育效果。     

骨科患者健康教育的有效性调查分析

目的 了解骨科患者对健康教育的掌握情况.方法 采用自行设计的问卷对1 250例骨科患者进行健康教育有效性及健康教育满意度调查.结果 健康知识及健康技能完全掌握者分别为250例(20.0%)和500例(40.0%);患者对健康教育的满意率15.0%～34.0%.结论 骨科患者对健康教育有效性及对健康教育满意度较低,医护人员需寻求适合骨科患者的健康教育路径,以提高健康教育效果.     

Contingent Valuation Studies in Orthopaedic Surgery: A Health Economic Review

Background

A greater emphasis on providing high-value orthopaedic interventions has resulted in increased health economic reporting. The contingent-valuation method (CVM) is used to determine consumer valuation of the benefits provided by healthcare interventions. CVM is an important value-based health economic tool that is underutilized in orthopaedic surgery.

Questions/Purposes

The purpose of this study was to (1) identify previously published CVM studies in the orthopaedic literature, (2) assess the methodologies used for CVM research, and (3) understand how CVM has been used in the orthopaedic cost–benefit analysis framework.

Methods

A systematic review of the literature using the MEDLINE database was performed to compile CVM studies. Search terms incorporated the phrase willingness to pay (WTP) or willingness to accept (WTA) in combination with orthopaedic clinical key terms. Study methodology was appraised using previously defined empirical and conceptual criteria for CVM studies.

Results

Of the 160 studies retrieved, 22 (13.8%) met our inclusion criteria. The economics of joint arthroplasty (n?=?6, 27.3%) and non-operative osteoarthritis care (n?=?4, 18.2%) were the most common topics. Most studies used CVM for pricing and/or demand forecasting (n?=?16, 72.7%); very few studies used CVM for program evaluation (n?=?6). WTP was used in all included studies, and one study used both WTP and WTA. Otherwise, there was little consistency among included studies in terms of CVM methodology. Open-ended questioning was used by only ten studies (45.5%), a significant number of studies did not perform a sensitivity analysis (n?=?9, 40.9%), and none of the studies accounted for the risk preference of subjects. Only two of the included studies applied CVM within a cost–benefit analysis framework.

Conclusion

CVM is not commonly reported in orthopaedic surgery and is seldom used in the context of cost–benefit analysis. There is wide variability in the methods used to perform CVM. We propose that CVM is an appropriate and underappreciated method for understanding the value of orthopaedic interventions. Increased attention should be paid to consumer valuations for orthopaedic interventions.

     

Podium versus poster publication rates at the Orthopaedic Trauma Association

Original studies at orthopaedic meetings are presented on the podium and in poster format. Publication of those studies in peer-reviewed journals is the standard of communicating scientific data to colleagues. Investigators of previous studies have reported publication rates, but never differentiated between the modes of presentation. We evaluated the annual meeting of the Orthopaedic Trauma Association from 1994-1998 and found that studies presented on the podium were 1.3 times more likely to be published than those presented in a poster format (67% versus 52%). The mean time to publication was similar, 21.6 months for poster presentations and 24.8 months for podium presentations. Podium presentations were more likely to be published in the Journal of Orthopaedic Trauma, Clinical Orthopaedics and Related Research, and the Journal of Bone and Joint Surgery (American and British editions). Our findings suggest different rates and distribution of publication between podium and poster presentations at an international trauma meeting. These findings should be considered when evaluating studies of interest at the Orthopaedic Trauma Association meeting.     

Global Musculoskeletal Health: Inaugural Meeting of the International Society of Orthopaedic Centers

The International Society of Orthopaedic Centers (ISOC) was founded in 2006 to function as a think tank for leading international orthopaedic academic centers. ISOC’s mission is to facilitate the exchange of ideas and cutting edge practices among these centers and to work together on patient care, education, and research in order to make global improvements in orthopaedic care. The inaugural meeting, hosted by Hospital for Special Surgery on May 17–19, 2007, is described here.     

Orthopaedic recertification

This report summarizes a symposium presented at the 2001 Annual Meeting of the American Orthopaedic Association that was designed to assess the current status of recertification by the American Board of Orthopaedic Surgery (ABOS) and to determine how it will change in the near future. Recertification is a process whereby the general public is assured of quality medical care by a competent and knowledgeable physician. As a professional organization, we have an obligation to provide quality care. The nature of the public demand for standards ensuring competence and the history of recertification in orthopaedic surgery are examined. The recertification of commercial airline pilots is reviewed, as it provides a model of an unrelated but highly skilled profession requiring intellectual and technical proficiency. The goals and plans of the American Board of Medical Specialties (ABMS), which encompasses the views of all twenty-four major specialty boards including orthopaedic surgery, are reviewed. Finally, the future plans of the ABOS for recertification are considered.     

Publication rate of Trauma abstracts presented at an International Orthopaedic conference

INTRODUCTION: Oral presentations at major conferences are often used to present new material and generate discussion. However, conference abstracts that ultimately fail to be published are of little use to the wider medical community. The aim of this study was to evaluate the publication rate of trauma papers presented at an international orthopaedic conference, and to assess the factors which predict publication. METHODS: All abstracts presented orally at the trauma sessions of the European Federation of National Associations of Orthopaedics and Traumatology (EFORT) Congresses in 1999 (Belgium) and 2001 (Greece) were assessed. A MEDLINE and EMBASE search was performed to identify articles written by the first, second and last authors of each abstract to identify a matching journal article. Subspecialty, country of origin of abstract, study type, journal of publication and publication year were tabulated. RESULTS: Two hundred and seventy eight trauma abstracts were presented orally, and 112 (40.3%) achieved subsequent publication. Abstracts on fractures of the proximal femur were the most common (18.7%) and had one of the highest rates of publication (44.2%). Greece and the UK provided the largest number of abstracts, and randomised trials were the study type with the highest rate of publication (80.0%). Thirty two percent of journal articles appeared within 1 year of the conference and 63% within 2 years. Injury was the journal most likely to publish the articles. CONCLUSION: About 60% of Trauma abstracts presented did not result in a subsequent full-text publication. The citation of conference proceedings should be discouraged, and clinicians should be wary of implementing information gleaned from conference presentations into their clinical practice.