PDF(Sci-hub)
Abstract：
The utilization of locum tenens physicians in the United States has risen significantly as a stopgap for clinical practice needs, particularly in rural and other underserved areas. The difficulty in hiring new physicians to remote hospitals has resulted in the dependence of these institutions on locum tenens coverage. Here, we assess the quality and cost of neurosurgical care between locum and non-locum neurosurgeons in the United States, the first study in our knowledge to do so.
A 5% random sample of the Medicare claims limited data set was queried for 2005-2011 for neurosurgical cases using International Classification of Diseases, Clinical Modification, 9th edition (ICD-9-CM) procedure codes for common cranial and spine procedures. Cases were divided into locum and non-locum groups using ICD modifier Q6. The association between locum care and 30-day surgical complications, disposition, and cost of care was evaluated.
A total of 112,397 patients met inclusion criteria, with locum tenens practitioners involved in 164 (0.15%) cases. Locum and non-locum cohorts were statistically and clinically similar at baseline, with respect to comorbidity and case type. Mortality (0.00% vs. 0.19%; P=0.739), discharge disposition (P=0.739), surgical complication rates, and length of stay (8.74 ± 12.24 vs. 10.54 ± 15.51 days; P = 0.117) did not appear to differ significantly between the 2 groups. Hospitalization costs were also similar (158,780.20 ± 223,735.50 vs. 168,104.40 ± 308,074.90 USD; P = 0.698), as were amounts paid by patients (39,197.70 ± 14,144.75 vs. 39,234.36 ± 15,467.63 USD, P = 0.976).
Among Medicare beneficiaries, there exists no difference in short-term complication rates, lengths of hospitalization, or costs between locum and non-locum neurosurgeons.
A 5% random sample of the Medicare claims limited data set was queried for 2005-2011 for neurosurgical cases using International Classification of Diseases, Clinical Modification, 9th edition (ICD-9-CM) procedure codes for common cranial and spine procedures. Cases were divided into locum and non-locum groups using ICD modifier Q6. The association between locum care and 30-day surgical complications, disposition, and cost of care was evaluated.
A total of 112,397 patients met inclusion criteria, with locum tenens practitioners involved in 164 (0.15%) cases. Locum and non-locum cohorts were statistically and clinically similar at baseline, with respect to comorbidity and case type. Mortality (0.00% vs. 0.19%; P=0.739), discharge disposition (P=0.739), surgical complication rates, and length of stay (8.74 ± 12.24 vs. 10.54 ± 15.51 days; P = 0.117) did not appear to differ significantly between the 2 groups. Hospitalization costs were also similar (158,780.20 ± 223,735.50 vs. 168,104.40 ± 308,074.90 USD; P = 0.698), as were amounts paid by patients (39,197.70 ± 14,144.75 vs. 39,234.36 ± 15,467.63 USD, P = 0.976).
Among Medicare beneficiaries, there exists no difference in short-term complication rates, lengths of hospitalization, or costs between locum and non-locum neurosurgeons.
摘要：
在美国，作为临床实践需求的权宜之计，特别是在农村和其他服务不足的地区。在远程医院雇用新医生的困难导致这些机构依赖本地服务。这里,我们评估了美国本地和非本地神经外科医生之间的神经外科护理质量和成本，这是我们知识中的第一个研究。
2005-2011年，使用国际疾病分类对神经外科病例进行了5%的医疗保险索赔有限数据集的随机样本查询，临床改造,第9版（ICD-9-CM）普通头颅和脊柱手术的程序代码。使用ICD修饰符Q6将病例分为locum组和非locum组。局部护理和30天手术并发症之间的关联，处置,并对护理费用进行了评估。
共有112,397名患者符合纳入标准，与ocumtenens从业者涉及164例（0.15％）。基线时，基因座和非基因座队列在统计学和临床上相似，关于合并症和病例类型。死亡率（0.00%vs.0.19%；P=0.739），放电配置（P=0.739），手术并发症发生率，和住院时间（8.74±12.24vs.10.54±15.51天；P=0.117）在两组之间没有显着差异。住院费用也相似（158,780.20±223,735.50与168,104.40±308,074.90美元；P=0.698)，患者支付的金额(39,197.70±14,144.75vs.39,234.36±15,467.63美元，P=0.976)。
在医疗保险受益人中，短期并发症发生率没有差异，住院时间,或者局部和非局部神经外科医生之间的费用。
2005-2011年，使用国际疾病分类对神经外科病例进行了5%的医疗保险索赔有限数据集的随机样本查询，临床改造,第9版（ICD-9-CM）普通头颅和脊柱手术的程序代码。使用ICD修饰符Q6将病例分为locum组和非locum组。局部护理和30天手术并发症之间的关联，处置,并对护理费用进行了评估。
共有112,397名患者符合纳入标准，与ocumtenens从业者涉及164例（0.15％）。基线时，基因座和非基因座队列在统计学和临床上相似，关于合并症和病例类型。死亡率（0.00%vs.0.19%；P=0.739），放电配置（P=0.739），手术并发症发生率，和住院时间（8.74±12.24vs.10.54±15.51天；P=0.117）在两组之间没有显着差异。住院费用也相似（158,780.20±223,735.50与168,104.40±308,074.90美元；P=0.698)，患者支付的金额(39,197.70±14,144.75vs.39,234.36±15,467.63美元，P=0.976)。
在医疗保险受益人中，短期并发症发生率没有差异，住院时间,或者局部和非局部神经外科医生之间的费用。
