PDF(Pubmed)
Abstract：
UNASSIGNED: Differences in the utilization of carpal tunnel release (CTR) by Blacks and women are well documented, but less is known regarding the impact of patient-provider concordance on treatment recommendations. To investigate this, we surveyed hand surgeons using hypothetical scenarios to evaluate variations in treatment recommendations for carpal tunnel syndrome based on patient-related factors and patient-provider concordance.
UNASSIGNED: Three pairs (six total) of hypothetical scenarios with clinical symptoms of carpal tunnel syndrome were created varying sex, race, and occupation. We used names as a proxy for sex and race. Occupation included manual laborers, secretaries, athletes, and retirees. American Society for Surgery of the Hand members were emailed an anonymous web-based link to participate. We used descriptive statistics to analyze the scenario-based treatment recommendations.
UNASSIGNED: We identified 3,067 eligible members for participation; 770 surgeons responded (25%) and provided recommendations for 3,742 scenarios. For scenarios involving symptomatic patients without electrodiagnostic studies (EDS), with normal EDS, and with abnormal EDS, no difference was noted in surgeon treatment recommendations based on patients\' race, sex, and occupation. Surgeons recommended EDS for 31% and 32.8% of the scenarios with Black female and White male patients, respectively, who did not have EDS at presentation and CTR for 32.3% and 33% of White females and Black males with normal EDS, respectively. Among retired Black female and White male patients older than 80 years of age with abnormal EDS, surgeons recommended CTR in 89.9% and 89.3% of them, respectively. For patient-provider racially concordant pairs, White surgeons recommended CTR to a similar proportion of Black and White hypothetical patients; however, Black surgeons recommended CTR to a greater proportion of patients with Black-sounding names.
UNASSIGNED: We found that surgeon treatment recommendation was not associated with patient race, sex, or occupation; however, differences did emerge based on patient-provider racial concordance, suggesting that alignment of patient and provider identities may influence treatment recommendations.
UNASSIGNED: Prognostic III.
UNASSIGNED: Three pairs (six total) of hypothetical scenarios with clinical symptoms of carpal tunnel syndrome were created varying sex, race, and occupation. We used names as a proxy for sex and race. Occupation included manual laborers, secretaries, athletes, and retirees. American Society for Surgery of the Hand members were emailed an anonymous web-based link to participate. We used descriptive statistics to analyze the scenario-based treatment recommendations.
UNASSIGNED: We identified 3,067 eligible members for participation; 770 surgeons responded (25%) and provided recommendations for 3,742 scenarios. For scenarios involving symptomatic patients without electrodiagnostic studies (EDS), with normal EDS, and with abnormal EDS, no difference was noted in surgeon treatment recommendations based on patients\' race, sex, and occupation. Surgeons recommended EDS for 31% and 32.8% of the scenarios with Black female and White male patients, respectively, who did not have EDS at presentation and CTR for 32.3% and 33% of White females and Black males with normal EDS, respectively. Among retired Black female and White male patients older than 80 years of age with abnormal EDS, surgeons recommended CTR in 89.9% and 89.3% of them, respectively. For patient-provider racially concordant pairs, White surgeons recommended CTR to a similar proportion of Black and White hypothetical patients; however, Black surgeons recommended CTR to a greater proportion of patients with Black-sounding names.
UNASSIGNED: We found that surgeon treatment recommendation was not associated with patient race, sex, or occupation; however, differences did emerge based on patient-provider racial concordance, suggesting that alignment of patient and provider identities may influence treatment recommendations.
UNASSIGNED: Prognostic III.
摘要：
■黑人和女性使用腕管松解术（CTR）的差异有据可查，但关于患者-提供者一致性对治疗建议的影响知之甚少.为了调查这一点，我们使用假设情景调查了手外科医师,以评估基于患者相关因素和患者-提供者一致性的腕管综合征治疗建议的差异.
■3对（共6种）具有腕管综合征临床症状的假设情景被创建为不同性别，种族,和职业。我们用名字来代表性别和种族。职业包括体力劳动者，秘书,运动员,退休人员。美国手外科协会成员通过电子邮件发送了一个匿名的基于网络的链接来参与。我们使用描述性统计来分析基于情景的治疗建议。
■我们确定了3,067名符合条件的参与成员；770名外科医生（25％）做出了回应，并为3,742种情况提供了建议。对于没有电诊断研究（EDS）的症状患者，正常EDS,和异常的EDS，根据患者种族，外科医生的治疗建议没有差异，性别,和职业。在黑人女性和白人男性患者的情况下，外科医生推荐了31％和32.8％的EDS，分别,在EDS正常的白人女性和黑人男性中，有32.3％和33％的CTR没有EDS，分别。在80岁以上的退休黑人女性和白人男性患者中，EDS异常，其中89.9%和89.3%的外科医生推荐CTR，分别。对于患者提供者种族一致的配对，白人外科医生向相似比例的黑人和白人假设患者推荐CTR；然而，黑人外科医生向更大比例的黑人名字患者推荐CTR。
■我们发现外科医生的治疗建议与患者种族无关，性别,或职业；然而，基于患者与提供者的种族一致性，确实出现了差异，提示患者和提供者身份的一致性可能会影响治疗建议.
■预后III.
■3对（共6种）具有腕管综合征临床症状的假设情景被创建为不同性别，种族,和职业。我们用名字来代表性别和种族。职业包括体力劳动者，秘书,运动员,退休人员。美国手外科协会成员通过电子邮件发送了一个匿名的基于网络的链接来参与。我们使用描述性统计来分析基于情景的治疗建议。
■我们确定了3,067名符合条件的参与成员；770名外科医生（25％）做出了回应，并为3,742种情况提供了建议。对于没有电诊断研究（EDS）的症状患者，正常EDS,和异常的EDS，根据患者种族，外科医生的治疗建议没有差异，性别,和职业。在黑人女性和白人男性患者的情况下，外科医生推荐了31％和32.8％的EDS，分别,在EDS正常的白人女性和黑人男性中，有32.3％和33％的CTR没有EDS，分别。在80岁以上的退休黑人女性和白人男性患者中，EDS异常，其中89.9%和89.3%的外科医生推荐CTR，分别。对于患者提供者种族一致的配对，白人外科医生向相似比例的黑人和白人假设患者推荐CTR；然而，黑人外科医生向更大比例的黑人名字患者推荐CTR。
■我们发现外科医生的治疗建议与患者种族无关，性别,或职业；然而，基于患者与提供者的种族一致性，确实出现了差异，提示患者和提供者身份的一致性可能会影响治疗建议.
■预后III.
