Associations Between Insurance Type and the Presentation of Cubital Tunnel Syndrome
Associations Between Insurance Type and the Presentation of Cubital Tunnel Syndrome
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DOI：
10.1016/j.jhsa.2019.07.011
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发表时间：
2020-01-01
影响因子：
1.9
通讯作者：
Rodner, Craig M.
中科院分区：
文献类型：
--
作者：
Cheng, Christopher;Rodner, Craig M.
在肘管综合征（CuTS）的情况下，诊断的延迟可能会造成永久性的影响，包括感觉丧失，肌肉无力和手部固有肌肉萎缩。本研究旨在评估保险类型与割伤严重程度的关系。我们假设，公共保险患者将延迟到骨科办公室和更显著的病情严重程度。方法回顾性分析2013年12月至2018年1月在我院三级转诊中心接受培训的骨科手部和上肢外科医生评估的所有切口患者。比较了保险类型、人口统计和cut严重程度的措施。结果严重程度大于或等于McGowan 2A期的患者获得公共保险的几率是私人保险的4.4倍。公共保险患者肘部运动和感觉速度分别为42.2 +/- 1390万/秒和33.0 +/- 2080万/秒，而私人保险患者为47.5 +/- 11.3 m/秒和47.0 +/- 1640万/秒。公共保险患者的运动和感觉振幅为6.6 +/- 3.8 mV和16.9 +/- 17.8 mV，而私人保险患者的运动和感觉振幅为8.5 +/- 3.2 mV和26.0 +/- 18.9 mV。公共保险患者在首次就诊前出现症状的时间更长，平均为82.8 +/- 86.5周，而私人保险患者为42.4 +/- 58.9周。结论公保患者就诊于骨科医生评估和治疗切口的时间明显延迟，且临床和电诊断表现较私保患者更为严重。这些发现表明，除其他社会经济因素外，保险类型可能是削减支出计划护理的障碍。美国手部外科学会版权所有。版权所有。
Purpose In the setting of cubital tunnel syndrome (CuTS), delays in diagnosis can have permanent effects including sensory loss, muscle weakness, and atrophy of intrinsic hand muscles. This study sought to evaluate the association of insurance type on the severity of CuTS. We hypothesized that publicly insured patients will have delayed presentation to the orthopedics office and more significant condition severity.Methods A retrospective chart review was conducted for all patients evaluated for CuTS between December 2013 and January 2018 by a fellowship-trained orthopedic hand and upper extremity surgeon at our tertiary referral center. Insurance type, demographics, and measures of CuTS severity were compared.Results Patients presenting with CuTS of severity greater than or equal to McGowan stage 2A had 4.4-fold greater odds of being publicly insured than privately. Motor and sensory velocities across the elbow were diminished at 42.2 +/- 13.9m/s and 33.0 +/- 20.8m/s in publicly insured patients compared with 47.5 +/- 11.3 m/s and 47.0 +/- 16.4m/s for privately insured patients. The same trend was present for motor and sensory amplitudes at 6.6 +/- 3.8 mV and 16.9 +/- 17.8 mV in publicly insured patients compared with 8.5 +/- 3.2 mV and 26.0 +/- 18.9 mV in privately insured patients. Patients with public insurance were symptomatic for longer prior to their initial visit, on average 82.8 +/- 86.5 weeks, compared with 42.4 +/- 58.9 weeks for patients with private insurance.Conclusions Publicly insured patients were significantly delayed in seeing an orthopedic surgeon for evaluation and treatment of CuTS and presented with more severe clinical and electrodiagnostic findings compared with privately insured patients. These findings suggest that insurance type, among other socioeconomic factors, may be a barrier to CuTS care. Copyright (C) 2020 by the American Society for Surgery of the Hand. All rights reserved.