Determinants of demand for total hip and knee arthroplasty: a systematic literature review.
Determinants of demand for total hip and knee arthroplasty: a systematic literature review.
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DOI：
10.1186/1472-6963-12-225
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发表时间：
2012-07-30
影响因子：
2.8
通讯作者：
Drummond M
中科院分区：
文献类型：
--
作者：
Mota RE;Tarricone R;Ciani O;Bridges JF;Drummond M
全关节置换术 (TJA) 中记录的年龄、性别、种族和社会经济差异表明，需要手术的人可能不会接受手术，并且对解释未满足需求的原因提出了挑战。目前尚不清楚医生是否限制了患者的治疗机会，也不清楚患者对手术的信念和期望（包括他们的有偿工作状况和退休计划）对接受 TJA 的决定有何影响。确定需求的社会经济和其他决定因素将为设计有效和高效的卫生政策提供信息。本次审查的目的是确定导致患者需要接受 TJA 的因素。 2011 年 9 月对 Embase 和 Medline (Ovid) 书目数据库进行的电子检索发现了英文研究，这些研究报告了促使需要髋关节或膝关节置换术的患者接受手术的因素。该审查包括符合条件的患者的择期手术率报告，或者在控制疾病严重程度的情况下，一般受试者的择期手术率，并陈述了临床专家和患者对接受 TJA 的适合性或意愿的意见。对定量和定性研究进行了审查，但排除了涉及少于 20 名受试者的定量研究。个别研究的质量是根据研究设计（即前瞻性与回顾性）、磨损报告、混杂效应的调整和报告以及报告的需求测量（自我报告与医生评估）进行评估的。报告的混杂因素调整分析对手术概率影响的估计以叙述形式进行总结，并综合为各个决定因素的比值比 (OR) 森林图。该审查包括 26 项定量研究，其中 23 项涉及个人对手术的决定或看法，3 项涉及健康专业人员的意见，以及 10 项定性研究。 TJA 使用的民族和种族差异与社会经济因素以及对手术过程和结果的期望有关。在美国，健康保险覆盖范围会影响需求，包括医疗保险人群的需求，对于他们来说，补充医疗补助覆盖范围会增加接受 TJA 的可能性。与没有接受过高等教育的患者相比，接受过高等教育的患者更有可能需要进行髋关节或膝关节手术（OR 范围为 0.87-2.38）。女性与男性一样愿意接受手术，但与有相同需求的男性相比，女性接受专家手术的可能性较小。随着年龄的增长，患者的需求存在相当大的变化，髋部和膝部的模式不同。带薪工作似乎会增加接受手术的机会，但没有发现研究调查退休计划与 TJA 需求之间的关系。有证据表明，在国家公共卫生系统覆盖的地区内，获得关节置换术的机会存在很大的地理差异，这不可能仅用偏好差异或无法衡量的需求来解释。文献往往关注关联，而不是检验因果关系，并且不足以评估决定因素的相对重要性。患者使用髋关节和膝关节置换术是其社会经济环境的函数，这加剧了源自医患互动的性别和种族差异。退休年龄后接受手术的意愿急剧下降，此时一些符合条件的患者可能会降低对健康状况实现的期望。有一些证据表明，独立有偿就业会增加手术的可能性。手术决策的差异对国家内不同地区的访问差异的相对贡献值得进一步研究，以控制临床需求和患者生活方式偏好，包括退休决定。关于这个问题的证据对于人口老龄化社会的服务规划和政策设计将变得越来越重要。
Documented age, gender, race and socio-economic disparities in total joint arthroplasty (TJA), suggest that those who need the surgery may not receive it, and present a challenge to explain the causes of unmet need. It is not clear whether doctors limit treatment opportunities to patients, nor is it known the effect that patient beliefs and expectations about the operation, including their paid work status and retirement plans, have on the decision to undergo TJA. Identifying socio-economic and other determinants of demand would inform the design of effective and efficient health policy. This review was conducted to identify the factors that lead patients in need to undergo TJA. An electronic search of the Embase and Medline (Ovid) bibliographic databases conducted in September 2011 identified studies in the English language that reported on factors driving patients in need of hip or knee replacement to undergo surgery. The review included reports of elective surgery rates in eligible patients or, controlling for disease severity, in general subjects, and stated clinical experts’ and patients’ opinions on suitability for or willingness to undergo TJA. Quantitative and qualitative studies were reviewed, but quantitative studies involving fewer than 20 subjects were excluded. The quality of individual studies was assessed on the basis of study design (i.e., prospective versus retrospective), reporting of attrition, adjustment for and report of confounding effects, and reported measures of need (self-reported versus doctor-assessed). Reported estimates of effect on the probability of surgery from analyses adjusting for confounders were summarised in narrative form and synthesised in odds ratio (OR) forest plots for individual determinants. The review included 26 quantitative studies−23 on individuals’ decisions or views on having the operation and three about health professionals’ opinions-and 10 qualitative studies. Ethnic and racial disparities in TJA use are associated with socio-economic access factors and expectations about the process and outcomes of surgery. In the United States, health insurance coverage affects demand, including that from the Medicare population, for whom having supplemental Medicaid coverage increases the likelihood of undergoing TJA. Patients with post-secondary education are more likely to demand hip or knee surgery than those without it (range of OR 0.87-2.38). Women are as willing to undergo surgery as men, but they are less likely to be offered surgery by specialists than men with the same need. There is considerable variation in patient demand with age, with distinct patterns for hip and knee. Paid employment appears to increase the chances of undergoing surgery, but no study was found that investigated the relationship between retirement plans and demand for TJA. There is evidence of substantial geographical variation in access to joint replacement within the territory covered by a public national health system, which is unlikely to be explained by differences in preference or unmeasured need alone. The literature tends to focus on associations, rather than testing of causal relationships, and is insufficient to assess the relative importance of determinants. Patients’ use of hip and knee replacement is a function of their socio-economic circumstances, which reinforce disparities by gender and race originating in the doctor-patient interaction. Willingness to undergo surgery declines steeply after the age of retirement, at the time some eligible patients may lower their expectations of health status achievement. There is some evidence that paid employment independently increases the likelihood of operation. The relative contribution of variations in surgical decision making to differential access across regions within countries deserves further research that controls for clinical need and patient lifestyle preferences, including retirement decisions. Evidence on this question will become increasingly relevant for service planning and policy design in societies with ageing populations.
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DOI：
10.1097/01.blo.0000214436.49527.5e
发表时间：
2006-05-01
影响因子：
4.2
作者：
Cross, William W., III;Saleh, Khaled J.;Kane, Robert L.
通讯作者：
Kane, Robert L.
DOI：
10.1002/art.10538
发表时间：
2002-08-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Blake, VA;Allegrante, JP;Charlson, ME
通讯作者：
Charlson, ME
影响因子：
27.4
作者：
Birrell, F;Johnell, O;Silman, A
通讯作者：
Silman, A
DOI：
10.1257/aer.98.5.2242
发表时间：
2008-12
期刊：
The American economic review
影响因子：
--
作者：
Card D;Dobkin C;Maestas N
通讯作者：
Maestas N
影响因子：
3.2
作者：
Conner-Spady, Barbara L.;Johnston, Geoffrey H.;Noseworthy, Tom W.
通讯作者：
Noseworthy, Tom W.