Primary Care Provider Density and Elective Total Joint Replacement Outcomes.
Publication/Presentation Date
8-1-2021
Abstract
BACKGROUND: Primary care physicians (PCPs) are often gatekeepers to specialist care. This study assessed the relationship between PCP density and total knee (TKA) and total hip arthroplasty (THA) outcomes.
METHODS: We obtained patient-level data from an institutional registry on patients undergoing elective primary TKA and THA for osteoarthritis, including Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years. Using geocoding, we identified the number of PCPs in the patient's census tract (communities). We used Augmented Inverse Probability Weighting and Cross-validated Targeted Minimum Loss-Based Estimation to compare provider density and outcomes adjusting for potential confounders.
RESULTS: Our sample included 3606 TKA and 4295 THA cases. The median number of PCPs in each community was similar for both procedures: TKA 2 (interquartile range 1, 6) and for THA 2 (interquartile range 1, 7). Baseline and 2-year follow-up WOMAC pain, function, and stiffness scores were not statistically significantly different comparing communities with more than median number of PCPs to those with less than median number of PCPs. In sensitivity analyses, adding 1 PCP to a community with zero PCPs would not have statistically significantly improved baseline or 2-year follow-up WOMAC pain, function, and stiffness scores.
CONCLUSIONS: In this sample of patients who underwent elective TKA or THA for osteoarthritis, we found no statistically significant association between PCP density and pain, function, or stiffness outcomes at baseline or 2 years. Further studies should examine what other provider factors affect access and outcomes in THA and TKA.
Volume
10
First Page
73
Last Page
78
ISSN
2352-3441
Published In/Presented At
Mehta, B., Brantner, C., Williams, N., Szymonifka, J., Navarro-Millan, I., Mandl, L. A., Bass, A. R., Russell, L. A., Parks, M. L., Figgie, M. P., Nguyen, J. T., Ibrahim, S., & Goodman, S. M. (2021). Primary Care Provider Density and Elective Total Joint Replacement Outcomes. Arthroplasty today, 10, 73–78. https://doi.org/10.1016/j.artd.2021.05.010
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
34527799
Department(s)
Administration and Leadership
Document Type
Article