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Review of Physician Referrals to Orthopedic Spine versus Neurosurgery.

ABSTRACT: Background:Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology. Methods:In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locations (suburban community hospital, urban academic university hospital, and urban private practice) were asked to participate in the study. Consenting physicians completed our 24-question survey addressing their beliefs according to pathologies, locations of pathologies, and surgical interventions. Results:Overall, 108 physicians (24%) completed our survey. Fifty-seven physicians (52.8%) felt that neurosurgeons would provide better long-term comprehensive spinal care. Overall, 66.7% of physicians would refer to neurosurgery for cervical spine radiculopathy; 52.8%, to neurosurgery for thoracic spine radiculopathy; and 56.5%, to orthopedics for lumbar spine radiculopathy. Most physicians would refer all spine fractures to orthopedics for treatment except cervical spine fractures (56.5% to neurosurgeons). Most physicians would refer to neurosurgery for extradural tumors (91.7%) and intradural tumors (96.3%). Most would refer to orthopedic surgeons for chronic pain. Finally, physicians would refer to orthopedics for spine fusion (61.1%) and discectomy (58.3%) and to neurosurgery for minimally invasive surgery (59.3%). Conclusions:Even though both orthopedic surgeons and neurosurgeons are intensively trained to treat a similar breath of spinal pathology, physicians vary in their referring patterns according to spinal pathology, location of pathology, and intended surgery. Education on the role of spine surgeons among PCPs is essential in ensuring unbiased referral patterns.

SUBMITTER: Malige A

PROVIDER: S-EPMC7031437 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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Review of Physician Referrals to Orthopedic Spine versus Neurosurgery.

Malige Ajith A Yuh Roger R Yellapu Vikas V Lands Vince V Woods Barrett B Sokunbi Gbolabo G

Clinics in orthopedic surgery 20200213 1

<h4>Background</h4>Previous studies have reported what patients value while choosing their surgeon, but there are no studies exploring the patterns of referral to spine surgeons among primary care physicians (PCPs). This study aims to identify any trends in PCPs' referral to orthopedic surgery versus neurosurgery for spinal pathology.<h4>Methods</h4>In total, 450 internal medicine, family medicine, emergency medicine, neurology, and pain management physicians who practice at one of three locatio ...[more]

PMID: 32117539

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Project description:There is a noticeable increase in the unnecessary ordering of Magnetic Resonance Imaging (MRI) of the knee in older patients. This quality improvement study assessed the frequency of unnecessary pre-consultation knee MRIs and investigated the effect on the outcome of the patients' consultation with the orthopedic surgeon. 650 medical charts of patients aged 55 years or older referred to an orthopedic clinic with knee complaints were reviewed. Patients arriving with a pre-consultation MRI were identified, and the usefulness of the MRI was evaluated using the appropriateness criteria developed to support this study. Of the 650 patient charts reviewed, 225 patients presented with a pre-consultation MRI, 76% of which were not useful for the orthopedic surgeon. The ordered knee MRI scans were considered not useful because they were requested for confirmed meniscal tear for patients ≥55 years, suspected degenerative disorder and ligament/tendon injury, or for patients with severe osteoarthritis without locking or extension. These MRI scans were done despite the absence of signs of effusion, tenderness, soft tissue swelling, decreased range of motion, or difficulty of weight-bearing, a lack of persistent knee joint pain at the time of assessment, or with no x-ray before ordering MRI. Half of the patients with a pre-consult MRI did not present with plain radiographs of their knee, however, 35% of those still required an x-ray to be ordered at the time of the surgical consult. A logistic regression analysis on post-consult disposition found that patients with pre-consult MRI were less likely to be considered for total knee arthroplasty (TKA) (OR 0.424, CI 0.258-0.698, p = 0.001). Patients assessed by an advanced practice physiotherapist prior to referral for surgical consult were 4.47 more likely to have TKA (CI 2.844-7.039, p< 0.000). Most of the pre-consult knee MRIs were deemed as unnecessary for the orthopedic surgeon's clinical decision-making. This study highlights the potential benefits of following a comprehensive model of care within the referral process to reduce the unnecessary high orders of pre-consult MRI scans.

Project description:ImportanceDisparities in quality of care according to patient race and socioeconomic status persist in the US. Differential referral patterns to specialist physicians might be associated with observed disparities.ObjectiveTo examine whether differences exist between Black and White Medicare beneficiaries in the observed patterns of patient sharing between primary care physicians (PCPs) and physicians in the 6 specialties to which patients were most frequently referred.Design, setting, and participantsThis cross-sectional observational study of Black and White Medicare beneficiaries used claims data from 2009 to 2010 on 100% of traditional Medicare beneficiaries who were seen by PCPs and selected high-volume specialists in 12 health care markets with at least 10% of the population being Black. Statistical analyses were conducted from December 20, 2017, to September 30, 2020.ExposuresDifferences in patterns of patient sharing among Black and White patients.Main outcomes and measuresPrimary care physician and specialist degree (the number of other PCPs or specialists to whom each physician is connected) and strength (the number of shared patients per connection, overall, for Black patients and White patients and after equalizing the numbers of Black and White patients per PCP), as well as distance between PCP and patient and specialist zip code centroids.ResultsThe 12 selected markets ranged in size from Manhattan, New York (187 054 Black or White beneficiaries seen by at least 2 physicians within an episode of care; 9794 total physicians), to Tallahassee, Florida (44 644 Black or White beneficiaries seen by at least 2 physicians within an episode of care; 847 total physicians). The percentage of Black beneficiaries ranged from 11.5% (Huntsville, Alabama) to 46.8% (Chicago, Illinois). The mean PCP-specialist degree (number of specialists with whom a PCP shares patients) was lower for Black patients than for White patients. For instance, the mean PCP-cardiologist degree across all markets for White patients was 17.5 compared with 8.8 for Black patients. After sampling White patients to equalize the numbers of patients seen, the degree differences narrowed but were still not equivalent in many markets (eg, for all specialties in Baton Rouge, Louisiana: 4.5 for Black patients vs 5.7 for White patients). Specialist networks among White patients were much larger than those constructed based just on Black patients (eg, for cardiology across all markets: 135 for Black patients vs 330 for White patients), even after equalizing the numbers of patients seen per PCP (123 for Black patients vs 211 for White patients). The overall test for differences in referral patterns was statistically significant for all 6 specialties examined in 7 of the 12 markets and in 5 specialties for another 3.Conclusions and relevanceThis study suggests that differences exist in specialist referral patterns by race among Medicare beneficiaries. This is an observational study, and thus some differences might have resulted from patient-initiated visits to specialists.

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Review of Physician Referrals to Orthopedic Spine versus Neurosurgery.

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Review of Physician Referrals to Orthopedic Spine versus Neurosurgery.

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