Background
Methods
Data sources and overview
Patient sample
Measures
Physician specialty designation
Treatment utilization variables
Covariates
Analyses
Results
Study sample by physician specialty
Patient Characteristics
| Total Study Sample (N = 572) | Non-Orthopaedic Physician (N = 98) | Orthopaedic Specialist (N = 474) | |
---|---|---|---|---|
Age | Mean | 60.3 | 61.5 | 60.1 |
(95% CI) | (59.2, 61.4) | (58.9, 64.1) | (58.9, 61.3) | |
Male Sex | n (%) | 302 (52.8) | 44 (44.9) | 258 (54.4) |
(95% CI) | (48.6, 56.9) | (34.8, 55.3) | (49.8, 59.0) | |
Insurance type | ||||
Public | n (%) | 307 (53.7) | 45 (45.9) | 262 (55.3) |
(95% CI) | (49.5, 57.8) | (35.8, 56.3) | (50.7, 59.8) | |
Private | n (%) | 219 (38.3) | 48 (48.9) | 171 (36.1) |
(95% CI) | (34.3, 42.4) | (38.7, 59.3) | (31.7, 40.6) | |
Worker’s compensation | n (%) | 35 (6.1) | 2 (2.0) | 33 (7.0) |
(95% CI) | (4.3, 8.4) | (0.2, 7.2) | (4.8, 9.6) | |
Other | n (%) | 11 (1.9) | 3 (3.1) | 8 (1.7) |
(95% CI) | (0.9, 3.4) | (0.6, 8.7) | (0.7, 3.3) | |
Concurrent Shoulder Diagnosesa | ||||
Rotator Cuff Tear | n (%) | 173 (30.2) | 16 (16.3) | 157 (33.1) |
(95% CI) | (26.5, 34.2) | (9.6, 25.2) | (28.9, 37.6) | |
Rheumatoid Arthritis | n (%) | 7 (1.2) | 7 (7.1) | 0 (0.0) |
(95% CI) | (0.6, 2.7 | (2.9, 14.2) | (0.0, 1.2) | |
Humerus Fracture | n (%) | 6 (1.0) | 0 (0.0) | 6 (1.3) |
(95% CI) | (0.4, 2.3) | (0.0, 3.7) | (0.5, 2.7) | |
Instability | n (%) | 9 (1.6) | 0 (0.0) | 9 (1.9) |
(95% CI) | (0.7, 3.0) | (0.0, 3.7) | (0.9, 3.6) | |
Adhesive capsulitis | n (%) | 19 (3.3) | 1 (1.0) | 18 (3.8) |
(95% CI) | (2.0, 5.1) | (0.03, 5.5) | (2.2, 5.9) | |
Charlson Comorbidity Indexb | ||||
Score 0 | n (%) | 223 (69.0) | 55 (68.0) | 168 (69.4) |
(95% CI) | (63.7, 74.0) | (56.6, 77.8) | (63.2, 75.2) | |
Score 1 | n (%) | 54 (16.7) | 15 (18.5) | 39 (16.1) |
(95% CI) | (12.8, 21.2) | (10.7, 28.7) | (11.7, 21.4) | |
Score 2 | n (%) | 38 (11.8) | 7 (8.6) | 31 (12.8) |
(95% CI) | (8.5, 15.8) | (3.5, 17.0) | (8.9, 17.7) | |
Score 3 | n (%) | 4 (1.2) | 2 (2.5) | 2 (0.8) |
(95% CI) | (0.3, 3.1) | (0.3, 8.6) | (0.1, 2.9) | |
Score 4 | n (%) | 2 (0.6) | 1 (1.2) | 1 (0.4) |
(95% CI) | (0.08, 2.2) | (0.03, 6.7) | (0.01, 2.3) | |
Healthcare utilization in the 365 days prior to index shoulder visit | ||||
Patients who visited a NOP | n (%) | 221 (38.6) | 70 (71.4) | 151 (31.9) |
(95% CI) | (34.6, 42.7) | (61.4, 80.1) | (27.7, 36.3) | |
Number of visits to NOPc | Mean | 4.1 | 4.3 | 4.0 |
(95% CI) | (3.6, 4.7) | (3.6, 5.0) | (3.3, 4.8) | |
Patients who visited an OS | n (%) | 88 (15.4) | 18 (18.4) | 70 (14.8) |
(95% CI) | (12.5, 18.6) | (11.3, 27.5) | (11.7, 18.3) | |
Number of visits to OSd | Mean | 2.2 | 2.1 | 2.3 |
(95% CI) | (1.9, 2.6) | (1.5, 2.7) | (1.9, 2.7) |
Treatment utilization by physician specialty
Total Study Sample (N = 572) | Non-Orthopaedic Physician (n = 98) | Orthopaedic Specialist (n = 474) | p value | ||
---|---|---|---|---|---|
Days from index shoulder visit to OA diagnosis | Mean | 19.6 | 21.6 | 19.2 | 0.25* |
(95% CI) | (17.5, 21.8) | (16.3, 26.9) | (16.9, 21.6) | ||
Days from index shoulder visit to first treatment | Mean | 18.2 | 32.3 | 16.3 | < 0.01* |
(95% CI) | (14.8, 21.5) | (21.0, 43.6) | (12.8, 19.7) | ||
First Treatment Initiated | |||||
Physical therapy | n (%) | 66 (11.5) | 13 (13.3) | 53 (11.2) | < 0.01‡ |
(95% CI) | (7.3, 21.6) | (8.5, 14.4) | |||
Injection | n (%) | 286 (50.0) | 33 (33.7) | 253 (53.4) | |
(95% CI) | (24.4, 43.9) | (48.8, 57.9) | |||
Arthroscopic surgery | n (%) | 79 (13.8) | 7 (7.1) | 72 (15.2) | |
(95% CI) | (2.9, 14.2) | (12.1, 18.7) | |||
Total joint replacement | n (%) | 25 (4.4) | 2 (2.0) | 23 (4.8) | |
(95% CI) | (0.2, 7.1) | (3.1, 7.2) | |||
Watchful Waiting | n (%) | 116 (20.3) | 43 (43.9) | 73 (15.4) | |
(95% CI) | (33.9, 54.3) | (12.3, 19.0) | |||
Treatment ever receiveda | |||||
Physical therapy | n (%) | 94 (16.4) | 21 (21.4) | 73 (15.4) | 0.14† |
(95% CI) | (13.8, 30.9) | (12.3, 19.0) | |||
Injection | n (%) | 351 (61.4) | 46 (46.9) | 305 (64.3) | < 0.01† |
(95% CI) | (36.8, 57.3) | (59.8, 68.7) | |||
Arthroscopic surgery | n (%) | 196 (34.3) | 18 (18.4) | 178 (37.5) | < 0.01† |
(95% CI) | (11.3, 27.5) | (33.2, 42.1) | |||
Total joint replacement | n (%) | 52 (9.1) | 4 (4.1) | 48 (10.1) | 0.08‡ |
(95% CI) | (1.1, 10.1) | (7.5, 13.2) | |||
Watchful Waiting | n (%) | 116 (20.3) | 43 (43.8) | 73 (15.4) | < 0.01† |
(95% CI) | (33.9, 54.3) | (12.3, 19.0) | |||
Number of PT sessions over treatment periodc | Mean | 1.2 | 1.2 | 1.2 | 0.81* |
(95% CI) | (1.1, 1.3) | (1.0, 1.4) | (1.1, 1.3) | ||
Number of injections over treatment periodb | Mean | 1.6 | 1.6 | 1.6 | 0.42* |
(95% CI) | (1.5, 1.7) | (1.4, 1.9) | (1.5, 1.7) | ||
Days from index shoulder visit to surgeryd | Mean | 65.4 | 96.9 | 62.5 | < 0.01* |
(95% CI) | (58.0, 72.8) | (62.6, 131.1) | (55.1, 69.8) |
Model | |
---|---|
Surgery within 1 year± | |
Index visit with Non-Orthopaedic Physician |
Reference
|
Index visit with Orthopaedic Specialist | 2.65** [1.42, 4.95] |
Male | 1.40 [0.93, 2.11] |
Age | |
18–34 |
Reference
|
35–49 | 1.00 [0.27, 3.62] |
50–64 | 0.72 [0.20, 2.57] |
65–79 | 0.44 [0.12, 1.70] |
80+ | 0.18* [0.04, 0.92] |
Insurance Type | |
Private |
Reference
|
Public | 1.08 [0.61, 1.90] |
Other | 1.45 [0.34, 6.25] |
Worker’s Comp | 2.54* [1.05, 6.17] |
Previous Healthcare Utilization | |
Family Medicine visit | 0.94 [0.61, 1.46] |
Orthopaedic Specialist visit | 1.35 [0.76, 2.39] |
Concurrent Shoulder Diagnoses | |
Rotator Cuff Tear | 10.69*** [6.76, 16.93] |
Other shoulder diagnosis | 2.16* [0.99, 4.71] |
Comparison of key variables from charts
Total Study Sample (N = 48) | Non-Orthopaedic Physician (n = 24) | Orthopaedic Specialist (n = 24) | ||
---|---|---|---|---|
BMI | Mean | 34.4 | 36.3 | 32.6 |
(95% CI) | (30.1, 38.8) | (28.1, 44.5) | (30.0, 36.2) | |
Number of current smokers | n (%) | 5 (10.4) | 2 (8.3) | 3 (12.5) |
(95% CI) | (3.5, 22.7) | (1.0, 27.0) | (2.7, 32.4) | |
Symptom duration in months | Mean | 10.7 | 3.5 | 17.9 |
(95% CI) | (5.4, 16.0) | (0.3, 6.8) | (8.3, 27.5) | |
Pain scale score | Mean | 5.7 | 5.7 | 5.7 |
(95% CI) | (5.0, 6.4) | (4.4, 7.0) | (4.8, 6.6) |