RESUMEN
OBJECTIVES: This study examined ninety-day and one-year postoperative healthcare utilization and costs following total knee arthroplasty (TKA) from the health sector and patient perspectives. DESIGN: This study relied on: 1) patient-reported medical resource utilization data from diaries in the Knee Arthroplasty Pain Coping Skills Training (KASTPain) trial; and 2) Medicare fee schedules. Medicare payments, patient cost-sharing, and patient time costs were estimated. Generalized linear mixed models were used to identify baseline predictors of costs. RESULTS: In the first ninety days following TKA, patients had an average of 29.7 outpatient visits and 6% were hospitalized. Mean total costs during this period summed to $3,720, the majority attributed to outpatient visit costs (84%). Over the year following TKA, patients had an average of 48.9 outpatient visits, including 33.2 for physical therapy. About a quarter (24%) of patients were hospitalized. Medical costs were incurred at a decreasing rate, from $2,428 in the first six weeks to $648 in the last six weeks. Mean total medical costs across all patients over the year were $8,930, including $5,328 in outpatient costs. Total costs were positively associated with baseline Charlson comorbidity score (P < 0.01). Outpatient costs were positively associated with baseline Charlson comorbidity score (P = 0.03) and a bodily pain burden summary score (P < 0.01). Mean patient cost-sharing summed to $1,342 and time costs summed to $1,346. CONCLUSIONS: Costs in the ninety days and year after TKA can be substantial for both healthcare payers and patients. These costs should be considered as payers continue to explore alternative payment models.
Asunto(s)
Cuidados Posteriores/economía , Artroplastia de Reemplazo de Rodilla/economía , Costos de la Atención en Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
OBJECTIVE: Knee arthroplasty (KA) is an effective surgical procedure. However, clinical studies suggest that a considerable number of patients continue to experience substantial pain and functional loss following surgical recovery. We aimed to estimate pain and function outcome trajectory types for persons undergoing KA, and to determine the relationship between pain and function trajectory types, and pre-surgery predictors of trajectory types. DESIGN: Participants were 384 patients who took part in the KA Skills Training randomized clinical trial. Pain and function were assessed at 2-week pre- and 2-, 6-, and 12-months post-surgery. Piecewise latent class growth models were used to estimate pain and function trajectories. Pre-surgery variables were used to predict trajectory types. RESULTS: There was strong evidence for two trajectory types, labeled as good and poor, for both Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function scores. Model estimated rates of the poor trajectory type were 18% for pain and function. Dumenci's latent kappa between pain and function trajectory types was 0.71 (95% CI: 0.61-0.80). Pain catastrophizing and number of painful body regions were significant predictors of poor pain and function outcomes. Outcome-specific predictors included low income for poor pain and baseline pain and younger age for poor function. CONCLUSIONS: Among adults undergoing KA, approximately one-fifth continue to have persistent pain, poor function, or both. Although the poor pain and function trajectory types tend to go together within persons, a significant number experience either poor pain or function but not both, suggesting heterogeneity among persons who do not fully benefit from KA.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/rehabilitación , Osteoartritis de la Rodilla/cirugía , Dolor/etiología , Factores de Edad , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Osteoartritis de la Rodilla/complicaciones , Osteoartritis de la Rodilla/fisiopatología , Osteoartritis de la Rodilla/rehabilitación , Dolor/fisiopatología , Dimensión del Dolor/métodos , Periodo Posoperatorio , Pronóstico , Recuperación de la Función , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
Since chronic fatigue is so common, long-lasting, and fraught with functional and emotional consequences, early intervention can limit overuse of health care resources and forestall disability. To help patients, we must intervene before chronicity is established or iatrogenic harm has occurred. Care that integrates medical and psychologic concepts, together with symptom management, can prevent significant secondary impairment in most cases.
Asunto(s)
Síndrome de Fatiga Crónica/diagnóstico , Síndrome de Fatiga Crónica/terapia , Adyuvantes Inmunológicos/uso terapéutico , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Adulto , Alcoholismo/diagnóstico , Animales , Antidepresivos/uso terapéutico , Terapia Cognitivo-Conductual , Diagnóstico Diferencial , Progresión de la Enfermedad , Terapia por Ejercicio , Síndrome de Fatiga Crónica/clasificación , Femenino , Hepatitis B Crónica/diagnóstico , Hepatitis C Crónica/diagnóstico , Humanos , Masculino , Trastornos Mentales/diagnóstico , Atención Primaria de Salud/métodos , Pronóstico , Ratas , Trastornos del Sueño-Vigilia/diagnóstico , Tirotropina/sangreRESUMEN
Osteal density of 189 Kidney Deficiency (KD) women displayed after menopause as determined by the method of gamma-ray absorption. The result showed that the osteal density of the KD women was significantly lower than those women of same ages without KD (P < 0.001) and the osteal density of the women whose menopause occurred before the age of 45 was lower than that after 45 (P < 0.05). This suggested that the prematurity of ovarial function and the decrease of estrogen ahead of time might be the cause. Therefore, the earlier the menopause, the lower the osteal density, as well as the more serious the KD well be.