RESUMEN
TKA is a highly effective means of treating (advanced knee arthritis) degenerative joint disease. Previous studies have demonstrated that a high surgical volume for total joint arthroplasty reduces morbidity and improved economic outcome, these methods for themselves are fraught with complexity, uncertainty and non-linear problem in terms of medical datasets may be unable to more accurately finding important information. As medical datasets often include a large number of features (attributes), some of which are irrelevant, and therefore it cannot intuitively understand the corresponding to main factors which affecting the resource utilizations of healthcare. In order to solve the problems mentioned above, this study employs specialist advice to filter relevant cases (records) and proposed an integrated five features selection methods to select the important features. Based on rough set theory (RST), the rules are extracted and compared with other methods in terms of accuracy. The contributions contain: (1) data screening based on specialist opinions, (2) two stage feature selection by analysis of variance (ANOVA) and proposed an integrated feature selection approach (IFSA), and (3) data discretization and rule generation by RST. The proposed model is verified by using three datasets for comparison accuracy. The results can provide a valuable reference for National Health Insurance Bureau (NHI) in establishing the TKA standard.
Asunto(s)
Artroplastia de Reemplazo de Rodilla/estadística & datos numéricos , Artroplastia de Reemplazo de Rodilla/normas , Osteoartritis de la Rodilla/cirugía , Algoritmos , Femenino , Humanos , Masculino , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Modelos BiológicosRESUMEN
BACKGROUND/PURPOSE: The impact of provider volume, comorbidity and adverse outcomes on hospital utilization of total hip arthroplasty (THA) has not yet been studied scientifically in Taiwan. This study aimed to examine the relationship between surgeon/hospital volume, perioperative complications, acute infections and hospital utilization for patients who underwent primary (THA). METHODS: We analyzed National Health Insurance (NHI) annual reimbursement data for all hospital admissions due to primary THA between January 2005 and December 2006. A total of 9335 patients with rheumatoid arthritis, osteoarthritis, avascular necrosis and other joint disorders were identified. Multivari-ate regression analyses were used to assess the relationship between provider volume and hospital utilization and the risk of adverse outcomes. Statistical analyses were adjusted for patient age, gender, comorbidity, type of arthritis, as well as hospital attributes. RESULTS: Reversed linear associations were found among hospital utilization, surgeon volume, and comorbidity score. Patients with acute infection tended to stay 8 days more and cost NT$32,451 more than their counterparts. Patients with perioperative complication tended to stay 2.30 days more and cost NT$15,327 more than their counterparts. Longer hospital stay and higher total hospital charge were associated with patient's age and Charlson index. CONCLUSIONS: This study revealed that the volume of THAs performed by individual surgeons was a more important determinant of hospital utilization than hospital volume. Perioperative adverse events were associated with patients' age and comorbidity.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedades Transmisibles/epidemiología , Hospitales/estadística & datos numéricos , Programas Nacionales de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/epidemiología , Enfermedad Aguda , Adulto , Anciano , Artroplastia de Reemplazo de Cadera/economía , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Comorbilidad , Economía Hospitalaria/estadística & datos numéricos , Femenino , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/economía , Factores de Riesgo , Taiwán/epidemiologíaRESUMEN
Our study examined how provider patient volume, postoperative infection rate, and perioperative complication affect length of stay, hospitalization charges, and adverse outcomes for patients undergoing total knee arthroplasty (TKA). The study sample included patients who had undergone total knee arthroplasty at all acute care hospitals in Taiwan between 2000 and 2003. Two economic indicators revealed linear associations with surgeon's patient volume, hospital's patient volume, and comorbidity score. Patients who developed postoperative infections remained hospitalized an average of 8.49 days longer than did patients with no infection. Postoperative infection was associated with surgeon experience. Our findings indicate that a surgeon's patient volume has a more significant effect than a hospital's patient volume on clinical outcomes. However, patient volumes for both surgeon and hospital are equally important in economic outcomes.