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 Hand Test 3: Topics of Interest
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:51-56 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Utilization of Orthopaedic Services for Hand and Wrist Conditions in a Capitated Population

C. Craig Crouch, MD1, Daniel P. O'Connor, PhD1, Peggy Pierce, BBA1 and Mark R. Brinker, MD1

1 Fondren Orthopedic Group (C.C.C., P.P., and M.R.B.) and Joe W. King Orthopedic Institute (D.P.O'C. and M.R.B.), Texas Orthopedic Hospital (C.C.C. and M.R.B.), 7401 South Main Street, Houston, TX 77030. E-mail address for D.P. O'Connor: dano{at}jwkoi.com

Investigation performed at Fondren Orthopedic Group and Joe W. King Orthopedic Institute, Texas Orthopedic Hospital, Houston, Texas

The authors did not receive grants or outside funding in support of their research or preparation of this work. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: The utilization of orthopaedic services (office visits and surgery) to treat hand and wrist conditions is not well known. In this study, we report the utilization rates for patients referred for orthopaedic treatment of hand and wrist conditions in a large population of individuals enrolled in a capitated insurance plan.

Methods: The study population consisted of individuals enrolled, between January 1998 and December 2001, in a capitated insurance plan that had an annual average membership of 135,188 during that period. This plan was serviced by an independent physician association of sixty-two orthopaedic surgeons who were responsible for all orthopaedic care. Data were collected prospectively in a centralized database as patients with various hand or wrist conditions were referred for orthopaedic services. Odds ratios were used to compare gender-specific and age-specific utilization rates.

Results: Overall utilization rates were 18.06 office visits and 6.47 surgical procedures per 1000 members per year. The most frequent hand or wrist conditions were fractures, carpal tunnel syndrome, tendinitis or tenosynovitis, and ganglion or synovial cysts. These four diagnoses accounted for 70% of all office visits and 71% of all surgical cases. Across all age groups, males had a significantly higher rate of utilization of office visits (p < 0.001). Between the ages of thirty-five and fifty-five years, utilization of office visits and surgery increased approximately linearly with age.

Conclusions: A comparison of these data with those of previous reports indicates that approximately one of every ten patients who are referred for orthopaedic services has a hand or wrist condition, and nearly half will require surgery.


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