Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis

Seyferth, Anne V.; Cichocki, Meghan N; Wang, Chien-Wei; Huang, Yun-Ju; Huang, Yi-Wei; Chen, Jung‐Sheng; Kuo, Chang‐Fu; Chung, Kevin C.

doi:10.1001/jamanetworkopen.2022.46299

Cited by 4 publications

(5 citation statements)

References 33 publications

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“…38 However, a recent study found quality of care for RA remains variable, especially for patients with Medicare and those with multiple morbidities. 14 As the ACA matured and increased patient access to health care, it is possible that the previously sharply decreasing rate of surgical intervention for RA of the hand abated due to an increase in patients with poorly treated RA interacting with hand surgeons and being candidates for surgery based on existing guidelines. As RA surgical care remains largely elective, shared decision-making continues to be a crucial aspect of patient care.…”

Section: Discussionmentioning

confidence: 99%

“…Oversight committees, such as the Arthritis Foundation (a national organization for RA), are taking steps to standardize care through publishing quality care measures . However, a recent study found quality of care for RA remains variable, especially for patients with Medicare and those with multiple morbidities . As the ACA matured and increased patient access to health care, it is possible that the previously sharply decreasing rate of surgical intervention for RA of the hand abated due to an increase in patients with poorly treated RA interacting with hand surgeons and being candidates for surgery based on existing guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with coexisting inflammatory arthritis diagnoses, including psoriatic arthritis, acute viral polyarthritis, gout, or calcium pyrophosphate deposition disease, were excluded (Figure 1). 14 This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and was ruled exempt from requiring informed patient consent by the University of Michigan Institutional Review Board because data were deidentified.…”

Section: Data Source and Cohort Selectionmentioning

confidence: 99%

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Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Dwivedi,

Cichocki,

et al. 2024

JAMA Surg

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ImportanceRheumatoid arthritis (RA) has severe functional and economic consequences. The implications of the Patient Protection and Affordable Care Act (ACA) and demographic factors for access to surgical treatment are unclear.ObjectiveTo investigate factors associated with time to RA hand surgery, surgical incidence, and cost after implementation of the ACA.Design, Setting, and ParticipantsThis cross-sectional study used insurance data from the IBM MarketScan Research Databases from 2009 through 2020 to compare time to surgery, surgical incidence, and treatment cost for RA of the hand before and after ACA implementations. Included patients were 18 years or older with a new diagnosis for RA of the hand and at least 1 procedural code for arthroplasty, arthrodesis, tenolysis, tendon repair, or tendon transfer. Patients with coexisting inflammatory arthritis diagnoses were excluded. Demographic variables analyzed included patient sex, age at index date, residence within or outside a metropolitan statistical area (MSA; hereafter urban or nonurban), insurance and health plan type, Social Deprivation Index, Elixhauser Comorbidity Index score, and Rheumatic Disease Comorbidity Index. Data analysis occurred from October 2022 to April 2023.ExposuresSurgery for RA of the hand during the pre-ACA (before 2014) vs post-ACA (2014 or later) periods.Main Outcomes and MeasuresTime to surgery, surgical incidence, and cost of treating RA in patients undergoing hand surgery for RA.ResultsAmong 3643 patients (mean [SD] age, 57.6 [12.3] years) who underwent hand surgery for RA, 3046 (83.6%) were women. Post-ACA passage, 595 (86.2%) patients who resided in urban areas had a significantly lower time to surgery than those who did not (−70.5 [95% CI, −112.6 to −28.3] days; P &lt; .001). Among urban patients, the least socially disadvantaged patients experienced the greatest decrease in time to surgery after ACA but the change was not statistically significant. For all patients, greater social disadvantage (ie, a higher SDI score) was associated with a longer time to surgery in the post-ACA period; for example, compared with the least socially disadvantaged group (SDI decile, 0-10), patients in SDI decile 10 to 20 waited an additional 254.0 days (95% CI, 65.2 to 442.9 days; P = .009) before undergoing surgery. Compared with the pre-ACA period, the mean surgical incidence in the post-ACA period was 83.4% lower (162.3 vs 26.9 surgeries per 1000 person-years; P &lt; .001), and surgical incidence was 86.3% lower in nonurban populations (27.2 vs 3.7 surgeries per 1000 person-years; P &lt; .001) but only 82.8% lower in urban populations (135.1 vs 23.2 surgeries per 1000 person-years; P &lt; .001). Per capita total costs of all treatment related to RA of the hand decreased in the post-ACA period but the change was not statistically significant. Insurer-paid costs were lower in the post-ACA period but the change was not statistically significant. Out-of-pocket expenses did not change.Conclusions and RelevanceFindings of this cross-sectional study suggest that after ACA passage, disparities exist in access to timely, cost-effective hand surgery for RA. Increased access to surgical hand specialists is needed for nonurban residents and those with greater social deprivation, along with insurance policy reforms to further decrease out-of-pocket spending for RA hand surgery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Source and Cohort Selectionmentioning

confidence: 99%

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Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Dwivedi,

Cichocki,

et al. 2024

JAMA Surg

Self Cite

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“…The clinical management of different patient groups has lately received attention for other hand surgical conditions and affects health care quality and equality 21 , 22 . A delay in diagnosis and treatment of UNE may decrease the likelihood of full recovery due to the risk of remaining injuries to the nerve trunk, particularly the nerve fibers, i.e., both the axons and the Schwann cells, even after the surgery 23 , 24 .…”

Section: Introductionmentioning

confidence: 99%

Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus

Andersson,

Zimmerman,

Perez

et al. 2024

Sci Rep

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Diabetes mellitus (DM) is a risk factor for the development of ulnar nerve entrapment (UNE). Differences in surgical outcomes for UNE between patients with and without DM have been reported, but studies on presurgical management are scarce. This study aimed to evaluate the presurgical management of UNE in patients with (DM diagnosis < 2 years of UNE diagnosis) and without DM regarding the level of care for diagnosis and the proportion that proceeds to surgery. Data from 6600 patients with UNE between 2004 and 2019 were included from the Skåne Health Care Register (SHR) and cross-linked with data from the Swedish National Diabetes Register (NDR). The group with UNE and DM was compared to the group with UNE without DM and prevalence ratios were calculated using Cox regression analysis. Patients with DM more often got their first UNE diagnosis in secondary care than in primary care (643/667, 96% vs. 5361/5786; 93%). Patients with and without DM, regardless of the type of DM, presence of retinopathy, or HbA1c levels, were surgically treated for UNE to the same extent (258/667, 39% of patients with DM vs. 2131/5786, 37% of patients without DM). The proportion of surgically treated was significantly lower among patients diagnosed with UNE in primary care compared to secondary care (59/449, 13% vs. 2330/5786, 38%). Men were more often surgically treated than women (1228/3191, 38% vs.1161/3262 36%). Patients with UNE and DM are surgically treated to the same extent as patients with UNE but without DM and are more likely to be diagnosed in specialized care.

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“…Based on a large retrospective cohort study of patients with rheumatoid arthritis (RA), researchers report that patients who were male, had Medicare insurance, or had increased comorbidities were generally less likely to meet selected RA quality care markers. (See Seyferth et al, 2022. )…”

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confidence: 99%

Study Explores Quality Care Markers in Rheumatoid Arthritis

2023

Lippincott's Bone and Joint Newsletter

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Factors Associated With Quality Care Among Adults With Rheumatoid Arthritis

Cited by 4 publications

References 33 publications

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Factors in Hand Surgery Access for Rheumatoid Arthritis Before vs After the Patient Protection and Affordable Care Act

Presurgical management of ulnar nerve entrapment in patients with and without diabetes mellitus

Study Explores Quality Care Markers in Rheumatoid Arthritis

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