Maine carpal tunnel study: Small area variations

Keller, Robert B.; Largay, Anne Marie; Soule, David N.; Katz, Jeffrey N.

doi:10.1016/s0363-5023(98)80057-9

Cited by 42 publications

(41 citation statements)

References 7 publications

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“…First, advances in surgical technique and anesthesia have improved postoperative care, allowing these procedures to be performed almost entirely on an ambulatory basis. 12 Second, given the substantial variation that exists in their use, [13][14][15][16][17] they are susceptible to the influences of financial incentives associated with surgicenter ownership.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

et al. 2010

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Many physicians confronting declining reimbursement from insurers have invested in ambulatory surgery centers, where they perform outpatient surgical and diagnostic procedures. An ownership stake entitles physicians to a share of the facility's profits from self-referrals. This arrangement can create a potential conflict of interest between physicians' financial incentives and patients' clinical needs. Our analysis of Florida data for five common procedures revealed a significant association between physician-ownership and higher surgical volume. Possible remedies include revising federal law to require disclosure of investment arrangements; reducing facility payments to dilute ownership incentives; and reforms (such as accountable care organizations) that discourage an excessive rate of procedures.

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Section: Study Data and Methodsmentioning

confidence: 99%

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

et al. 2010

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“…Carpal tunnel syndrome (CTS) is the most common compression neuropathy with an estimated 400,000 procedures performed in the USA per year to release the carpal tunnel [15]. In spite of this huge burden of illness, the etiology of CTS has not been clearly elucidated.…”

Section: Introductionmentioning

confidence: 99%

Preferred Sleep Position on the Side is Associated with Carpal Tunnel Syndrome

McCabe

Gupta

Tate

et al. 2010

Hand (New York, N,Y.)

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“…Twenty-®ve years later it is known that the frequency of most types of medical interventions varies widely between geographical and organizational units at all levels of aggregation (2). A recent study, from July 1998, that documents variation in physician practice patterns describes results from the Maine Carpal Tunnel Study (3). Keller et al demonstrate that carpal tunnel release rates across population-based service areas in the state of Maine, USA, varied 3.5-fold.…”

Section: Introductioǹ`tmentioning

confidence: 99%

Medical practice variations: changing the theoretical approach

Westert

Groenewegen

1999

Scand J Public Health

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Variations in medical practice are well documented, but there has been less progress in explaining these variations. This paper discusses the existing theories and hypotheses and concludes that a change in theoretical approach is required, to one that more directly highlights the social context influencing the behaviour of doctors in their daily practice. An initial alternative model for explaining variation in practice style is presented. The paper illustrates how (combinations of) important structural factors, such as the availability of hospital resources, the way the doctor is reimbursed, the availability of patients, professional uncertainty, and the way the hospital is financed, lead to hypotheses about when different local standards of medical care emerge. It is concluded that theoretical progress in research on variations in medical practice is possible and that empirical research needs to be driven by hypotheses that emphasize the role of social contexts in the doctor's decision behaviour. Some suggestions for future lines of research are outlined.

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Maine carpal tunnel study: Small area variations

Cited by 42 publications

References 7 publications

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

Physician-Ownership Of Ambulatory Surgery Centers Linked To Higher Volume Of Surgeries

Preferred Sleep Position on the Side is Associated with Carpal Tunnel Syndrome

Medical practice variations: changing the theoretical approach

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