Protocols for Management of Underserved Patients Undergoing Arthroplasty: A National Survey of Safety Net Hospitals | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 8، دوره 6، شماره 4، مهر 2018، صفحه 294-300 اصل مقاله (1.03 M) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2018.27452.1716 | ||
| نویسندگان | ||
| David N. Bernstein* 1؛ Hao-Hua Wu2؛ Harry E. Jergesen3 | ||
| 1University of Rochester School of Medicine & Dentistry, Rochester, USA | ||
| 2Orthopaedic Surgery Resident: Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, San Francisco, CA, USA | ||
| 3Institute for Global Orthopaedics and Traumatology, Orthopaedic Trauma Institute, San Francisco, CA, USA | ||
| چکیده | ||
| Background: Although it has been shown that perioperative protocols enhance arthroplasty care and safety, it is not known how prevalent their use is in safety net hospitals, which operate with a mandate to treat the poor and underserved. Understanding the elements currently included in standard perioperative arthroplasty protocols at various institutions may help guide future interventions and policy aimed at improving underserved patients’ outcomes. Methods: In this cross-sectional study, safety net hospitals were asked to complete a survey over the phone, via email or in person regarding existence and elements of perioperative management protocols for total hip arthroplasty (THA) and total knee arthroplasty (TKA). Implementation barriers were also addressed. Specifically, survey questions sought to determine the total yearly number of arthroplasty procedures performed at each institution and better understand, among other elements, the following: presence of preoperative pain management protocols, inpatient care pathways, use of social workers and involvement of physical therapy services. Descriptive statistics were calculated and reported. Results: Over 90% of safety net hospitals performing arthroplasty utilized regional anesthetic techniques, inpatient clinical care pathways and inpatient physical therapy. However, 16.7%, 20.0%, 23.3% and 73% lacked social services, anesthesia preoperative clinics, inpatient pain management protocols and preoperative sobriety pathways, respectively. Conclusion: Barriers to receiving arthroplasty care included lack of qualified surgical personnel and concerns about surgical risk in vulnerable patient populations. These findings suggest that further effort is warranted to expand and improve arthroplasty care for the underserved to ensure safety and high quality outcomes. | ||
| کلیدواژهها | ||
| Arthroplasty؛ Health Equity؛ Protocols؛ Safety net hospital | ||
| مراجع | ||
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