February 21, 2018 | Today’s News

Study: How does arthroscopy compare to PT for FAI?

A study published online in The American Journal of Sports Medicine compares arthroscopic surgery to nonsurgical management for femoroacetabular impingement (FAI). The authors conducted a randomized, controlled trial of 80 patients aged 18 to 60 years, of whom 73 (91.3 percent) were active-duty members of the military Patients in the rehabilitation cohort were treated with a 12-session physical therapy (PT) program within 3 weeks of enrollment in the study, while patients in the surgical cohort underwent surgery at a mean 4 months after enrollment. At 2-year follow-up, the authors noted statistically significant improvement in both groups in Hip Outcome Score and International Hip Outcome Tool, but the mean difference was not significant across cohorts. Two patients assigned to the surgery group did not undergo surgery and 28 patients in the rehabilitation group ended up undergoing surgery. However, a sensitivity analysis of “actual surgery” to “no surgery” did not change the outcome.

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Study: Hydroxychloroquine may not reduce symptomatic pain among patients with radiographic hand OA

Data from a study conducted in the United Kingdom and published online in the journal Annals of Internal Medicine suggest that hydroxychloroquine may be no more effective than placebo for pain reduction among patients with hand pain and radiographic osteoarthritis (OA). The researchers conducted a randomized, double-blind, placebo-controlled trial of 210 participants (mean age, 62.7 years) with symptomatic and radiographic hand OA, who were treated with 200 mg to 400 mg hydroxychloroquine or placebo for 12 months. At 3-, 6-, and 12-month follow-up, they found no significant difference in average hand pain across cohorts. The researchers write that baseline structural damage or synovitis did not affect treatment response. Overall, 15 serious adverse events were reported—seven in the hydroxychloroquine group (three defined as possibly related) and eight in the placebo group.

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According to a study published online in the journal Menopause, menopausal hormone therapy (HT) may help reduce risk of hyperkyphosis for elderly women. The authors reviewed data on 1,063 women (mean age, 83.7 years) participating in the Study of Osteoporotic Fractures They found that 46 percent of participants were characterized as never users of HT, 24 percent remote past users, 17 percent intermittent users, and 12 percent continuous users. After adjustment, the authors found that the mean Cobb angle was 2.8° less in continuous and remote past HT users compared with never users, while intermittent users did not differ from never users in degree of kyphosis.

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A study published in the Feb. 20 issue of The Journal of the American Medical Association ( JAMA) estimates administrative costs associated with physician billing activities in a large academic healthcare system with a certified electronic health record system. Members of the research team interviewed 27 health system administrators and 34 physicians to construct a process map charting the path of an insurance claim through the revenue cycle management process at a single academic medical center. They estimated processing time and total costs for billing and insurance-related activities to be 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of those, time and costs for activities carried out by physicians were estimated to be 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure.

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Findings from an exploratory study published online in the journal Health Education Research suggest that a lay health worker (LHW) model may help reduce readmission rates for certain high-risk patients. The researchers implemented a quasi-experimental study to assess implementation of an LHW model for assisting high-risk patients with post-discharge social needs at a single, rural, community hospital. They found that implementation of the LHW model was associated with a 47.7 percent relative reduction of 30-day hospital readmissions. After adjustment for education, transportation cost, and anxiety symptoms, they found a 77 percent decrease in likelihood of readmission among those exposed to the LHW program.

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An opinion piece published in the Feb. 20 issue of JAMA argues that service sharing arrangements may offer a mechanism to help small medical practices meet the broader goals of delivery system reform. The writers note that from 1983 to 2014, the percentage of physicians in practices of 10 or fewer declined from 80 percent to 61 percent, and the percentage of physicians in solo practice fell from 44 percent to 19 percent. “Some small practices are experimenting with ways to pool resources across groups, while maintaining their independence and intimacy,” they write. Contracts with shared service providers to pool and manage resources may take several forms, and “may allow small practices to compete in value-based contracts and a policy atmosphere favoring consolidation.”

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Call for volunteers: Shoulder & Elbow Evaluation Committee

March 31 is the last day to apply for chair of the Shoulder & Elbow Evaluation Committee. Members of the Evaluation Committees write questions for the orthopaedic self-assessment examinations. Applicants for this position must be active or emeritus fellows with extensive knowledge and experience in shoulder and elbow.

Learn more and submit your application…  (member login required)