factors associated with operative treatment of de quervain tendinopathy
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abstract
background: geographic and doctor-to-doctor variations in care are a focus of quality and safety efforts in medicine. this study addresses factors associated with variation in the rate of operative treatment of de quervain tendinopathy. methods: we used a database including all patient encounters at 2 large medical centers, to study the experience of 10 hand surgeons and 1 physiatrist working in a hand surgery office in the treatment of 2,513 patients with de quervain tendinopathy over a 12-year period. survival analysis using the kaplan-meier method was used to compare surgery rates and time to surgery. cox multivariable regression analysis was applied to identify factors associated with operative treatment. results: one hundred ninety nine (7.9%) patients had surgery. the odds of operative treatment were 1.7 times greater after corticosteroid injection and varied more than 10-fold among providers. there was substantial variation in the overall rate of surgery by provider. corticosteroid injection delayed surgery slightly, but was associated with a higher rate of surgery. conclusion: providers have substantial influence on treatment of de quervain tendinopathy. the use of decision aids and other methods that help involve the patient in decision-making merit investigation as interventions to help reduce doctor-to-doctor variation.
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the archives of bone and joint surgeryجلد ۳، شماره ۳، صفحات ۱۹۸-۲۰۳
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