Speaker | Transcript |
| Ken Kovats | Hello, everybody. My name is Ken Kovats. I work for the US Army's Medical Command Readiness Analytics Division at Fort Sam Houston, Texas. |
| The question we sought to answer was whether there was a significant difference in the rates of surgical intervention for military service members diagnosed with a meniscal tear between those treated in a military treatment facility and those referred to the civilian network. |
| The incidence in miniscus injury in active duty military service members is almost 10 times higher than that of the civilian population. Treatment of miniscal tears can either be done surgically or non surgically. |
| Surgical intervention not only costs more, but also has a risk of post operative complications and can extend the time of soldier is on limited duty, which impacts unit readiness. |
| Depending on the installation they are stationed at, military service members can be treated at either a Department of Defense military treatment facility or they can be referred to a local civilian provider in the surrounding community. |
| We wondered if military service members who were referred to a civilian provider had a higher probability of having surgical treatment than a service member treated at the military treatment facility. |
| One working theory is that civilian orthopedic surgeons might be more inclined to recommend surgical intervention, as surgical procedures are reimbursed at a higher rate. |
| Whereas military orthopedic surgeons, who are salaried, may lean towards more non surgical intervention, such as extensive physical therapy. |
| Data for the study was extracted from the military health system medical data repository, which contains clinical encounter and procedure data for both military and civilian patient encounters. |
| Using SAS version 9.4, we extracted data from active duty service members who had an initial diagnosis of meniscus tear during the calendar year 2017, and we then extracted all follow up encounters from one that diagnosis. |
| It included MRIs and other radiological studies, physical therapy visits, orthopedic surgeon encounters, and if necessary, a surgical encounter. |
| We then converted the episode of care into a character string, displaying each encounter for each unique individual as you see in Figure 1 in the center of the main slide. |
| This data set was then imported into JMP. We used the REGEX function in the JMP Formula Editor to create two key variables. |
| The first variable is direct versus purchased care. Did the difinitive care occur in a military or civilian facility based upon whether the orthopedic encounter occured |
| at any military or civilian practice. |
| Second was the treatment variable. |
| Did the patient undergo a surgical procedure based upon the key word "surgery" in the encounter text string? |
| Our second slide here shows descriptive statistics of our study group |
| that you can see in the upper left hand corner. |
| There were a total of 5,158 unique military service members identify. We excluded those stationed overseas and those who had no record of orthopedic surgeon consultation or an MRI on record. |
| 59% were evaluated in the military treatment facilities. |
| 87% were male and 44% of the group were between the ages of 20 and 30. |
| Over all, 64% of the individuals in our study received surgical intervention for their meniscal tears. |
| Using the contingency table...using the contingency table platform in JMP, we observed that of the patients that received care by civilian network provider, 72% received a surgical intervention, compared to 59% of the patients seen by military orthopedic provider, with an odds ratio of 1.79. |
| We also found that males were more likely to have surgery the females, 65% male versus 56% females. And the service members in the 20-30 year old groupd were more likely to have surgery than the other older age group. |
| Now there are several caveats with our initial findings. |
| Although there are higher rates of surgical intervention for the civilian purchased care cohort, we cannot determine if the differences in surgical rates were due to the overtreatment in purchased care setting or the undertreatment in the direct care setting. |
| The source data from the study was primarily administrative and perhaps may have some coding errors or lack of details to understand the exact nature of the surgical decision making process. A peer review of clinical records may be necessary to provide more insight as to the rationale of surgical or nonsurgical intervention. |
| Most of the military service members referred to the civilian network we were stationed at locations without on-base orthopedic |
| surgical capabilities, thus requiring those folks to be evaluated and treated downtown in most cases. |
| Based upon our initial findings at the probability of surgical intervention was higher for civilian orthopedic providers than for military |
| orthopedic providers, future studies will now look at specific military installation locations with high rates of surgical intervention. We will focus on outcome measures and lost duty time, which can aid in the determination of the distribution of military orthopedic surgeons in the near future. |
| That's our study. |
| Thank you for listening. |
