Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery
IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic va...
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| Veröffentlicht in: | JAMA internal medicine 2014-03, Vol.174 (3), p.380-388 |
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| creator | Thilen, Stephan R Treggiari, Miriam M Lange, Jane M Lowy, Elliott Weaver, Edward M Wijeysundera, Duminda N |
| description | IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non–medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small ( |
| doi_str_mv | 10.1001/jamainternmed.2013.13426 |
| format | Article |
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Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non–medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0–69%]), even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. CONCLUSIONS AND RELEVANCE Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation.</description><identifier>ISSN: 2168-6106</identifier><identifier>EISSN: 2168-6114</identifier><identifier>DOI: 10.1001/jamainternmed.2013.13426</identifier><identifier>PMID: 24366269</identifier><language>eng</language><publisher>Chicago, IL: American Medical Association</publisher><subject>Age Factors ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cataract Extraction ; Female ; General aspects ; Humans ; Lens diseases ; Male ; Medical sciences ; Medicare ; Ophthalmology ; Preoperative Care ; Referral and Consultation ; Retrospective Studies ; Risk Factors ; United States</subject><ispartof>JAMA internal medicine, 2014-03, Vol.174 (3), p.380-388</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright 2014 American Medical Association. All rights reserved. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a469t-ad1022761e71057c0f1ba46b32194e08ac3059fec1ea651a1d19a3a11042fca93</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/articlepdf/10.1001/jamainternmed.2013.13426$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2013.13426$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,230,314,780,784,885,3338,27922,27923,76259,76262</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28192166$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24366269$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thilen, Stephan R</creatorcontrib><creatorcontrib>Treggiari, Miriam M</creatorcontrib><creatorcontrib>Lange, Jane M</creatorcontrib><creatorcontrib>Lowy, Elliott</creatorcontrib><creatorcontrib>Weaver, Edward M</creatorcontrib><creatorcontrib>Wijeysundera, Duminda N</creatorcontrib><title>Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery</title><title>JAMA internal medicine</title><addtitle>JAMA Intern Med</addtitle><description>IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non–medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0–69%]), even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. CONCLUSIONS AND RELEVANCE Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation.</description><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cataract Extraction</subject><subject>Female</subject><subject>General aspects</subject><subject>Humans</subject><subject>Lens diseases</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medicare</subject><subject>Ophthalmology</subject><subject>Preoperative Care</subject><subject>Referral and Consultation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>United States</subject><issn>2168-6106</issn><issn>2168-6114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1rGzEQhkVpaUKSP5BD2UuhFzsaSatdXQrFpB_gkECTsxhrZ12FteRKu4H8-8q16zS6aKR55p1hXsYq4HPgHK4ecYM-jJTChrq54CDnIJXQb9ipAN3ONIB6e4y5PmEXOT_yclrOlZTv2YlQUmuhzSlb3iWKW0o4-ieqFjHkaRjLowRVH1N1Q513mKi6K58Uxlw9hI7SOvqwrhY4YkI3Vj-ntKb0fM7e9ThkujjcZ-zh6_X94vtsefvtx-LLcoZKm3GGHXAhGg3UAK8bx3tYlcxKCjCKeItO8tr05IBQ14DQgUGJAFyJ3qGRZ-zzXnc7rcoOXJkr4WC3yW8wPduI3r7OBP_LruOTVaCbtpFF4NNBIMXfE-XRbnx2NAwYKE7ZQs2VqqWWdUHbPepSzDlRf2wD3O78sK_8sDs_7F8_SumH_8c8Fv7bfgE-HgDMDoc-YXA-v3AtmOLiTuhyz5VOL-0bw43R8g_Uf6GK</recordid><startdate>20140301</startdate><enddate>20140301</enddate><creator>Thilen, Stephan R</creator><creator>Treggiari, Miriam M</creator><creator>Lange, Jane M</creator><creator>Lowy, Elliott</creator><creator>Weaver, Edward M</creator><creator>Wijeysundera, Duminda N</creator><general>American Medical Association</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20140301</creationdate><title>Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery</title><author>Thilen, Stephan R ; Treggiari, Miriam M ; Lange, Jane M ; Lowy, Elliott ; Weaver, Edward M ; Wijeysundera, Duminda N</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a469t-ad1022761e71057c0f1ba46b32194e08ac3059fec1ea651a1d19a3a11042fca93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cataract Extraction</topic><topic>Female</topic><topic>General aspects</topic><topic>Humans</topic><topic>Lens diseases</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medicare</topic><topic>Ophthalmology</topic><topic>Preoperative Care</topic><topic>Referral and Consultation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thilen, Stephan R</creatorcontrib><creatorcontrib>Treggiari, Miriam M</creatorcontrib><creatorcontrib>Lange, Jane M</creatorcontrib><creatorcontrib>Lowy, Elliott</creatorcontrib><creatorcontrib>Weaver, Edward M</creatorcontrib><creatorcontrib>Wijeysundera, Duminda N</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thilen, Stephan R</au><au>Treggiari, Miriam M</au><au>Lange, Jane M</au><au>Lowy, Elliott</au><au>Weaver, Edward M</au><au>Wijeysundera, Duminda N</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery</atitle><jtitle>JAMA internal medicine</jtitle><addtitle>JAMA Intern Med</addtitle><date>2014-03-01</date><risdate>2014</risdate><volume>174</volume><issue>3</issue><spage>380</spage><epage>388</epage><pages>380-388</pages><issn>2168-6106</issn><eissn>2168-6114</eissn><abstract>IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75-84 years vs 66-74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04-1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65-0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49-1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05-1.15]), anesthesia provider (anesthesiologist vs non–medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10-1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33-4.10]). The burden of comorbidity was associated with consultation, but the effect size was small (<10%). Variation in frequency of consultation across hospital referral regions was substantial (median [range], 12% [0–69%]), even after accounting for differences in patient-level, anesthesia provider–level, and facility-level characteristics. CONCLUSIONS AND RELEVANCE Between 1995 and 2006, the frequency of preoperative consultation for cataract surgery increased substantially. Referrals for consultation seem to be primarily driven by nonmedical factors, with substantial geographic variation.</abstract><cop>Chicago, IL</cop><pub>American Medical Association</pub><pmid>24366269</pmid><doi>10.1001/jamainternmed.2013.13426</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Age Factors Aged Aged, 80 and over Biological and medical sciences Cataract Extraction Female General aspects Humans Lens diseases Male Medical sciences Medicare Ophthalmology Preoperative Care Referral and Consultation Retrospective Studies Risk Factors United States |
| title | Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery |
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