接受过研究员培训的军事骨科肿瘤学家在军事环境中执业时,是否治疗了足够多的患者以保持其肿瘤学专长?

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Ashley B Anderson, Julio A Rivera, James H Flint, Jason Souza, Benjamin K Potter, Jonathan A Forsberg
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引用次数: 0

摘要

背景:美军中接受过研究员培训的骨科肿瘤专家提供常规临床护理,同时还必须随时准备提供战斗伤员护理。然而,肿瘤手术量少可能会妨碍这些外科医生保持相关外科专业知识的能力。军事医疗系统(MHS)中其他手术量较少的专科已经与邻近的民用中心建立了合作关系,以增加手术量,但肿瘤骨科医生是否需要建立类似的合作关系尚未进行研究。本研究的目的是了解美军接受过研究员培训的骨科肿瘤专家的实践模式:我们提出了以下问题:(1) 接受过美军研究员培训的骨科肿瘤专家会治疗哪些诊断?(2)接受过美军研究员培训的骨科肿瘤学家实施了哪些手术?我们使用 MHS 的管理和报告工具查询了军事数据存储库(Military Data Repository),该存储库是国防卫生局内所有医疗保健受益人(现役军人、家属和退休人员)的医疗保健数据的集中存储库,其中包含与现役军人、受过研究金培训的骨科肿瘤学家的国家医疗服务提供者标识符(NPI)编号相关的所有国际通用程序分类法(CPT)代码、ICD-9 和 ICD-10 代码。接受过研究员培训的骨科肿瘤学家由军事专业负责人确定。然后,我们根据 NPI 编号确定了肿瘤骨科医生在 2013 至 2022 财年实施的所有手术。我们根据相关的 ICD 代码,按顶级骨科手术类别(如截肢[因肿瘤和非肿瘤原因实施]、骨折、关节成形术、肿瘤)对 CPT 代码进行了分层。然后按最常见的治疗诊断进行列表:结果:13%的诊断(5996 例中的 796 例)为肿瘤,其中 45%(796 例中的 357 例)为恶性肿瘤。44%的恶性肿瘤(357 例中的 158 例)是原发性的,56% 的恶性肿瘤(357 例中的 199 例)是继发性的;这意味着每位外科医生每年平均治疗 2 名原发性恶性肿瘤患者和 2.5 名继发性恶性肿瘤患者。在研究期间,9 位骨科肿瘤专家共进行了 5996 例骨科手术,即每位外科医生每年进行 74 例手术。21%的手术(5996 例中的 1252 例)是肿瘤手术;其余手术包括 897 例关节置换术、502 例骨折相关手术、275 例非肿瘤适应症截肢手术、204 例感染手术、142 例关节镜手术和 2724 例其他手术:尽管军事骨科肿瘤学家拥有可直接用于战斗伤员护理和战备的专业技能,但在MHS医院内,他们治疗的肿瘤诊断患者相对较少,其中涉及恶性肿瘤的不到二分之一:尽管毕业后的手术量在过去十年中保持稳定,但在肌肉骨骼肿瘤学研究员培训结束后,有多少肿瘤诊断的新患者就诊以及有多少相应的肿瘤手术是保持能力或建立信心所必需的,目前尚不得而知。值得注意的是,目前还没有军事骨科肿瘤学研究金,所有现役骨科肿瘤学家都在民事机构接受培训。与大容量癌症中心建立军民合作关系可使军事骨科肿瘤学家在民用癌症中心工作,以增加其肿瘤工作量,从而确保维持与业务相关的知识、技能和能力,并改善患者护理和治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?

Background: Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship-trained orthopaedic oncologists.

Questions/purposes: We asked the following questions: (1) What are the diagnoses treated by US military fellowship-trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship-trained orthopaedic oncologists?

Methods: We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS's Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship-trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated.

Results: Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures.

Conclusion: Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies.

Clinical relevance: Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.

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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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