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首页> 外文期刊>JAMA surgery >Association of Work Measures and Specialty with Assigned Work Relative Value Units among Surgeons
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Association of Work Measures and Specialty with Assigned Work Relative Value Units among Surgeons

机译：工作措施与外科医生所分配的工作相对价值单位的工作措施和专业

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Importance: The primary data sources used to generate and update work relative value units (RVUs) are surveys of small groups of specialists who are asked to estimate the time and intensity needed to perform surgical procedures. Because these surveys are conducted by specialty societies and rely on subjective data, these sources have been challenged as potentially biased. Objective: To assess whether objective work measures are associated with a surgical procedure's assigned work RVUs and whether differences exist by surgical specialty. Design, Setting, and Participants: This cross-sectional study obtained data from the 2016 and 2017 participant use files of the American College of Surgeons National Surgical Quality Improvement Program. The 2017 physician fee schedule of the Centers for Medicare & Medicaid Services was a secondary data source. Procedures were included if they had at least 100 patient-level observations over the 2-year period. Data were analyzed from August 29, 2018, to April 2, 2019. Main Outcomes and Measures: The dependent variable was a procedure's assigned work RVU. Independent variables of work RVUs were 4 procedure-level work measures (median operative time, median postoperative length of stay, all-cause 30-day readmission rate, and all-cause 30-day reoperation rate) and surgeon specialty (10-level category using general surgery as the reference). Results: The data set included 628 unique Current Procedural Terminology (CPT) codes and 726 CPT-specialty combinations from 1239991 patient observations. Statistically significant associations were found between each work measure and assigned work RVU, as follows: median operative time (R2 = 0.74; 95% CI, 0.71-0.78), postoperative length of stay (R2 = 0.42; 95% CI, 0.36-0.48), rate of readmission (R2 = 0.18; 95% CI, 0.13-0.23), and rate of reoperation (R2 = 0.15; 95% CI, 0.10-0.20). Including all 4 measures explained 80.2% (95% CI, 77.3%-83.1%) of the variation. Adding the surgical specialty improved the overall fit of the model (likelihood ratio test χ2 = 231.27; P <.001). Cardiac (7.78; 95% CI, 4.25-11.31; P <.001) and neurosurgery (2.46; 95% CI, 1.08-3.83; P <.001) had higher work RVUs compared with general surgery, whereas orthopedics (-1.53; 95% CI, -2.48 to -0.59; P =.002), urology (-1.58; 95% CI, -2.88 to -0.29; P =.02), plastics (-2.70; 95% CI, -4.39 to -1.01; P =.002), and otolaryngology (-3.05; 95% CI, -4.69 to -1.42; P <.001) had lower work RVUs compared with general surgery. Conclusions and Relevance: Objective work measures appeared to be associated with assigned work RVUs, predominantly with operative time; registry data can be used to augment and inform the generation and updating processes of the work RVUs. ? 2019 American Medical Association. All rights reserved.
机译：重要性：用于生成和更新工作相对价值单位（RVU）的主要数据源是一小组专家调查，他们被要求估计执行外科手术所需的时间和强度。因为这些调查由专业社会进行并依赖主观数据，因此这些来源受到潜在偏见的挑战。目的：评估客观工作措施是否与手术程序分配的工作RVU相关，以及外科专业是否存在差异。设计，设置和参与者：此横断面研究从美国外科医生国家外科质量改善计划的美国学院的参与者使用档案中获得了数据。 Medicare＆Medicaid Service中心的2017年医生费表是辅助数据源。如果在2年期间至少有100名患者级别观察，则包括程序。从2018年8月29日到2019年8月29日分析了数据。主要结果和措施：受抚养变量是一个程序分配的工作RVU。独立的工作变量RVU是4个程序级工作措施（中位数手术时间，术后术后长度，全部导致30天的入院率，以及全部导致的30天重新进入率）和外科医生专业（10级类别使用普通手术作为参考）。结果：数据集包括628个独特的当前程序术语（CPT）代码和来自1239991患者观察的726个CPT-专业组合。每个工作措施和分配的工作RVU之间发现了统计学意义的关联，如下所示：中值操作时间（R2 = 0.74; 95％CI，0.71-0.78），术后停留长度（R2 = 0.42; 95％CI，0.36-0.48 ），再入率（R2 = 0.18; 95％CI，0.13-0.23）和再生率（R2 = 0.15; 95％CI，0.10-0.20）。包括所有4个措施，解释了80.2％（95％CI，77.3％-83.1％）的变异。添加外科专业改善了模型的整体拟合（似然比测试χ2= 231.27; p <.001）。心脏（7.78; 95％CI，4.25-11.31; p <.001）和神经外科（2.46; 95％CI，1.08-3.83; p <.001）与普通手术相比，矫形器（-1.53​​; 95％CI，-2.48至-0.59; p = .002），泌尿外科（-1.58; 95％CI，-2.88至-0.29; p = .02），塑料（-2.70; 95％CI，-4.39至-4.39 1.01; p = .002）和耳鼻喉科（-3.05; 95％CI，-4.69至-1.42; p <.001）与普通手术相比，RVU较低。结论和相关性：客观的工作措施似乎与指定的工作RVU相关，主要是手术时间;注册表数据可用于增强和通知工作RVU的生成和更新进程。还2019年美国医学协会。版权所有。

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