All ETDs from UAB

Advisory Committee Chair

Nancy Borkowski

Advisory Committee Members

Christy H Lemak

Allyson Hall

Monica Aswani

Document Type

Dissertation

Date of Award

2023

Abstract

THE INFLUENCE OF PROXIMITY ON PATIENT OUTCOMES FOR DIFFERENTLY STRUCTURED AMBULATORY SURGERY CENTERSWENDY SMITH HEALTH SERVICES ADMINISTRATION ABSTRACT This study examines the complication rates and patient-reported outcome measures (PROMs) for total hip and knee replacement surgeries conducted in one of two differently structured ambulatory surgical centers (ASCs) with varying interprofessional surgical teams. There is an ongoing shift from in-hospital total joint replacement surgeries to ASCs. Additionally, there is specialization occurring within ASCs. In this study, we compare single specialty ASCs designed to perform solely TJR surgeries with one orthopedic group and interprofessional team, with multi-specialty ASCs that perform an array of surgical procedures including TJR with multiple orthopedic groups and interprofessional team members. Understanding the influence proximity has on the varying interprofessional surgical teams and outcomes, this study used paid claims for 2,843 observations of total hip and knee (TJR) performed in six ASC structures (3 single specialty and 3 multi-specialty) to examine if proximity in the single vs multi-specialty ASCs influenced patient outcomes for two population sets - under 65 and over 65 age groups. Using the Diagnosis Related Grouping (DRG) 470 (without major co-morbidities) for total hip and knee joint replacements performed in either a single specialty or multi-specialty ASC, this study reported low complication rates and high patient-reported outcomes for both populations and ASC structures., with the multi-specialty ASCs outperforming the single-specialty ASCs. As such, our results show that the variation and proximity of the teams did not influence outcomes. Future research should include an expanded set of ASCs with more observations, weighted risk adjustment scores for patient complexities, and a mixed methods approach to address the training and processes within differently structured ASCs.

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