Variation in the Use of Therapy following Distal Radius Fractures in the United States

Abstract

Background:Distal radius fractures (DRFs) are one of the most common injuries among the elderly, resulting in significant expense and disability. The specific aims of this study are (1) to examine rates of therapy following DRFs and (2) to identify those factors that influence utilization of therapy and time span between DRF treatment and therapy among a national cohort of elderly patients.Methods:We examined national use of physical and occupational therapy among all Medicare beneficiaries who suffered DRFs between January 1, 2007, and October 1, 2007, and assessed the effect of treatment, patient-related, and surgeon-related factors on utilization of therapy.Results:Overall, 20.6% of patients received either physical or occupational therapy following DRF. Use of therapy varied by DRF treatment, and patients who underwent open reduction and internal fixation were more likely to receive therapy compared with patients who received closed reduction. Patients who received open reduction and internal fixation were also referred to therapy earlier compared with patients who received external fixation, percutaneous pinning, and closed reduction. Surgeon specialization is associated with greater use of postoperative therapy. Patient predictors of therapy use include younger age, female sex, higher socioeconomic status, and fewer comorbidity conditions.Conclusion:Use of therapy following DRF varies significantly by both patient- and surgeon-related factors. Identifying patients who benefit from postinjury therapy can allow for better resource utilization following these common injuries.

Thirty-day Emergency Department Utilization after Distal Radius Fracture Treatment: Identifying Predictors and Variation

“…Consequently, variation in care has been of great interest for researchers investigating ways to help promote high-quality care. 36,37 In our study, we found geographic variation in the ED utilization for DRF-related and potentially preventable pain diagnoses 30 days after treatment. Our findings corroborated with other research on variation in ED admission rates across different United States regions.…”

Utilization of Post-Acute Care Following Distal Radius Fracture Among Medicare Beneficiaries

“…Finally, patients who underwent operative intervention were more likely to receive post-acute rehabilitation, suggesting that treatment type and fracture severity is correlated with the time needed to return to independent functioning. (4)…”

“…Additionally, we excluded all enrollees of Medicare Advantage plans or with bone-malignancy related claims. (4, 5,17) To capture incidence DRF cases, we only included patients who were treated operatively (open reduction and internal fixation (ORIF), external fixation, or percutaneous pinning) or non-operatively (closed reduction, casting or splinting) within 14 days following the earliest diagnosis of DRF. (Appendix 2)…”

“…(1–3) Expenditures related to the treatment of DRFs among Medicare beneficiaries are substantial, and over $210 million is spent annually on DRF treatment by Medicare in the United States. (4,5) Preservation of upper extremity function is essential for independent self-care, and DRF patients commonly experience pain and difficulty in carrying out activities of daily living following injury. (6,7)…”

The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review

“…37 Higher SES has also been found to be associated with greater use of postoperative therapy such as physical or occupational therapy that would presumably be associated with better patient outcomes. 34 A review of claims and regional data revealed that patients of high (OR, 1.57; 95% CI, 1.46-1.70) or medium (OR, 1.22; 95% CI, 1.12-1.32) SES were more likely to receive therapy compared with patients of lower SES.…”