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Abstract
Stenosing tenosynovitis (trigger finger) affects approximately 2% of the population. Given the prevalence of trigger finger and rising health care costs, adherence to the cost-effective and evidence-based treatment algorithm will permit better outcomes and allocation of resources. To examine treatment patterns for trigger finger and to determine surgeon-level and patient-level factors that influence adherence to evidence-based treatment. This retrospective population-based cohort study examined deidentified claims for treatment of trigger finger from a national insurance provider using the Clinformatics Data Mart database. Patients were included if they were 18 years or older and treated from January 1, 2002, through December 31, 2016 (excluding a washout period from July 1, 2008, until June 30, 2010), with a new diagnosis of single-digit trigger finger. Data were analyzed from December 21, 2018, through April 28, 2019. Cost-effective and evidence-based research published in July 2009 for the treatment of trigger finger. After excluding the 1-year washout period on either side of July 1, 2009, adherence to the recommended treatment algorithm of 2 corticosteroid injections before surgical release of trigger finger was compared with practice before publication of research supporting this cost-effective and evidence-based approach. In this analysis of 83 667 patients with trigger finger, 52 698 (63.0%) were women, and 20 045 (24.0%) had type 1 or 2 diabetes. Mean (SD) age was 61 (13) years. From 2002 to 2016, an overall increasing trend in adherence to the cost-effective and evidence-based approach to treatment was noted, with no significant increase in adherence in the postpublication era (67.5% vs 73.3%; P = .27). Substantial variation in adherence was observed at the surgeon level (intraclass correlation, 33%). Plastic surgeons had no change in adherence over time compared with orthopedic surgeons (odds ratio [OR], 1.00; 95% CI, 0.98-1.02; P = .90), whereas general surgeons had increased adherence (OR, 1.04; 95% CI, 1.02-1.06; P < .001). Higher-volume surgeons were also more adherent to these evidence-based recommendations (OR, 1.59; 95% CI, 1.53-1.65; P < .001). This study found substantial surgeon-level variation in adherence to evidence-based treatment of trigger finger. Surgeon specialty and volume were associated with differences in adherence. Efforts to understand surgeon barriers to implementation, regardless of physician specialty, appear to be necessary, and better implementation strategies may permit increased uptake of evidence-based treatment of trigger finger.
Highlights
Evidence-based practices are associated with better treatment outcomes and patient satisfaction.[1,2] Despite comprehensive recommendations from researchers and policy makers, physicians often fail to provide patients with proper treatment, resulting in detrimental care, wasted resources, and unnecessary spending.[3]
As health care costs in the United States continue to rise,[4] policy makers are becoming increasingly interested in identifying variations in care to reduce discretionary spending and increase the quality of care
Even with a washout period of 1 year to allow for surgeon uptake of evidence, only 73.3% of patient treatment plans adhered to the cost-effective and evidence-based recommendations outlined in the publication by Kerrigan and Stanwix[14] and reinforced by additional research.[10,11]
Summary
Evidence-based practices are associated with better treatment outcomes and patient satisfaction.[1,2] Despite comprehensive recommendations from researchers and policy makers, physicians often fail to provide patients with proper treatment, resulting in detrimental care, wasted resources, and unnecessary spending.[3] As health care costs in the United States continue to rise,[4] policy makers are becoming increasingly interested in identifying variations in care to reduce discretionary spending and increase the quality of care. Surgical treatment provides patients with satisfactory outcomes, recent evidence suggests that conservative treatment modalities, corticosteroid injections, should be attempted before surgery.[10,11,12,13] In 2009, Kerrigan and Stanwix[14] published a costminimization analysis to identify the least costly and most effective treatment algorithm for trigger finger. Given the high prevalence of trigger finger, a comprehensive understanding of the treatment variations may help guide clinical decisions and aid in the allocation of resources for this patient population
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