Abstract：
:Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.
journal_name
Clin Orthop Relat Resjournal_title
Clinical orthopaedics and related researchauthors
Luft HSdoi
10.1007/s11999-009-0930-7subject
Has Abstractpub_date
2009-10-01 00:00:00pages
2497-505issue
10eissn
0009-921Xissn
1528-1132journal_volume
467pub_type
杂志文章abstract：:Eleven hips in eight patients with Ficat Stage II osteonecrosis were treated with core decompression and placement of an electrical stimulating coil in the anterior superior quadrant of the femoral head. The hips were followed two to five years (average, three and one-half years). Five hips required reoperation at an ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-07-01 00:00:00
abstract：:Musculoskeletal medicine is not taught adequately in American medical schools and the predictable consequences are seen. Students cannot show cognitive mastery of the subject and lack confidence in this topic. To address this, the Academic Orthopaedic Society held a symposium on medical school education at its annual ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000093922.26658.3c
更新日期：2003-10-01 00:00:00
abstract：:In the past decade, two concepts have caused considerable controversy in orthopedic surgery of the knee. Some orthopedic centers contend that osteotomy of the tibia is the procedure of choice for unicompartmental gonarthrosis of the knee and resist the concept of unicompartmental arthroplasty. The other concept is tha...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-01-01 00:00:00
abstract：:The use of a peritoneal catheter enhances diagnosis using arthroscopy by affording a clear visibility of the knee joint. The accuracy in diagnosis is significantly enhanced using this method of irrigation. No better method of irrigation is available for cases of acute knee joint injuries. ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-10-01 00:00:00
abstract：:Varus derotational osteotomy of the femur is designed to correct coxa valga and femoral anteversion which contribute to progressive hip subluxation and dislocation in certain cases of cerebral palsy. By the application of a careful preoperative evaluation, vigorous postoperative rehabilitation and treatment of complic...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1977-06-01 00:00:00
abstract：:Changes in flexural rigidity and compression strength of 18 sheep tibias were investigated after laser perforation and partial demineralization. Test bones were divided into three groups: Group 1, no treatment; Group 2, laser hole grid; and Group 3, laser hole grid and partial demineralization. Starting in the anterio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199808000-00028
更新日期：1998-08-01 00:00:00
abstract：:We evaluated the healing rate, complications, and functional outcomes in 32 adult patients with very short metaphyseal fragments in fractures of the distal tibia treated with a polyaxial locking system. The average distance from the distal extent of the fracture to the tibial plafond was 11 mm. All fractures healed an...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0459-1
更新日期：2009-03-01 00:00:00
abstract：:A prospective study ascertained the effect of lateral retinacular release and/or excision of the infrapatellar fat pad on patellar vascularity after total knee arthroplasty. Fifty patients (70 knees) had postoperative technetium bone scans, which revealed a higher incidence of vascular compromise of the patella after ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-11-01 00:00:00
abstract：UNLABELLED:Proximal tibia fractures present a difficult treatment challenge with historically high complication rates. In a prospective study, we asked whether the Less Invasive Stabilization System (LISS) plate can adequately treat extraarticular and complex intraarticular proximal tibia fractures and provide low comp...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000203467.58431.a0
更新日期：2006-04-01 00:00:00
abstract：:The alkaline phosphatase in leukocytes (LAP) was measured in patients who had undergone various types of total arthroplasty of the hip, in patients who had undergone synovectomy and in whom tibial fractures had been treated conservatively. The LAP-Score increased rapidly and reached a maximum within a few days and ret...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1976-01-01 00:00:00
abstract：:Shoulder arthrodesis, while providing a useful and predictable solution to many problems associated with glenohumeral degeneration, has been less than desirable for many patients due to the frequent need for postoperative spica cast or airplane splint immobilization. A new technique of external fixation of shoulder fu...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1986-10-01 00:00:00
abstract：:With the resurgence of metal-on-metal bearings, there is renewed interest in total hip resurfacing. A cementless acetabular component used for resurfacing with a wall thickness of fewer than 5 mm is comparable in size to acetabular components used for total hip replacement. The fixation of a porous-ingrowth acetabular...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：10.1097/01.blo.0000150319.35347.2d
更新日期：2004-12-01 00:00:00
abstract：:Symptomatic (Stage II) impingement of the rotator cuff against the coracoacromial arch has been treated with anterior acromioplasty in 60 shoulders in 56 patients. Patient selection is crucial. Arthrography of the shoulder was routinely included in the preoperative diagnostic tools to rule out a tear of the rotator cu...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1990-03-01 00:00:00
abstract：:Several extracellular matrices are formed by healing fractures, and the collagens within these matrices have been identified in rabbit and rat fracture models. Type III collagen is the major collagen of the fibrous matrix that forms along the periosteal surface. Type I collagen is secreted in large amounts as trabecul...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1990-06-01 00:00:00
abstract：:Three patients with osteonecrosis of the femoral head in whom the extent of necrosis increased by repeated episodes of osteonecrosis are described. In all cases the evidence of two attacks of osteonecrosis was detected clearly on magnetic resonance images. The significance of the recurrent attacks of osteonecrosis is ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000037441.23683.ee
更新日期：2003-01-01 00:00:00
abstract：:The importance of prompt surgical repair of complete ligament ruptures was quantitated using 38 rabbits with standardized transection injuries ofthe medial collateral ligament of one knee. Tensile testing of the mechanical properties, coupled with histological evaluation allowed assessment of the integrity of suture r...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1978-09-01 00:00:00
abstract：:Reconstruction of the proximal humerus after resection for tumor and modification of the clavicular transposition procedure is described in which the blood supply of the clavicle is preserved and the clavicle is used to bridge the defect. An 11-year-old boy presented with shoulder pain, and the diagnosis was osteosarc...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-200104000-00026
更新日期：2001-04-01 00:00:00
abstract：:Obtaining continuing education can be difficult in countries with limited resources. Members of the Pediatric Orthopaedic Society of North America (POSNA) have developed a program for providing outreach continuing education courses in pediatric orthopaedics. POSNA members provide their own transportation to the host c...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-008-0381-6
更新日期：2008-10-01 00:00:00
abstract：:A review of the existing data on shoulder laxity in females reveals there are insufficient data to confirm the commonly held belief that shoulders in females are more lax than shoulders in males. Laxity is not synonymous with instability. Although females may have increased generalized joint laxity relative to males, ...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：2000-03-01 00:00:00
abstract：UNLABELLED:We report the results of a minimum 21-year followup of a consecutive series of 103 patients who had 136 Marmor cemented unicompartmental knee replacements done between 1975 and 1982. Patients were evaluated clinically and radiographically. At minimum 21-year followup 14 patients (19 knees) were alive, 87 pat...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000185451.96987.aa
更新日期：2005-11-01 00:00:00
abstract：BACKGROUND:Bacteria shed by operating room personnel is a source of wound contamination and postoperative infections. The personal protection system (PPS) was designed to decrease airborne bacteria and intraoperative contamination in total joint arthroplasty. QUESTIONS/PURPOSES:We determined the microbial contaminatio...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-011-1883-1
更新日期：2011-11-01 00:00:00
abstract：:The forces and torques that occur during walking gait, particularly during toe-off, promote articulation in the posteromedial quadrant of tibial inserts. Retrieved components of failed knee arthroplasties show ultrahigh molecular weight polyethylene damage patterns in this region. Component-designed constraint, compro...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000063597.67412.e9
更新日期：2003-05-01 00:00:00
abstract：:Health care costs for inpatient care have been escalating. Homeless and indigent patients may be unable to have access to clean toilet facilities to perform adequate wound care. Evaluation of delayed primary closure of upper extremity soft tissue infections after incision and drainage in 34 patients was done. Patients...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1997-02-01 00:00:00
abstract：BACKGROUND:Exchangeable neck stems, defined as those with a dual taper (that is, a modular junction between the femoral head and the femoral neck and an additional junction between the neck and the stem body), were introduced in THA to improve restoration of joint biomechanics (restoring anteversion, offset, and limb l...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1007/s11999-017-5260-6
更新日期：2017-08-01 00:00:00
abstract：:Prompt diagnosis of proximal lower extremity deep vein thrombosis in outpatients is critical because of the risk of pulmonary embolism. Our purpose was to determine the accuracy of orthopaedists' clinical decisions regarding the diagnosis of proximal deep vein thrombosis in outpatients. A nationally representative ran...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/01.blo.0000152599.53574.a5
更新日期：2005-03-01 00:00:00
abstract：:Design of a synthetic replacement or selection of a biologic substitute requires detailed knowledge of the mechanical properties of the normal ligament. Femur-anterior cruciate ligament-tibia unit (ACL) data have been frequently used for this purpose, although not always properly. Mechanical properties of the human AC...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章,评审
doi：
更新日期：1985-06-01 00:00:00
abstract：:Two hundred thirty-four primary total knee prostheses were evaluated with a 45 degrees merchant view to examine patellar position and fixation. Despite a standardized technique for obtaining roentgenographs, patellar position varied with leg position. Overall, 54.7% tracked centrally, 31.2% tilted, and 14.5% displaced...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：:Bilateral epiphyseometaphyseal cupping of the distal femoral epiphysis occurred in a 9-year-old girl with a history of infantile scurvy. This rare condition is characterized by a cup-shaped depression of the metaphyseal end, growth disturbance at the distal femoral epiphysis and knee flexion contracture which develops...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1980-11-01 00:00:00
abstract：:The radiographs of 57 patients who had undergone 58 callus distractions and 13 epiphyseal distractions were evaluated. During the course of treatment, the density of the distraction areas on radiographs was measured in total and along the medial, lateral, ventral, and dorsal margins using a digital radiograph processi...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：10.1097/00003086-199602000-00036
更新日期：1996-02-01 00:00:00
abstract：:After reviewing a series of 220 patients operated upon between 1975 and 1985 for traumatic brachial plexus injuries, the authors present the results of 103 myelographies, 48 computed tomographies (CT scans) combined with standard myelography, and 25 series of images obtained by magnetic resonance imaging (MRI). To eva...
journal_title：Clinical orthopaedics and related research
pub_type： 杂志文章
doi：
更新日期：1988-12-01 00:00:00
