Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons

PURPOSE: Previous studies have suggested that specialists may achieve bette r clinical outcomes for patients, albeit often at greater cost. We sought t o compare outcomes of care and resource utilization among patients with sho ulder or knee problems who were heated by general internists, rheumatologis ts, and orthopedic surgeons. SUBJECTS AND METHODS: Outpatients with knee or shoulder complaints who were seen by general internists, rheumatologists, or orthopedic surgeons at an academic medical center were administered questionnaires at enrollment in t he study and again 3 months later. The questionnaires included validated me asures of satisfaction, functional status, and pain severity, as well as re source utilization. We compared baseline clinical characteristics, satisfac tion with care, resource utilization, and changes in function and symptoms during 3 months of follow-up among patients who were cared for by the three different types of providers. RESULTS: A total of 534 patients responded to the baseline survey and 436 ( 82%) to the 3-month follow-up survey. About 60% (n = 323) had knee pain. Or thopedists cared for 40% (n = 211) of the patients, with the remainder trea ted in approximately equal numbers by general internists or rheumatologists . At baseline, patients of internists had less severe pain (differences of 0.3 to 0.6 points on a 1 to 5 scale, P <0.05) and functional limitations (d ifferences of 0.4 to 0.6 points on a 1 to 5 scale, P <0.0006) than patients of rheumatologists and orthopedic surgeons. Adjusting for baseline differe nces, there were no significant differences among provider groups in pain r elief or functional improvement during follow-up. However, in adjusted anal yses, patients with shoulder pain who were cared for by orthopedic surgeons were least satisfied with the office environment [adjusted mean (+/- SD) s atisfaction score of 1.6 +/- 0.8 on a 1 to 4 scale for orthopedic surgeons vs 1.3 +/- 0.8 for rheumatologists and 1.4 +/- 0.8 for internists, P = 0.00 4]. Among patients with knee pain, those treated by rheumatologists and ort hopedic surgeons were more satisfied with the doctor-patient interaction (a djusted mean satisfaction scores of 1.1 +/- 0.9 for rheumatologists and 1.2 +/- 0.7 for orthopedic surgeons on a 1 to 4 scale vs 1.4 +/- 0.8 for gener al internists, P = 0.003). Orthopedic surgeons obtained significantly more radiographs of the knee or shoulder and more magnetic resonance imaging sca ns of the knee. Rheumatologists performed significantly more aspirations or injection procedures. Among all patients, those treated by rheumatologists were most satisfied with the physician interaction, and chose treated by o rthopedic surgeons were most satisfied with treatment results. CONCLUSION: The relative benefits of specialist compared with generalist ca re for patients with. knee or shoulder pain depend on the importance attach ed to resource utilization, patient satisfaction, and health outcomes. Am J Med. 2000;108:28-35. (C)2000 by Excerpta Medica, Inc.