title: Time from Booking Until Appointment and Healthcare Utilization in Hand Surgery Patients with Discretionary Conditions.
abstract: Delaying treatment for benign musculoskeletal conditions may allow patients to learn self-efficacy and develop coping strategies, leading to less medical intervention and reduced cost. We tested the hypothesis that time from booking until appointment is not associated with healthcare costs. We further tested the secondary hypothesis that time from booking to appointment is not associated with specific healthcare utilizations. We identified 16,750 patients (55 % women; mean age 50 years) making first clinic visits to hand surgeons at our hospital between January 1, 2003 and December 31, 2012. Booking time was defined as the time between the scheduling of an appointment and the actual visit. Imaging procedures, injections, nerve conduction studies, occupational therapy visits, surgery, and referrals were determined up until the patient's second visit with the surgeon, or 90 days. Costs were determined in Relative Value Units. Duration between booking and office visit was not associated with higher cost (regression coefficient [β] 0.0023, P = 0.77). Duration between booking and office visit was associated with a higher rate of nerve conduction studies (odds ratio [OR] 1.02, P < 0.001) and a lower rate of occupational therapy (OR 0.98, P < 0.001). There was substantial variation between surgeons. Greater wait time was not therapeutic, but is associated with different diagnostic and treatment measures that suggest people that are willing to wait have different types of problems. The variation by surgeon may make variation based on other factors, including time between booking and appointment, difficult to discern.
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kuntz
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Teun
authors.initials: T
authors.lastname: Teunis
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Johann
authors.initials: J
authors.lastname: Blauth
authors.affiliation: Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David
authors.initials: D
authors.lastname: Ring
keywords: Cost; Utilization; Variation; Wait time