Taxonomy I Part II-A2 (Fracture Care & Orthopaedics)

(16 March 2006 18:47)

NATIONAL PROJECT ON THE COMMUNITY BENEFITS

OF FAMILY MEDICINE RESIDENCY PROGRAMS

CUMULATIVE QUESTIONNAIRE RESPONSES

Taxonomy Section I Part IIA

(Sports Medicine, Fracture Care and Orthopaedics)

Part 2 (Fracture Care and Orthopaedics)

SD I.13b (L32) Does your residency provide specialty care?

SD I.13b(0) If yes, list these services in approximate order of volume or revenue.

(Is fracture clinic listed?)

Site-visited profiled residencies:

Yes:

Northridge        (Listed after maternity care and sports medicine; and before dermatology, podiatry, neurology and minor surgical care)

SD I.13b(1) (L32) Does your residency program provide the following kinds of specialty care?  b. Fracture clinic? Yes __ No __ Additional Info:

If yes, are these services provided during special clinics? What is the number of patients seen? What are the revenues that are generated?

Yes:

UCSD Traditional         (within family health center)

White Memorial            (within family health center)

USC Univ & SG          (happens in private orthopods? offices)

Indiana U Methodist     (we provide fracture care)

No:

Scripps Chula Vista

UCSD St Vincent

UC Irvine

Riverside

Durant                          (fracture care provided in an outpatient setting)

OSU Tulsa

Modesto

Saints

SD I.13b(2.1) (SD I.13b(2) (L32)) Does your residency program provide the following kinds of specialty care?  b. Fracture care? Yes__ No __

Yes:

Pomona

Arrowhead

Loma Linda

Stockton

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

No:

Whittier

Natividad

Las Vegas                      (Not very often)

SD I.13b(2.2) (SD I.13b(3)) If you do provide fracture care, are these services provided as normal family health center appointments?

Yes __ No __

Yes:

Pomona

Loma Linda

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Fresno

Springfield

Glasgow

Lexington

No:

Arrowhead

Stockton

SD I.13b(2.3) (SD I.13b(4)) If you do provide fracture care, are these services provided during special clinics? Yes __ No __

If yes, what is the number of patients seen?  What revenues are generated in each specialty service?

Yes:

Pomona

Arrowhead                   (120)

Loma Linda                  (1000/yr)

Stockton                      (24 patients per half-day; no idea of revenues)

OU Tulsa                     (fracture care is performed during sports medicine clinics; typically 3 out of 19 patients involve fractures)

OU Oklahoma City      (number of patients and revenues to be determined)

Klamath Falls               (2 fracture cases a week; $100/wk revenue)

Kaiser LA                    (most fractures are seen in the orthopaedic clinic, where FP residents provide services, or in the ER; however, fracture care does take place in the sports medicine clinic)

Lexington                     (Will check with sports medicine coordinator on productivity and revenues)

OHSU Portland            (2/wk maybe, generating $400/mo income)

No:

Louisville

MCE Birmingham

Glendale

Dayton Community

Miami Valley

Decatur

Mercer

Lehigh Valley

Mercy Toledo

Tyler

Fresno

Springfield

Glasgow

SD I.13b(2.31) (PP) Do you perform initial evaluation of extremity injuries within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail responses (2005 Questionnaire 1):

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

NPCB P2 I.13b(2.32) (SD I.13b(2.32) (PP)) Does your residency program provide interpretation of X-rays of potential extremity fractures within your family medicine center?

Yes __ No __

Yes:

Fresno

Springfield

Lexington

OHSU Portland

Yes (Phase 2 Responses):

Sparrow

Huntsville

Ventura

Long Beach

Crozer-Keystone

Jefferson

Oahu

Shadyside                     (The x-rays are over-read by the Department of Radiology, which is tied to our program electronically)

St Margaret

Fairfax

No:

Las Vegas

Glasgow

No (Phase 2 Responses):

U Penn

McKeesport

Johnstown

Altoona

SD I.13b(2.33) (PP) Do you provide splinting and casting services within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

E-mail responses (2005 Questionnaire 1):

Yes:

UCSD Traditional

UC Irvine

White Memorial

Riverside

Indiana U Methodist

Whittier                        (rarely)

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

No:

UCSD St Vincent

Modesto

Arrowhead

*NPCB P2 I.13b(2.33.1) (SD I.13b(2.33.1)) Does your residency program provide splinting services within your family medicine center? Yes __ No __

Yes:

Glasgow

Lexington

OHSU Portland

Sparrow

Huntsville

Ventura

Long Beach

U Penn

Crozer-Keystone

Jefferson

Oahu

No:

McKeesport

*NPCB P2 I.13b(2.33.2) (SD I.13b(2.33.2)) Does your residency program provide casting services within your family medicine center? Yes __ No __

Yes:

OHSU Portland

Sparrow

Huntsville

Ventura

Long Beach

U Penn

Crozer-Keystone

Jefferson

Oahu

No:

Glasgow

Lexington                     (rarely)

McKeesport

SD I.13b(2.34) (PP) Do you take care of non-displaced, closed fractures within your family medicine center? Yes__ No__

Yes:

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

No:

Las Vegas

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UC Irvine

White Memorial

Riverside

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale                       (rarely)

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

No:

UCSD St Vincent

Modesto

SD I.13b(2.35) Do you perform selected closed reductions of the extremities within your family medicine center? Yes __ No __

Yes:

Lexington

OHSU Portland

No:

Las Vegas

Fresno

Springfield

Glasgow

E-mail Responses (2005 Questionnaire 1)

Yes:

UC Irvine

Riverside

Indiana U Methodist

Glendale                       (rarely)

Dayton Community

Klamath Falls

Kaiser LA

Tyler

No:

UCSD Traditional

UCSD St Vincent

White Memorial

Modesto

Whittier

Arrowhead

Loma Linda

Decatur

Mercer

Lehigh Valley

Mercy Toledo

SD I.13b(2.36) (PP) Do you evaluate and manage clavicular fractures within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow                       (but we haven?t had any)

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UC Irvine

White Memorial

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

No:

UCSD St Vincent

No Response:

UCSD Traditional

Riverside

SD I.13b(2.4) (SD I.13b(5)) Describe the kinds of fracture care that typically take place within the family health center (whether as normal appointments or during special clinics):

Glendale                       (casting and splinting)

OU Tulsa                     (splints and casts; closed reductions)

OU Oklahoma City      (initial evaluation; follow-up monitoring of rehabilitation; splints and casting)

Dayton Community       (splints, casting)

Miami Valley                (simple fractures; casting and splinting; x-rays)

Decatur                        (non-displaced fractures, splints only, no casting)

Mercer                         (arm and hand splints; simple casts)

Klamath Falls               (fractured wrists; clavicles; non-surgical injuries; if requiring casting or specialty care, patient is referred to orthopaedics)

Mercy Toledo              (non-displaced closed fractures; digits ? toes, hands and feet)

Kaiser LA                    (fracture care in sports medicine clinic)

Tyler                            (management of splinting and casting; uncomplicated fracture care; X-ray interpretation)

SD I.13b(2.41) (SD I.13b(5)) Describe any other kinds of fracture care that typically take place within the family health center (whether as normal appointments or during special clinics):

Las Vegas                    (none)

Fresno  (none)

Springfield                    (ankle injuries)

Glasgow                       (none)

Lexington                     (this question should be answered by our sports medicine coordinator)

OHSU Portland            (Rib fractures; nose fractures)

SD I.13c (L32) Does your residency provide specialty care?

SD I.13c (0) If yes, list these services in approximate order of volume or revenue.

(Is orthopaedic care listed?)

Yes:

Kansas U                     (orthopaedics clinic (for the orthopaedics service))

Klamath Falls               (listed first, followed by urology clinic, psych consult clinic and sports medicine clinic)

SD I.13c(1) (L32) Does your residency program provide the following kinds of specialty care?   c. Orthopaedic clinic Yes __ No __ Additional Info:

If yes, are these services provided during special clinics? What is the number of patients seen? What are the revenues that are generated?

Yes:

UCSD Traditional         (within family health center)

White Memorial            (within family health center)

USC Univ & SG          (happens within private orthopods offices)

Modesto

No:

Scripps Chula Vista

UCSD St Vincent

UC Irvine

Riverside

Durant

OSU Tulsa

Saints

Indiana U Methodist

SD I.13c(3.1) (SD I.13c(2) (L32)) Does your residency program provide the following kinds of specialty care?  c. Other orthopaedic care Yes __ No __

Yes:

Whittier

Pomona

Arrowhead

Loma Linda

Stockton

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

SD I.13c(3.2) (SD I.13c(3)) If you do provide orthopaedic care, are these services provided as normal family health center appointments? Yes __ No __

Yes:

Whittier

Pomona

Loma Linda

Stockton

Louisville

MCE Birmingham

Glendale

OU Tulsa

OU Oklahoma City

Dayton Community

Miami Valley

Decatur

Mercer

Natividad

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

No:

Arrowhead

SD I.13c(3.3) (SD I.13c(4)) If you do provide orthopaedic care, are these services provided during special clinics? Yes __ No __

If yes, what is the number of patients seen?  What revenues are generated in each specialty service?

Yes:

Arrowhead                   (500 patients)

Loma Linda                  (1000/yr)

Stockton                      (14 per clinic; revenues of an unknown amount are generated)

OU Tulsa                     (part of the sports medicine clinic)

OU Oklahoma City      (patient numbers and revenues to be determined)

Dayton Community       (clinics takes place in the orthopaedic service clinic of the hospital; because there are no orthopaedic residents, that department depends on family medicine residents)

Klamath Falls               (30 week, producing $1800/wk revenue)

Las Vegas                    (revenues generated; number of patients and revenues presently unknown)

Lexington                     (will obtain revenue and productivity data)

OHSU Portland            (off-site, not sure of numbers; no revenues generated)

No:

Whittier

Pomona

Louisville

MCE Birmingham

Glendale                       (we used to have an orthopod supervising a special clinic)

Miami Valley                (FP residents have clinics in both Miami Valley and Children?s Hospital orthopaedic services; and in community orthopods offices.  Orthopaedic residents are also present at Miami Valley Hospital and at Children?s Hospital)

Decatur

Mercer

Natividad

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

Fresno

Springfield

Glasgow

SD I.13c(3.31) (PP) Do you evaluate and manage back pain within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

Riverside

White Memorial

Modesto

Whittier

Arrowhead

Loma Linda

Indiana U Methodist

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

SD I.13c(3.32) (PP) Do you treat osteoarthritis within your family medicine center?

Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

SD I.13c(3.33) Do you perform joint aspirations within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Lehigh Valley

Mercy Toledo

Kaiser LA

Tyler

No:

White Memorial

SD I.13c(3.34) (PP) Do you treat tendonitis within your family medicine center

Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Mercy Toledo

Kaiser LA

Tyler

SD I.13c(3.35) Do you evaluate and manage carpal tunnel syndrome within your family medicine center? Yes __ No __

Yes:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

OHSU Portland

E-mail Responses (2005 Questionnaire 1)

Yes:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Arrowhead

Loma Linda

Glendale

Dayton Community

Decatur

Mercer

Klamath Falls

Mercy Toledo

Kaiser LA

Tyler

SD I.13c(3.36) (PP) Do you routinely refer carpal tunnel syndrome patients to orthopaedics?  Yes __ No __

Yes and No:

OHSU Portland            (About one-third are treated conservatively

within the residency program; about two-thirds are referred for surgery)

No:

Las Vegas

Fresno

Springfield

Glasgow

Lexington

E-mail Responses (2005 Questionnaire 1)

Yes:

Arrowhead

Decatur

No:

UCSD Traditional

UCSD St Vincent

UC Irvine

White Memorial

Riverside

Modesto

Indiana U Methodist

Whittier

Loma Linda

Glendale

Mercer                         (The question is unclear; we routinely refer when they do not respond to conservative care, so would you answer ?Yes??)

Klamath Falls

Mercy Toledo              (Not routinely)

Kaiser LA

Tyler

No Response:

Dayton Community

SD I.13c(3.4) (SD I.13c(5)) Describe the kinds of orthopaedic care that typically take place within the family health center (whether as normal appointments or during special clinics):

Glendale                       (shoulder and back pain; shoulder, elbow and knee injections for inflammatory pain)

OU Tulsa                     (back pain; arthritis joint injections; therapeutic injections; we refer MRIs, CTs and surgery)

OU Oklahoma City      (tendonitis; neck and back pain; rotator cup strains; PT oversight)

Dayton Community       (splints; casting; knee bracing; determining if MRIs are needed; shoulder, back, knee, feet, hand pain)

Miami Valley                (casting and splinting; joint injections and aspirations; x-rays; osteoporosis; major joints, rotator cuff and shoulder disorders; generalized osteoarthritis; hip, knee and ankle disorders)

Decatur                        (injections; sprains; strains; refer out casting, no casting)

Mercer                         (sprains, backaches, inpatient orthopaedic consultation)

Natividad                     (low back pain; carpo-tunnel syndrome; tennis elbow; routine pediatric musculo-skeletal injuries; shoulder, knee, ankle sprains)

Klamath Falls               (assessment of joints; arthritis; joint injections; referrals for physical training; referrals for investigative treatment and surgery)

Lehigh Valley                (back pain; knee pain; osteoarthritis; hip pain; shoulder pain)

Mercy Toledo              (post-surgical care; post-hit replacement; joint injections; tendonitis; soft tissue injections)

Kaiser LA                    (low back pain; other minor orthopaedic presentations)

Tyler                            (chronic arthritis; back and shoulder pain management; joint injections)

SD I.13c(3.5) Describe any other kinds of orthopaedic care that typically takes place within the family medicine center

Las Vegas                    (sprains, strains, bursitis)

Fresno                          (none)

Springfield                    (neck pain; shoulder pain)

Glasgow                       (trigger point injections; joint injections; plantarfasciitis; neck pain; spinal stenosis)

Lexington                     (strains and sprains of all kinds; joint injections)

OHSU Portland            (joint injections; tendon sheath injections; trigger point injections)

NPCB P2 I.13c(3.37) For what conditions would your residency program refer patients to orthopaedists? What is the expected wait time before the patient is seen?

Sparrow                       (Any kind of complicated fracture care ? necks, backs; nerve compression requiring surgery; joints needing scoping or surgery; occasionsally, unexplained shoulder or knee pain.  Accedss is very difficult for Medicaid patients ? 3 weeks to be seen, although sometimes immediately with a physician?s call; however, most referral specialists will only see the Medicaid patient in the ER.)

Huntsville                      (Open fractures go straight to the emergency room; we will see some non-displaced, especially single bone fractures in the family medicine center, but many of these are referred to orthopaedists.)

Ventura                        (Any complex fracture that requires reduction, apart from simple finger fractures, etc.; wait time is one day or less.)

Long Beach                  (We will do closed, non-displaced fractures.  Anything else we refer; referrals are seen within a week.)

U Penn                         (Any referrals are physician specific.  The wait time is from the same day to two or three months.)

Crozer-Keystone          (Surgery only; patients are seen within two weeks)

Jefferson                       (Surgical; wait time depends on acuity of injury.  An acute injury is seen within two days; routine injuries take 4-6 weeks.)

McKeesport                 (Fractures; candidates for surgery; herniated disks; the wait time is from one day to one week.)

Oahu                            (Any complicated fractures; if urgent, they are seen the same day)

Shadyside                     (Surgical orthopaedics and certain kinds of fracture care; usually, our patients are seen the same day)

Johnstown                    (All fractures; anything needing operative orthopaedic management; the next day for fractures, two weeks for chronic conditions, except that only one orthopaedist will see patients without medical assistance)

Altoona                        (Fractures; any orthopaedic problem that may need arthroscopy or surgery; the referral time depends upon the problem – the more acute problems may be seen the same day)

St Margaret                  (surgical care; 1 week wait)

Fairfax                          (Most acute things are done here, but some acute injuries or complicated fractures are referred; arthroscopy and surgery; also unstable knee, not responding to conventional practice)

*NPCB P2 I.13c(4)  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient or outpatient settings (or both)?

a) osteoporosis?         Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(4)  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient or outpatient settings (or both)?

b) osteoarthritis?        Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(4)  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient or outpatient settings (or both)?

c) carpal tunnel?         Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(4)  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient or outpatient settings (or both)?

d) tendenosis?            Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(4)  Does your residency program manage the following disorders for your family medicine center patients either in the inpatient or outpatient settings (or both)?

e) simple fractures?   Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(5) Does your residency program follow professional guidelines regarding ordering x-rays for ankle and knee injuries? Yes __ No __

Yes:

Yes:

Santa Rosa

Reading

York                            (Ottawa rules)

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(6) Does your residency program participate in the identification, referral and follow-up care of patients requiring the following tertiary care services?

a) complex open fractures?   Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Lawton

No:

Erie                              (most of these are referred to the trauma center with its own orthopaedic surgery group)

*NPCB P2 I.13c(6) Does your residency program participate in the identification, referral and follow-up care of patients requiring the following tertiary care services?

b) tendon damage?                 Yes __ No __

Yes:

Santa Rosa

Reading                        (we work with sub-specialists on this)

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

*NPCB P2 I.13c(7) Is your residency program able to assure that your family medicine patients have access to the following diagnostic tests, either within your family medicine center or through a process of referral or consultation?

a) imaging of joints, bones and soft tissues?            Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

b) imaging of fractures?                                             Yes __ No __

Yes:

Santa Rosa

Reading

York

Lebanon

Billings

Monroeville

Beaver

Latrobe

Erie

Lawton

Last Updated (04 September 2006 18:31)