Clinical studyClinical effectiveness of laparoscopic fundoplication in a U.S. community
Section snippets
Patient selection
We identified patients who underwent laparoscopic fundoplication between 1997 and 1999 in the largest managed care organization in southeastern Wisconsin (United Healthcare of Wisconsin, Inc.), which had an annual membership of 226,000 to 236,000 during the study. Milwaukee County had a population of 940,164 in 2000 (5). Patients were identified from claims data using codes for laparoscopic fundoplication. All patients received a letter from the managed care organization that outlined the
Results
One hundred and fifty-one patients were identified and sent invitations to participate in the study. One patient had died from unknown causes, and 2 had moved with no forwarding address. Of the 148 patients who are presumed to have received the invitation, 87 (59%) agreed to participate. Six patients were identified as children (under 7 years of age) who could not fill out the symptom questionnaire and were therefore excluded. One patient indicated that the operation had not been performed and
Discussion
We found that the effectiveness of laparoscopic fundoplication in routine clinical practice is poorer than has been reported by referral centers. Effectiveness is an important consideration in disease management and patient education programs because some treatments with proven efficacy are less effective in typical clinical practice (9). Our data suggest that patients need more information about the indications, advantages, and disadvantages of surgery. A few patients underwent surgery solely
Acknowledgements
We are grateful to Janet Edwards of UnitedHealthcare of Wisconsin Inc. for her assistance with the study.
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