ANALYSIS/PRACTICES: HIP FRACTURE REPAIR & OSTEOARTHRITIS

这个五年计划建议评估替代的管理途径。 适用于髋部骨折和人工全髋关节置换术患者 骨性关节炎的替代物。这是两个密切相关的程序 每年在美国老年人口中有很大一部分人进行了这项研究。这个 最终目标是向从业者提供准确的信息，以便 提高医疗质量，优化医疗服务利用 资源。 该项目的主要目标是：1)进行研究以评估 替代管理选项的有效性；2)构建 根据这些研究的分析提出管理建议；3) 向从业者广泛传播这些建议；4)衡量， 在可能的情况下，这些建议对实践模式的影响。 为了实现前两个目标，我们建议使用一个决策 确定替代护理管理选项的分析方法。结果 决策分析所需的概率将根据数据进行估计 源自：1)使用帐单对辅助数据进行回溯分析 65岁及以上老年医疗保险的五年100%抽样数据 接受髋部骨折住院治疗的受益人 马里兰州所有医院的骨关节炎全髋关节置换术 1985-1989年；和2)通过以下途径获得的主要数据的前瞻性分析 两项针对不同患者队列的平行研究。一种新的合成方法 来自这些研究的数据将填写决策中的概率 模型并将为临床提供建议的基础 管理层。 为实现第三个目标，将传播这些建议 通过在继续教育计划中的演讲，演讲到 个别医院工作人员，在马里兰州会议上的陈述 矫形外科学会，期刊出版物，并为Lay制作视频 公开的。 第四个目标，即评价影响，将通过一个 使用医疗保险账单数据前后分析的一系列研究， 七(加一)护理过程前后分析 医院与医生态度前后的比较 问卷调查。

This five year project proposes to evaluate alternative management pathways for patients with hip fracture and patients being considered for total hip replacement for osteoarthritis. These are two closely related procedures performed on a large percent of the elderly U.S. population annually. The ultimate goal is to provide accurate information to practitioners in order to improve quality of care and to optimize utilization of health care resources. The primary objectives of this project are: 1) to conduct studies to assess the effectiveness of alternative management options; 2) to construct management recommendations based on the analysis of these studies; 3) to widely disseminate these recommendations to practitioners; 4) to measure, where possible, the impact of these recommendations on practice patterns. To achieve the first two objectives, we propose to utilize a decision analysis approach defining alternative care management options. Outcome probabilities needed for the decision analysis will be estimated from data derived from: 1) a retrospective analysis of secondary data, using billing data on a five year 100% sample of 65 years and older Medicare beneficiaries undergoing hospital management of hip fracture and receiving total hip replacement for osteoarthritis in all Maryland hospitals from 1985-1989; and 2) a prospective analysis of primary data obtained through two parallel studies on separate cohorts of patients. A synthesis of the data from these studies will fill out the probabilities in the decision models and will provide the basis of recommendations for clinical management. To achieve the third objective, the recommendations will be disseminated via presentations at continuing education programs, presentations to individual hospital staffs, presentations at the meetings of the Maryland Orthopedic Society, journal publications, and a video production for lay public. The fourth objective, evaluation of impact, will be achieved through a series of studies using before and after analyses of medicare billing data, before and after analyses of process of care in the seven (plus one) hospitals, and before and after comparisons of physician attitude questionnaires.