ANALYSIS/PRACTICES: HIP FRACTURE REPAIR & OSTEOARTHRITIS

分析/实践：髋部骨折修复

• 批准号: 3372330
• 负责人: JAMES I HUDSON
• 金额: $ 24.54万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 1990
• 资助国家: 美国
• 起止时间: 1990-09-30 至 1995-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3372330
• 关键词: Medicare /Medicaid; decision making; health care service evaluation; hip fractures; hip prosthesis; hip surgery; hospital patient care; human old age (65+); human subject; information dissemination; longitudinal human study; osteoarthritis; patient care management; patient care personnel attitude; patient care planning; physicians; questionnaires

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.

这个为期五年的项目建议评估替代管理途径 对于髋部骨折患者和考虑进行全髋关节置换的患者 骨关节炎的替代品这是两个密切相关的程序 每年在美国大部分老年人身上进行。的 最终目标是为从业人员提供准确的信息， 提高保健质量和优化保健利用 资源 该项目的主要目标是：1）进行研究， 替代管理方案的有效性; 2）构建 根据这些研究的分析提出管理建议; 3） 将这些建议广泛传播给从业人员; 4）测量， 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，我们建议利用一项决定， 确定替代照料管理办法的分析方法。结果 决策分析所需的概率将从数据中估计出来 来源于：1）对二手数据的回顾性分析，使用计费 65岁及以上老年人五年100%样本的数据 接受髋部骨折医院治疗和接受 全髋关节置换术治疗骨关节炎在所有马里兰州医院， 1985-1989年;和2）对通过以下方式获得的原始数据进行前瞻性分析 两项针对不同患者队列的平行研究。的综合 这些研究的数据将填补决策中的概率 模型，并将提供临床建议的基础 管理 为实现第三个目标，将传播这些建议， 通过在继续教育课程的演讲，演讲， 个别医院工作人员，在马里兰州会议上的发言 骨科学会、期刊出版物和为外行制作的视频 公众 第四个目标，即评价影响，将通过一个 一系列的研究使用之前和之后的医疗保险账单数据的分析， 护理过程分析之前和之后，在七（加一） 医院，前后比较医生的态度 问卷调查