Regionalization of elective total joint replacement

描述(由申请人提供)： 医院和外科医生的数量和全关节置换术的结果之间有很强的关系。因此，区域化，将病例从低容量医院转移到大容量医院，选择性全关节置换术可能是有益的。区域化的可能好处包括通过降低并发症和翻修手术的比率改善患者的结局和降低医疗费用。然而，如果传统上服务不足的患者在寻求区域化治疗时面临障碍，区域化的好处可能得不到公平的分配。获得区域化外科护理的不同机会可能会扩大已经存在的健康差距。 这项研究的目的是：1)描述美国选择性全关节置换术区域化的频率和预测因素；2)评估选择性全关节置换术的区域化是否与改善患者的短期预后有关。这些目标将通过确定接受全关节置换的患者的百分比来实现，这些患者超越他们的医院服务区(HSA)前往另一家HSA容量更大的医院接受全关节置换。在当地HSA接受护理的人将被视为“本地化”，而在其他地方接受护理的人将被视为“地区化”。 患者将通过全美21个州现有的医院出院数据库进行识别。将使用多变量重复测量模型评估患者、年龄、性别、种族/民族、保险状况和合并症对接受区域化护理的可能性的影响，其中包括考虑由同一外科医生或在同一医院内进行的手术的相关性的方法。为了确定区域化是否改善了短期结果，将比较区域化和非区域化患者的手术并发症和翻修手术的比率，调整潜在的混杂因素。 这项研究的结果将为区域化骨科护理的预测因素和结果提供重要的见解。如果区域化与手术并发症和翻修手术的发生率降低有关，如果区域化在传统上缺乏服务的人群中不太常见，那么增加获得区域化护理的干预措施可能会减少全关节置换术结果的差异。

DESCRIPTION (provided by applicant): There is a strong relationship between hospital and surgeon volume and outcomes of total joint replacement. Therefore, regionalization, the movement of cases from low volume hospitals to high volume hospitals, of elective total joint replacements may be beneficial. The possible benefits of regionalization include improved patient outcomes and lower health care costs through a decreased rate of complications and revision surgery. However, the benefits of regionalization may not be equitably distributed if traditionally underserved patients face barriers to seeking regionalized care. Differential access to regionalized surgical care could possibly widen health disparities that already exist. The aims of this research are: 1) to describe the frequency and predictors of regionalization of elective total joint replacement in the US; and 2) to assess whether regionalization for elective total joint replacement is associated with improved short-term patient outcomes. These aims will be accomplished by identifying the percentage of patients undergoing total joint replacements who traveled beyond their hospital service area (HSA) to undergo total joint replacement at a higher volume hospital in another HSA. Those who receive care in their local HSA will be considered "localized" while those who receive care elsewhere will be considered "regionalized." Patients will be identified through existing hospital discharge databases for 21 states throughout the US. The effects of patient, age, sex, race/ethnicity, insurance status and comorbidity on the likelihood of receiving regionalized care will be evaluated using multivariable repeated measures models including methods that account for the correlation of procedures performed by the same surgeon or within the same hospital. To determine whether regionalization improves short-term outcomes, rates of surgical complication and revision procedures will be compared between patients who regionalize and those who do not, adjusting for potential confounders. The results of this research will provide important insights regarding predictors and outcomes of regionalized orthopedic care. If regionalization is associated with reduced rates of surgical complications and revision procedures, and if regionalization is less common among traditionally underserved populations, then interventions to increase access to regionalized care may reduce disparities in outcomes of total joint replacement.