Regionalization of elective total joint replacement

选择性全关节置换术的区域化

• 批准号: 7483279
• 负责人: STEPHEN L LYMAN
• 金额: $ 8.58万
• 依托单位: HOSPITAL FOR SPECIAL SURGERY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7483279
• 关键词: Accounting; Admission activity; Age; Area; Atlases; Caring; Cessation of life; Comorbidity; Complication; Databases; Deep Vein Thrombosis; Ethnic Origin; Face; Failure; Frequencies; Goals; Health Care Costs; Health Policy; Healthcare; Hip region structure; Hospitals; Implant; Infection; Insurance; Insurance Coverage; Intervention; Knee; Lead; Localized; Measures; Methods; Modeling; Movement; Myocardial Infarction; Operative Surgical Procedures; Orthopedics; Outcome; Patient Care; Patients; Postoperative Period; Procedures; Prospective Studies; Pulmonary Embolism; Race; Rate; Repeat Surgery; Replacement Arthroplasty; Research; Research Personnel; Services; Shoulder; State Hospitals; Subgroup; Surgeon; Surgical complication; Travel; Underserved Population; United States; Zip Code; base; cohort; health disparity; improved; insight; male; sex

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.

描述（由申请人提供）： 医院和外科医生的数量和总关节置换量之间存在牢固的关系。因此，区域化，从低容量医院到高容量医院的病例移动，选修课总置换术可能是有益的。区域化的可能益处包括改善患者的结果和通过降低并发症和修订手术的降低医疗费用。但是，如果传统上服务不足的患者面临寻求区域化护理的障碍，则区域化的好处可能无法公平分布。获得区域化手术护理的差异可能会扩大已经存在的健康差异。 这项研究的目的是：1）描述美国选择性总关节置换区域化的频率和预测因素； 2）评估选择性总关节置换的区域化是否与改善的短期患者结局有关。这些目标将通过确定在其医院服务区域（HSA）以外的关节置换术的患者百分比来实现，以便在另一家HSA的高量医院进行全部关节置换。那些在当地HSA中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“区域化”。 将通过现有的21个州的现有医院出院数据库来确定患者。患者，年龄，性别，种族/种族，保险状况和合并症对接受区域化护理的可能性的影响将使用多变量重复措施模型进行评估，包括说明同一外科医生或同一医院内执行程序相关的方法。为了确定区域化是否改善了短期结局，将在区域化的患者和不进行的患者之间比较手术并发症和修订程序的速度，以调整潜在的混杂因素。 这项研究的结果将提供有关预测因子和区域化骨科护理结果的重要见解。如果区域化与降低手术并发症和修订程序的率有关，并且在传统服务不足的人群中区域化较不常见，那么增加获得区域化护理的干预措施可能会减少关节总替代结果的差异。