Impact of Discordant Patient-Surgeon Expectations on Joint Arthroplasty Outcomes

描述(由申请人提供)：随着全关节置换术(TJA)使用量的急剧增加(比1998-2005年翻了一番)，患者的人口统计学特征也发生了变化。TJA越来越多地被更年轻、功能不那么虚弱的人使用，他们对手术的期望更高。知道未满足的期望与不满意和潜在的功能低下有关，解决这些日益增长的期望并为手术设定现实可实现的目标成为一个真正的挑战。虽然外科医生的目标是通过与患者的讨论来指导预期，但外科医生和患者就手术的目标、他们的一致程度以及这种不协调对结果的影响以及在哪些患者亚群中仍然知之甚少等问题达成一致。因此，这项拟议的研究将评估预期不一致对TJA近期和长期功能结果的影响。该提案的指导阶段将评估不和谐现象的存在程度及其相关因素。独立阶段将开发预测模型，以检查这种不协调对短期和长期结果的影响。这项研究将使用特殊外科医院(HSS)CERT TJA登记的数据，该登记是在AHRQ的支持下于2007年建立的，迄今已招募了8000多名患者。受试者在手术前进行评估，并在6个月和2年进行随访，以评估满意度和功能变化。期望值将在手术前使用经过验证的HSS TJA期望值调查进行衡量。 公共卫生相关性：这项研究的结果将有助于确定患者的亚群，如果他们的期望与他们的外科医生的期望不一致，那么他们的期望可能会对他们的结果产生临床意义的影响，并将这些信息输入到有针对性的干预中，例如术前教育课程，这样期望就可以现实地实现。

DESCRIPTION (provided by applicant): The dramatic increase in utilization of total joint arthroplasty (TJA) (doubling from 1998-2005) has been accompanied by a change in patients' demographic profile. TJA is increasingly being utilized by younger and less functionally debilitated individuals who expect more from the surgery. Knowing that unmet expectations are associated with dissatisfaction and potentially inferior function, addressing these increasing expectations and setting realistically achievable goals for the surgery becomes a real challenge. While surgeons aim to guide expectations through discussions with their patients so surgeons and patients agree on the goals of surgery, the degree to which they are aligned and what impact that discordance has on outcomes and in which subpopulations of patients remains poorly understood. Therefore, the proposed research will evaluate the impact of discordance in expectations on TJA immediate and long-term functional outcomes. The mentored phase of this proposal will evaluate the degree to which the phenomenon of discordance exists and what its correlates are. The independent phase will develop predictive models to examine the effect of this discordance on immediate as well as short and long-term outcomes. This study will use data from the Hospital for Special Surgery (HSS) CERT TJA registry, which was established in 2007 with support from AHRQ and has thus far enrolled more than 8000 patients. Subjects are evaluated preoperatively and followed up at 6 months and 2 years to assess satisfaction and changes in function. Expectations will be measured preoperatively using the validated HSS TJA expectations surveys. PUBLIC HEALTH RELEVANCE: Results of this study will help identify subpopulations of patients whose expectations may have a clinically meaningful effect on their outcomes, if they were discordant with those of their surgeons, and feed this information into targeted interventions such as the preoperative educational class so that expectations are realistically achievable.