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Impact of Discordant Patient-Surgeon Expectations on Joint Arthroplasty Outcomes

患者与外科医生不一致的期望对关节置换术结果的影响

基本信息

批准号：
8020125
负责人：
Hassan Ghomrawi
金额：
$ 9万
依托单位：
WEILL MEDICAL COLL OF CORNELL UNIV
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-02-03 至 2011-04-30
项目状态：
已结题

项目摘要

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.

描述（由申请人提供）：全关节置换术（TJA）的使用率急剧增加（从 1998 年到 2005 年翻了一番）伴随着患者人口统计特征的变化。 TJA 越来越多地被年轻且功能衰弱程度较轻的人使用，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较差有关，解决这些不断增加的期望并为手术设定实际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引导期望，以便外科医生和患者就手术目标达成一致，但他们的一致程度以及这种不一致对结果的影响以及患者亚群仍然知之甚少。因此，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一致现象存在的程度及其相关因素。独立阶段将开发预测模型来检查这种不一致对近期以及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 登记处的数据，该登记处于 2007 年在 AHRQ 的支持下建立，迄今为止已招募了 8000 多名患者。受试者在术前进行评估，并在 6 个月和 2 年时进行随访，以评估满意度和功能变化。将使用经过验证的 HSS TJA 期望调查在术前测量期望。公共健康相关性：这项研究的结果将有助于确定患者的亚群，如果他们的期望与外科医生的期望不一致，则这些患者的期望可能会对他们的结果产生临床上有意义的影响，并将这些信息输入有针对性的干预措施中，例如术前教育课程，以便切实实现期望。