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

• 批准号: 8259126
• 负责人: Hassan Ghomrawi
• 金额: $ 18.16万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-02-03 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8259126
• 关键词: Accounting; Address; Agreement; Arthroplasty; Award; Caring; Client satisfaction; Clinical Pathways; Cohort Studies; Comorbidity; Data; Educational Intervention; Enrollment; Foundations; Goals; Hip region structure; Hospitalization; Hospitals; Individual; Inferior; Intervention; Joints; Knee; Literature; Measures; Mediating; Medical; Mentors; Operative Surgical Procedures; Orthopedics; Outcome; Outcome Measure; Patients; Phase; Physical Function; Placebo Effect; Procedures; Recovery; Registries; Rehabilitation therapy; Research; SF-36; Special Hospitals; Surgeon; Surveys; United States Agency for Healthcare Research and Quality; Walkers; Work; abstracting; cost; expectation; feeding; follow-up; functional outcomes; functional status; older patient; patient expectation; patient registry; predictive modeling; prospective; satisfaction; trend

Abstract The dramatic increase in utilization of total joint arthroplasty (TJA) (doubled between 1998-2005) has been accompanied by a change in patient's 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.

摘要 全关节置换术(TJA)的使用率显著增加(#年翻了一番 1998年至2005年)，伴随着患者人口统计资料的变化。TJA是 越来越多的年轻人和功能不那么虚弱的人使用 从手术中期待更多。知道未实现的期望与 不满意和潜在的劣质功能，满足这些日益增长的期望 为手术设定现实可实现的目标成为一个真正的挑战。而当 外科医生的目标是通过与患者的讨论来引导预期，因此外科医生 患者同意手术的目标，他们一致的程度和 这种不一致性对结果和患者的哪些亚群有什么影响 人们对此仍然知之甚少。因此，拟议的研究将评估 对TJA近期和长期功能结果的预期不一致。 该提案的指导阶段将评估该现象在多大程度上 不和谐是存在的，它的相关性是什么。独立阶段将会发展 预测模型，以检查这种不协调对即刻和 短期和长期结果。 这项研究将使用特殊外科医院(HSS)CERT TJA登记的数据， 它是在AHRQ的支持下于2007年成立的，到目前为止已经招收了更多的 超过8000名患者。受试者在手术前进行评估，并在6个月后进行随访。 两年来评估满意度和功能变化。期望值将是 术前使用经过验证的HSS TJA预期调查进行测量。