Development and Validation of a Risk Calculator for Total Joint Replacement

全关节置换风险计算器的开发和验证

• 批准号: 9921210
• 负责人: Alex Sox-Harris
• 金额: --
• 依托单位: VETERANS ADMIN PALO ALTO HEALTH CARE SYS
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9921210
• 关键词: Acute; Address; Age; Benefits and Risks; Body mass index; Cessation of life; Characteristics; Client satisfaction; Clinical; Clinical Data; Data; Data Set; Decision Support Systems; Degenerative polyarthritis; Development; Diabetes Mellitus; Diagnosis; Effectiveness; Electronic Health Record; Equilibrium; Goals; Health; Healthcare Systems; Hip Osteoarthritis; Infection; Informed Consent; Knee Osteoarthritis; Link; Manuals; Methods; Modeling; Obesity; Operative Surgical Procedures; Orthopedic Procedures; Orthopedics; Outcome; Pain; Pain-Free; Patient Care; Patient Preferences; Patients; Population; Probability; Procedures; Process; Quality of life; Replacement Arthroplasty; Resources; Risk; Risk Factors; Safety; San Francisco; Schedule; Smoking; Surgeon; Symptoms; Testing; Total Hip Replacement; United States; Validation; Variant; Veterans; Weighing patient; Weight; alcohol misuse; base; clinical predictors; cost; data warehouse; diabetic; disability; evidence base; expectation; follow-up; health administration; high risk; hip replacement arthroplasty; improved; knee replacement arthroplasty; modifiable risk; outcome prediction; recruit; risk minimization; satisfaction; shared decision making; support tools; surgical risk

DESCRIPTION (provided by applicant): Background and Anticipated Impacts on VA Patient Care: Of the 5.6 million patients treated by the Veterans Health Administration (VHA) in FY11, 14.6% had a diagnosis of osteoarthritis, the fourth most common health condition treated by the VHA, and the leading cause of disability in the United States.(1,2) Advanced osteoarthritis of the hip and knee is treated with total joint arthroplasty (TJA), roughly 11,000 of which were performed in VHA in fiscal year 2011. The overall risks of complications and death in total joint arthroplasty are relatively low (5% and <1% respectively), but certain patient characteristics (e.g., diabetes, obesity, smoking, alcohol misuse) have been associated with dramatically higher risks. Currently, orthopedic surgeons in VHA have no systematic and validated way of using a patient's demographic and clinical profile to estimate their personalized risk of complications or death related to TJA. Patients also vary substantially in how much they benefit from this common and expensive procedure. As with the estimation of risks, orthopedic surgeons in VHA have no systematic and validated way to estimate patients' personalized likelihood of improvement. It is impossible to balance risks and benefits unless they can be accurately and reliably quantified, a capability currently unavailable to orthopedic surgeons in VHA. The development and validation of a risk, benefit, and satisfaction calculator, that draws from both electronic health record and manually entered data, would allow orthopedic surgeons to easily and accurately estimate both the expected risks and benefits of TJA for each candidate. These data could then be used within a shared decision making (SDM) framework for more accurate and reliable patient informed consent, including the identification of modifiable risk factors (e.g., weight, smoking) that should be addressed before these elective procedures, and more effective SDM that maximizes effectiveness, safety, patient preferences, satisfaction, and therefore value. Aim 1: Develop and validate a total joint arthroplasty risk calculator for the VHA population. Using the most recent three years of VHA Corporate Date Warehouse (CDW) and VA Surgical Quality Improvement Project (VASQIP) data including roughly 30,000 total joint arthroplasty cases, we will merge data on outcomes, especially death and major complications, and many known and candidate predictors of outcomes. Aim 2: Develop and validate a total joint arthroplasty benefit calculator for the VHA population. Patients (n = 1200) scheduled to undergo TJA at three high volume VA facilities (Palo Alto, San Francisco, Minneapolis) will be recruited to provide pre-operative symptom, functioning, expectation, and quality of life data and then followed up for reassessment one year later. These data will then be linked with VASQIP and CDW data in order to develop predictive benefit models, especially changes in functioning and pain, based on the pre-operative and other (demographic and clinical) data. Aim 3: Develop and validate a total joint arthroplasty patient satisfaction calculator. Because the predictors of risks and benefits may be different than the predictors of satisfaction, we will also develop a patient satisfaction model using data from the 1200 patients described in Aim 2. Aim 4: Develop and pilot test the calculator interface and related decision support functionality. Once the models are developed, we will develop and pilot test a CDW-integrated risk and benefit calculator and decision support system that might be used within a SDM framework. The goal will be to visually display where the patient exists in the risk/benefit space, identify possible opportunities to modify risk and benefit factors, and provide resources and information to facilitate possible "prehabilitation."

描述（由申请人提供）： 背景和对VA患者护理的预期影响：在2011财年退伍军人健康管理局（VHA）治疗的560万患者中，14.6%的患者诊断为骨关节炎，这是VHA治疗的第四大常见健康状况，也是美国残疾的主要原因。（1，2）晚期髋关节和膝关节骨关节炎采用全关节置换术（TJA）治疗，2011财年VHA共实施了约11，000例TJA。全关节置换术的并发症和死亡的总体风险相对较低（5%和<1% 分别），但是某些患者特征（例如，糖尿病、肥胖、吸烟、酗酒）与高得多的风险有关。目前，VHA的骨科医生没有系统和有效的方法来使用患者的人口统计学和临床资料来估计他们与TJA相关的并发症或死亡的个性化风险。患者从这种常见而昂贵的手术中获益的程度也有很大差异。与风险估计一样，VHA中的骨科医生没有系统和有效的方法来估计患者的个性化改善可能性。除非能够准确可靠地量化风险和受益，否则不可能平衡风险和受益，而VHA的骨科医生目前无法实现这一能力。 风险、受益和满意度计算器的开发和验证（从电子健康记录和手动输入的数据中提取）将使骨科医生能够轻松准确地估计每个候选人的TJA预期风险和受益。然后，这些数据可以在共享决策（SDM）框架内使用，以获得更准确和可靠的患者知情同意，包括识别可修改的风险因素（例如，体重、吸烟），以及更有效的SDM，以最大限度地提高有效性、安全性、患者偏好、满意度，从而实现价值。目标1：开发并验证VHA人群的全关节置换术风险计算器。使用最近三年的VHA企业数据仓库（CDW）和VA手术质量改进项目（VASQIP）数据，包括大约30，000例全关节置换术病例，我们将合并结局数据，特别是死亡和主要并发症，以及许多已知和候选的结局预测因素。目标2：开发并验证VHA人群的全关节置换术受益计算器。将招募计划在三家高容量VA机构（Palo Alto、San弗朗西斯科、Minneapolis）接受TJA的患者（n = 1200），以提供术前症状、功能、预期和生活质量数据，然后随访一年后进行重新评估。然后将这些数据与VASQIP和CDW数据相关联，以便根据术前和其他（人口统计学和临床）数据开发预测性获益模型，特别是功能和疼痛的变化。目标3：开发和验证全关节置换术患者满意度计算器。因为风险和收益的预测因素可能与 满意度的预测因素，我们还将使用目标2中描述的1200名患者的数据开发患者满意度模型。目标4：开发和试点测试计算器接口和相关的决策支持功能。一旦开发出这些模型，我们将开发和试点测试一个与CDW相结合的风险和效益计算器和决策支持系统，该系统可能会在SDM框架内使用。目标是直观显示患者在风险/受益空间中的位置，识别修改风险和受益因素的可能机会，并提供 资源和信息，以促进可能的“预防”。"