Regionalization of elective total joint replacement

选择性全关节置换术的区域化

• 批准号: 7663112
• 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 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7663112
• 关键词: Accounting; Admission activity; Age; Area; Atlases; Caring; Cessation of life; Code; 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; Measures; Methods; Modeling; Movement; Myocardial Infarction; Operative Surgical Procedures; Orthopedics; Outcome; Patient Care; Patients; Postoperative Period; Procedures; Prospective Studies; Pulmonary Embolism; Race; Repeat Surgery; Replacement Arthroplasty; Research; Research Personnel; Services; Shoulder; State Hospitals; Subgroup; Surgeon; Surgical complication; Travel; Underserved Population; United States; 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与全关节置换术的结果之间有很强的关系。因此，选择性全关节置换术的区域化、病例从低容量医院到高容量医院的移动可能是有益的。区域化的潜在益处包括通过降低并发症和翻修手术的发生率来改善患者结局和降低医疗保健成本。然而，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配。获得区域化外科护理的机会不同，可能会扩大已经存在的健康差距。 本研究的目的是：1）描述美国选择性全关节置换术区域化的频率和预测因素; 2）评估选择性全关节置换术区域化是否与改善短期患者结局相关。这些目标将通过确定在医院服务区（HSA）以外的另一个HSA的高容量医院接受全关节置换术的患者百分比来实现。那些在当地HSA接受护理的人将被视为“本地化”，而那些在其他地方接受护理的人将被视为“区域化”。" 将通过美国21个州的现有出院数据库识别患者。将使用多变量重复测量模型评价患者、年龄、性别、人种/种族、保险状况和合并症对接受区域化治疗可能性的影响，包括说明由同一外科医生或同一医院内进行的手术相关性的方法。为了确定区域化是否改善了短期结局，将比较区域化患者和未区域化患者的手术并发症和翻修手术发生率，并对潜在混杂因素进行调整。 这项研究的结果将提供重要的见解，预测和区域化骨科护理的结果。如果区域化与手术并发症和翻修手术的发生率降低相关，并且如果区域化在传统上服务不足的人群中不太常见，则增加区域化护理的干预措施可能会减少全关节置换术结果的差异。