Improving Orthopedic Outcomes Through a National TJR Registry

通过国家 TJR 登记改善骨科治疗效果

• 批准号: 7940017
• 负责人: PATRICIA D FRANKLIN
• 金额: $ 299.68万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7940017
• 关键词: Improving; Orthopedic; Outcomes; Through; National

DESCRIPTION (provided by applicant): Each year, more than 700,000 US adults elect total joint replacement (TJR) surgery to restore physical function and eliminate the pain of advanced knee or hip arthritis that persists despite comprehensive medical treatment. Despite broad use, wide variation persists in surgical practice and outcomes. Furthermore, there is a lack of comparative effectiveness data to guide surgeon and patient decisions on optimal implant timing, surgical approach, implant selection, and peri-operative management to prevent adverse sequelae and revision. Therefore, the National Orthopedic Outcome Registry (NOOR) and Cohort Study will establish a national registry of over 33,000 diverse patients of 130 orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings. As such, the registry is designed to reflect typical US clinical practice, rather than focusing exclusively on high-volume academic centers. Data will include baseline patient attributes; procedure approach and technology; hospital course; surgeon and institutional characteristics; longitudinal patient function, post-procedure complications and revisions, and serum/DNA samples. Web-based data collection will enhance efficient data gathering. The research team will develop new outcome measures and will determine the relative contributions of patient factors, technology use, and delivery factors to (1) early functional failure and (2) adverse post-arthroplasty events; (3) examine disparities in TJR use and outcome, seeking to elucidate root causes; and (4) conduct economic analyses to determine the personal and societal value of TJR in working aged adults. A national network of orthopedists will partner with innovative scientists with expertise in large-scale registry development and implementation, web-based technology, outcome measurement, and statistical techniques to assure success. Sound governance principles will ensure efficient implementation. The registry will actively encourage ancillary research to assure optimal use of all data and biomaterials. We propose to transform the network of clinical centers and orthopedic offices into a research laboratory that will serve as a national model for comparative effectiveness research. PUBLIC HEALTH RELEVANCE: The proposed national orthopedic outcome registry will collect important patient, surgical, and delivery setting data to answer critical patient and surgeon questions about optimal implant selection, surgical timing and approach, and peri-operative care for the large number of patients who undergo total joint replacement and other procedures each year. Research will also address TJR value in young patients and use disparities,

描述（由申请人提供）：每年，超过 700,000 名美国成年人选择全关节置换 (TJR) 手术来恢复身体功能并消除晚期膝关节炎或髋关节炎的疼痛，尽管进行了综合治疗，但这种疼痛仍然持续存在。尽管用途广泛，但手术实践和结果仍然存在很大差异。此外，缺乏比较有效性数据来指导外科医生和患者决定最佳种植时机、手术方法、种植体选择和围手术期管理，以防止不良后遗症和翻修。因此，国家骨科结果登记处 (NOOR) 和队列研究将建立一个国家登记处，其中包含代表全国所有地区以及不同医院和外科医生诊所的 130 名骨科医生的 33,000 多名不同患者。因此，该注册中心旨在反映典型的美国临床实践，而不是仅仅关注大容量的学术中心。数据将包括基线患者属性；程序方法和技术；医院课程；外科医生和机构特征；纵向患者功能、术后并发症和修复以及血清/DNA 样本。基于网络的数据收集将提高数据收集的效率。研究小组将开发新的结果衡量标准，并确定患者因素、技术使用和交付因素对（1）早期功能衰竭和（2）关节置换术后不良事件的相对贡献； (3) 检查 TJR 使用和结果的差异，寻求阐明根本原因； (4) 进行经济分析，以确定 TJR 对工作老年人的个人和社会价值。全国骨科医生网络将与在大规模注册开发和实施、基于网络的技术、结果测量和统计技术方面拥有专业知识的创新科学家合作，以确保成功。健全的治理原则将确保有效实施。该登记处将积极鼓励辅助研究，以确保所有数据和生物材料的最佳利用。我们建议将临床中心和骨科办公室网络转变为研究实验室，作为比较有效性研究的国家模型。 公共健康相关性：拟议的国家骨科结果登记系统将收集重要的患者、手术和分娩设置数据，以回答患者和外科医生关于最佳植入物选择、手术时机和方法以及每年接受全关节置换和其他手术的大量患者的围手术期护理的关键问题。研究还将解决 TJR 在年轻患者中的价值和使用差异，