Quantifying Underuse and Overuse of Knee Replacement

量化膝关节置换术的使用不足和过度使用

• 批准号: 9265780
• 负责人: Hassan Ghomrawi
• 金额: $ 15.65万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-12-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9265780
• 关键词: Address; Affordable Care Act; African American; Age; American; Area; Behavior; Caring; Characteristics; Classification; Clinical; Cohort Studies; Consensus; Cost Control; Data; Data Set; Degenerative polyarthritis; Demographic Factors; Development; Education; Educational Background; Elements; Eligibility Determination; Environmental Risk Factor; Future; Gender; Health Insurance; Health Services Accessibility; Healthcare; Incentive Reimbursement; Individual; Insurance; Insurance Carriers; Insurance Coverage; Intervention; Knee Osteoarthritis; Knowledge; Literature; Longitudinal Studies; Low income; Medical; Methods; Modeling; Operative Surgical Procedures; Outcome; Patient-Focused Outcomes; Patients; Persons; Policies; Policy Maker; Population; Privatization; Procedures; Race; Reporting; Risk; Spain; Statistical Models; Study Subject; System; Time; United States National Institutes of Health; Update; arthritic pain; arthritis therapy; base; care seeking; caucasian American; clinical practice; cohort; cost; design; disadvantaged population; evidence base; health care delivery; improved; knee replacement arthroplasty; longitudinal dataset; member; patient oriented; pressure; prospective; provider intervention; public health relevance; racial and ethnic; response; time use; uptake

 DESCRIPTION (provided by applicant): Utilization of total knee replacement (TKR) is on the rise and projections of a 6-fold increase over the next 2 decades have alarmed policy makers, with several initiatives aimed at restraining costs.1 Yet, these projections do not dismiss TKR underuse, which was strongly endorsed by an NIH consensus panel in 2004 and is often discussed in the literature and acknowledged by policy makers.2 Starting in 2014, insurance expansion under the Affordable Care Act will include more than 50 million low-income Americans,1 among whom are subpopulations who have been reported to underuse TKR.3 Simply providing insurance will not fully address the utilization gap.4, 5 Factors associated with underuse and overuse need to be identified so that policies to address both phenomena can be developed in the context of cost control pressures. Little has been done to investigate the extent of underuse and overuse of TKR. The available literature on disparities in TKR utilization (e.g. between whites and African Americans) partially addresses this issue. However, because this literature is focused on actual surgeries, it fails to answer questions like: Is the gap in utilizaion between Whites and African-Americans due entirely to the African-Americans underutilizing the surgery or is part of it Whites overusing the surgery? By utilizing the Osteoarthritis Initiative (OAI) and Multicenter Osteoarthritis Study (MOST) longitudinal datasets of almost 8,000 persons with or at risk for knee osteoarthritis, this proposal takes a "prospective" approach to studying underuse and overuse of knee replacement in the US. We will apply appropriateness classification systems, which are evidence-based metrics used to assess both overuse and underuse of surgical procedures, to study utilization of TKR.6 We propose to apply the system to OAI and MOST subjects with or at risk of knee osteoarthritis to estimate rates of timely use, overuse and underuse. We then study the predictors of overuse and underuse of TKR. This study will be the first to prospectively assess the extent of underuse and overuse of TKR in the US. Results will help public and private insurers to consider underuse and overuse in developing reimbursement policies and to design along with providers interventions aimed at under and over users. In addition, findings from this project will provide critically important information for developing consensus-based evidence-based appropriateness criteria in the US.

 描述(由申请人提供)：全膝关节置换术(TKR)的使用率正在上升，未来20年将增长6倍的预测令政策制定者感到震惊，有几项旨在控制成本的举措。1然而，这些预测并未忽视TKR的使用不足，这一点在2004年得到了NIH共识小组的强烈支持，文献中经常讨论这一问题，并得到政策制定者的承认。2从2014年开始，根据《平价医疗法案》扩大保险范围将包括5000多万低收入美国人，其中1是据报道使用TKR不足的亚群。3单纯提供保险不能完全解决使用率差距。5需要查明与使用不足和过度使用有关的因素，以便在成本控制压力的情况下制定政策来解决这两种现象。对使用不足和过度使用TKR的程度进行调查的工作很少。现有的关于TKR使用差异(例如，白人和非裔美国人之间)的文献部分地解决了这一问题。然而，由于这篇文献关注的是实际的手术，它没有回答这样的问题：白人和非裔美国人之间的利用差距完全是由于非裔美国人没有充分利用手术，还是白人过度使用手术的一部分？通过利用骨关节炎倡议(OAI)和多中心骨关节炎研究(MOST)对近8000名膝骨性关节炎患者或有膝骨性关节炎风险的人的纵向数据集，这项建议采取了一种“前瞻性”的方法来研究美国膝关节置换的使用不足和过度使用。我们将应用适宜性分类系统来研究TKR的使用情况，这是一种基于证据的指标，用于评估外科手术的过度使用和使用不足。6我们建议将该系统应用于OAI和大多数患有或有膝骨性关节炎风险的受试者，以评估及时使用、过度使用和使用不足的比率。然后，我们研究了TKR过度使用和使用不足的预测因素。这项研究将首次前瞻性地评估美国对TKR的使用不足和过度使用的程度。结果将有助于公共和私营保险公司在制定补偿政策时考虑使用不足和过度使用，并与提供者一起设计针对用户以下和以上的干预措施。此外，该项目的发现将为在美国制定基于共识、基于证据的适当性标准提供至关重要的信息。