Early Identification of Poorly Performing Joint Replacements
早期识别表现不佳的关节置换术
基本信息
- 批准号:9503568
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2018
- 资助国家:美国
- 起止时间:2018-03-01 至 2019-02-28
- 项目状态:已结题
- 来源:
- 关键词:ArthritisCalendarCaringCurrent Procedural Terminology CodesDataDevicesEarly identificationElectronic Health RecordExcisionFailureFoundationsFutureGoalsGrantHandednessHealth Care CostsHealthcare SystemsHip region structureHospitalsImplantIndividualInfectionIntegrated Health Care SystemsJoint ProsthesisJointsKneeLinkLongevityMedical RecordsMetalsModelingMonitorNamesOperative Surgical ProceduresOutcomePainPatient-Focused OutcomesPatientsPerformancePilot ProjectsPostoperative PainProceduresProsthesisProsthesis ImplantationRecordsRegistriesRepeat SurgeryReplacement ArthroplastyReportingSourceStructureSurgeonSystemTechniquesTimeUnited States Food and Drug AdministrationVariantVendorVeteransWorkcare deliverycostdata warehousedemographicsdesignhealth administrationhip replacement arthroplastyimplant designimplantationimprovedindexinginpatient surgeryinsightoperationpost-marketsurvivorshiptrend
项目摘要
Joint replacement surgery is the most common inpatient surgery in the Veterans Health
Administration (VHA). 14,349 primary joint replacement cases were performed in the VHA in 2015. About
5% are reoperated by 10 years for failure or infection. Poor implants have a much higher reoperation rate
(e.g. 17-25% by 5 years for the DePuy ASR XL). Failed or unsatisfactory joint replacements are costly and
result in personal and financial hardship for veteran patients. In addition, failed joint replacements cost the
health care system about $38,000 per episode. As implant designs and techniques evolve, some changes
can have a negative effect on implant survival and harm patients. A prime example of this is metal on metal
hip arthroplasty, which recently resulted in recall of several commonly used implants.
To limit harm to patients and costs for the health care system, we must improve our ability to monitor
implant performance and identify poorly performing implants earlier than is now possible. Medical records
are a potentially rich source of information that may allow early identification of poorly performing implants
even before they end up having to be revised, and potentially sparing new patients from receiving them.
The VHA is the nation's largest integrated health care system and was among the earliest adopters
of the electronic health record (EHR). VHA EHRs may be used to create a VA joint implant registry. This
could inform future decisions on implant selection across the VA health care system to improve veteran
patient outcomes and minimize reoperations or complications. In addition, a VA joint replacement registry
could act to support a national implant surveillance system by computationally extracting and aggregating
individual prosthetic data for use by the FDA.
We propose a pilot project to extract and evaluate joint replacement prosthesis implantation and
explantation information from the VA Corporate Data Warehouse (CDW). The specific aims of the
proposed pilot work are:
Aim 1: Determine trends in national joint replacement implant use and regional variation in the VA
from 2000 to 2016. To establish a foundation for our overall goal of developing a post market surveillance
system for joint replacement, it will be essential to retrieve implant-specific information from the CDW
across the VHA over time, including Operative Date, Station, CPT code, Prosthesis Vendor, Prosthesis
Model, Prosthesis Size, and Prosthesis Name. After evaluating the completeness of these records across
the VHA over time, we will use these records to characterize implantation practices for each station and
each calendar year. This will support further study by quantifying trends in national joint replacement
implant use and provide insight into regional variation in implant selection across the VA system.
Aim 2: Build a level 1 registry of joint replacement implants in the VA system. A level 1 registry is
made up of patient demographics, hospital, surgeon, and procedure-related data including the laterality of
surgery, date of surgery and implant utilized. Not all of this information is available in structured records.
For example since laterality of the operation is not directly found in a structured field, we will need to
analyze unstructured fields to determine the fate of the index operation. Part (a) of this aim will focus on
extracting laterality information for both index surgery and any subsequent reoperations from unstructured
fields. This will tell us how long the joint prosthesis lasted before it needed to be reoperated on. Part (b) of
the aim will require a more challenging analysis of unstructured data to determine which component of the
joint replacement was problematic and removed. By completing this aim, we will generate reports on the
individual component survivorship free of reoperation or removal for each of the implants used across the
VA health care system.
关节置换手术是退伍军人健康中心最常见的住院手术
管理(VHA)。2015年在VHA进行了14,349例初次关节置换术。关于
5%的患者在10年后因失败或感染而再次手术。不良植入物的再次手术率更高
(e.g. DePuy ASR XL在5年内为17-25%)。失败或不满意的关节置换是昂贵的,
导致了老病人个人和经济困难。此外,关节置换术失败会使
每集大约38,000美元。随着植入物设计和技术的发展,一些变化
可能对植入物存活率产生负面影响并伤害患者。一个最好的例子就是金属对金属
髋关节置换术,最近导致几种常用植入物的召回。
为了限制对患者的伤害和医疗保健系统的成本,我们必须提高我们的监测能力
植入物性能,并比现在更早地识别性能较差的植入物。医疗记录
是一个潜在的丰富的信息来源,可以允许早期识别性能较差的植入物
甚至在它们最终不得不被翻修之前,并且潜在地使新的患者免于接受它们。
VHA是美国最大的综合医疗保健系统,也是最早采用该系统的机构之一
电子健康记录(EHR)。VHA EHR可用于创建VA关节植入物登记研究。这
可以告知未来在整个VA医疗保健系统中选择植入物的决定,以改善退伍军人
并最大限度地减少再次手术或并发症。此外,VA关节置换登记研究
可以通过计算提取和汇总来支持国家植入物监测系统
供FDA使用的个体假体数据。
我们提出了一个试点项目,以提取和评估关节置换假体植入和
VA公司数据仓库(CDW)中的取出信息。该委员会的具体目标
建议的试点工作包括:
目的1:确定国家关节置换植入物使用趋势和VA的地区差异
从2000年到2016年。为我们制定上市后监督的总体目标奠定基础
对于关节置换系统,从CDW中检索植入物特定信息将是至关重要的
整个VHA随时间的变化,包括手术日期、工作站、CPT代码、假体供应商、假体
型号、假体尺寸和假体名称。在评估了这些记录的完整性之后,
随着时间的推移,我们将使用这些记录来表征每个站点的植入实践,并
每个日历年。这将通过量化国家关节置换的趋势来支持进一步研究
种植体使用,并提供对整个VA系统种植体选择的区域差异的见解。
目标2:在VA系统中建立关节置换植入物的1级登记系统。一级注册表
由患者人口统计学资料、医院、外科医生和手术相关数据组成,包括
手术、手术日期和使用的植入物。并非所有这些信息都在结构化记录中可用。
例如,由于在结构化字段中无法直接找到运算的偏侧性,因此我们需要
分析非结构化字段以确定索引操作的命运。这一目标的(a)部分将侧重于
从非结构化数据中提取首次手术和任何后续再手术的偏侧信息
领域的这将告诉我们关节假体在需要再次手术之前持续了多长时间。
其目的是需要对非结构化数据进行更具挑战性的分析,以确定
关节置换存在问题并被移除。通过实现这一目标,我们将生成有关
在整个研究期间使用的每种植入物的无再次手术或取出的单个部件存活率
VA医疗保健系统。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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