Social Determinants and Timeliness of Total Knee Replacement: A National Perspective

项目摘要 拟议的R01旨在用射线读数增强来自FORCE-TJR国家登记处的数据， 地理空间信息和医疗保险索赔数据，以量化全膝关节置换(TKR)的及时性，以及 调查影响TKR时机的社会决定因素(SD)。我们提出了三个具体目标。目标1适用 对有代表性的FORCE-TJR登记患者样本进行分类验证的适当性标准 他们要么过早，要么合适，但有5种不同程度的功能残疾。AIM 2附加了这个 使用有关其环境的地理空间信息(SD)进行采样，并确定SD因素对 TKR利用率。目的3确定SD因素对术后改善的影响。我们研究了 与以下因素有关的SD因素的影响：(1)医疗环境(即获得和实践医疗服务的方式) 护理)和(2)建筑环境(即，我们生活和工作的所有物理部分(例如，家， 建筑物、街道、空地和基础设施))。我们的项目将是第一个研究将军澳铁路的时间安排 国家一级，并将提供关于医疗保健协会的新知识和建立 具有TKR使用时效性的环境。我们的发现也将为临床和公共政策提供参考 干预措施旨在将TKR目标对准那些将从该程序中受益最大的人，并增加证据 这将支持这样一个命题，即环境的改善可能导致 与膝骨性关节炎有关的残疾。

Project Summary The proposed R01 aims to augment data from the FORCE-TJR national Registry with radiographic readings, geospatial information and Medicare claims data to quantify timeliness of total knee replacement (TKR), and investigate the social determinants (SD) affecting timing of TKR. We propose 3 specific aims. Aim 1 applies validated appropriateness criteria to a representative sample of the FORCE-TJR registry patients to classify them as either premature or appropriate but with 5 different levels of functional disability. Aim 2 appends this sample with geospatial information (SD) about their environment and determine the effect of the SD factors on TKR utilization. Aim 3 determine the effect of the SD factors on improvement after surgery. We examine the effect of SD factors related to (1) the medical care environment (i.e., access to and practice patterns of medical care) and (2) the built environment (i.e., all of the physical parts of where we live and work (e.g., homes, buildings, streets, open spaces, and infrastructure)). Our project will be the first to examine timing of TKR at a national level, and will provide new knowledge regarding the association of the medical care and built environments with timeliness of TKR utilization. Our findings will also inform clinical and public policy interventions aimed at targeting TKR to those who would benefit most from the procedure, and add to evidence that would support the proposition that improvements to the environment could lead to an overall reduction in disability pertaining to knee osteoarthritis.