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

项目摘要 拟议的R 01旨在通过放射学读数增加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术（TKR）的及时性，以及 调查影响TKR时机的社会决定因素（SD）。我们提出三个具体目标。目标1适用 对FORCE-TJR登记研究患者的代表性样本进行分类的经验证的适当性标准 他们要么是早产儿，要么是合适的，但有5个不同程度的功能障碍。Aim 2添加了以下内容 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使用。目的3确定SD因素对术后改善的影响.我们研究的 与（1）医疗护理环境（即，获得和实践医疗模式 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，家园， 建筑物、街道、开放空间和基础设施）。我们的项目将是第一个研究TKR时间的项目， 国家一级，并将提供新的知识，有关协会的医疗保健和建立 环境与TKR利用的及时性。我们的研究结果也将为临床和公共政策提供信息 干预措施旨在将TKR定位于从手术中获益最多的人群，并增加证据 这将支持改善环境可导致全面减少 与膝关节骨关节炎有关的残疾。

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.