Effects of Musculoskeletal Surgery Rates on Outcomes

肌肉骨骼手术率对结果的影响

• 批准号: 10259760
• 负责人: JOHN M BROOKS
• 金额: $ 38.28万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10259760
• 关键词: Effects; Musculoskeletal; Surgery; Rates; Outcomes

Musculoskeletal (MSK) conditions affect more than half of the U.S. population and account for 1 in 5 healthcare visits. MSK care annual costs exceed $176 billion in direct and $876 billion in indirect healthcare costs and show large increases in per capita costs. Yet, there is remarkably little Level I evidence supporting this level of healthcare utilization with little consensus on proper treatment approaches across MSK conditions. Because of difficulties with randomization and blinding, less than 10% of MSK related-studies are clinical trials, and of the trials, less than 40% meet minimal guidelines. Thus, it is not surprising that substantial geographic variation exists in the use of invasive and costly treatments for MSK conditions. Using anecdotes, the popular press suggests that early surgery for new MSK conditions is overused. Simulation studies suggest that lower utilization rates of treatments not supported by clinical evidence, like surgery for MSK conditions, can dramatically lower Medicare costs without sacrificing quality. However, beyond anecdote and simulation studies, there is no evidence supporting the notion that lower surgery rates for patients with MSK conditions will lower costs and maintain quality. Lower surgery rates may keep surgery from patients who would benefit little from surgery. Conversely, lower surgery rates may result in many patients delaying beneficial treatment causing MSK conditions to worsen and result in poorer outcomes and higher long run costs. Our approach is to use the documented geographic variation in early surgery rates as natural experiments and apply instrumental variable estimators to assess the impact of higher rates of early surgery on outcomes and costs. In addition, we will use charts abstracted for a sample of patients to measure confounders unmeasured in Medicare claims to assess the assumptions underlying our natural experiment. We will then carefully interpret our estimates considering the outcomes measured and the validity of the assumptions associated with treatment effect heterogeneity and confounding. The investigative team has substantial experience assessing treatment effectiveness using Medicare data and a strong MSK clinical and empirical background. This study builds on our shoulder-related research using Medicare data from 2011. It will identify important relationships between early surgery choice, treatment success and costs for patients with MSK conditions. AHRQ has authority to conduct and support research to reflect the needs and priorities of the Medicare program. This research will provide key evidence for policy makers to assess whether early surgery for these MSK conditions are over or underused in practice for Medicare patients. Our study goals align with AHRQ’s goal of “producing evidence that can be used to increase the affordability and efficiency of health care”. 1

肌肉骨骼 (MSK) 疾病影响着一半以上的美国人口，占五分之一 医疗保健就诊。 MSK 斯隆护理年度直接成本超过 1,760 亿美元，间接成本超过 8,760 亿美元 医疗保健费用，并显示人均费用大幅增加。然而，I 级的数量却非常少。 支持这种医疗保健利用水平的证据，但在适当治疗方面几乎没有达成共识 跨 MSK 条件的方法。由于随机化和盲法的困难，少于 10% 的 MSK 斯隆相关研究属于临床试验，其中只有不到 40% 符合最低指导原则。 因此，侵入性且昂贵的技术的使用存在巨大的地理差异也就不足为奇了。 MSK 斯隆病症的治疗。大众媒体利用轶事表明，早期手术可以治疗新的疾病 MSK 条件被过度使用。模拟研究表明，较低的治疗利用率并不 有临床证据支持，例如针对 MSK 斯隆病症的手术，可以大幅降低医疗保险费用 在不牺牲质量的情况下。然而，除了轶事和模拟研究之外，没有证据表明 支持这样的观点：降低 MSK 斯隆病症患者的手术率将降低成本， 保持质量。较低的手术率可能会阻止那些获益甚少的患者进行手术 外科手术。相反，较低的手术率可能会导致许多患者推迟有益的治疗 导致 MSK 斯隆病情恶化并导致更差的结果和更高的长期成本。 我们的方法是利用记录在案的早期手术率的地理差异作为自然 实验并应用工具变量估计器来评估早期较高比率的影响 手术的结果和费用。此外，我们将使用从患者样本中提取的图表来 衡量医疗保险索赔中未衡量的混杂因素，以评估我们的假设 自然实验。然后，我们将考虑测量结果仔细解释我们的估计 以及与治疗效果异质性和混杂相关的假设的有效性。 调查团队在使用医疗保险评估治疗效果方面拥有丰富的经验 数据以及强大的 MSK 斯隆临床和经验背景。这项研究建立在我们与肩部相关的 使用 2011 年医疗保险数据进行的研究。它将确定早期手术之间的重要关系 MSK 斯隆 (MSK) 病症患者的选择、治疗成功率和费用。 AHRQ 有权进行 支持反映医疗保险计划的需求和优先事项的研究。这项研究将 为政策制定者评估这些 MSK 斯隆病症的早期手术是否已经结束提供关键证据 或在医疗保险患者实践中未得到充分利用。我们的研究目标与 AHRQ 的“生产 可用于提高医疗保健的负担能力和效率的证据”。 1