The 3 Cohort Study of Hip Fracture Functional Outcomes

描述(申请人提供)：髋部骨折是老年人死亡和功能依赖的重要原因，在这个国家每年大约有34万例髋部骨折发生。拟议的项目汇集了2819名髋部骨折患者的3个队列，以创建最大的髋部骨折患者数据集，并提供关于功能结果的随访信息。该数据集将用于解决髋部骨折研究中的两个重要主题：a)未来临床干预可能针对的患者亚组的特征，以及b)早期手术干预的作用。其具体目标是：a)结合西奈山、巴尔的摩和关节疾病医院髋部骨折队列，生成一个数据集，提供有关患者特征、骨折前功能、住院治疗过程以及对功能和其他结果的纵向随访信息；b)更好地描述髋部骨折患者亚组的死亡率和功能结果；c)测试骨折前功能、患者特征和合并疾病如何影响整体和主要亚组患者的功能结果；d)测试早期手术对髋部骨折患者的影响。我们的研究方法包括：a)收集数据集，并从3个队列中创建和测试研究变量的通用定义；b)使用聚类分析来确定临床上重要的亚组，并检查亚组之间死亡率和功能结果的差异；以及c)分析死亡率和功能结果的决定因素，包括早期手术的影响。在此过程中，我们将在a)如何将死亡率纳入到功能结果分析中，以及b)如何分析观察数据以评估不太可能在随机试验中评估的干预措施的有效性方面扩大方法学工作。这两个后两个主题是关于衰老的一系列其他临床主题的关键问题。我们建议开发和测试的方法广泛适用于其他衰老临床问题，在这些问题中，功能状态是一个重要的结果，死亡率也很高。

DESCRIPTION (provided by applicant): Hip fractures are an important cause of mortality and functional dependence among older adults and approximately 340,000 hip fractures occur annually in this country. The proposed project brings together 3 cohorts of 2819 patients with hip fracture to create the largest dataset of hip fracture patients with follow-up information on functional outcomes. This dataset will be used to address 2 important topics in hip fracture research: a) the characterization of patient subgroups that could be targeted for future clinical interventions, and b) the role of early surgical intervention. The specific aims are: a) to combine the Mount Sinai, Baltimore, and Hospital for Joint Disease hip fracture cohorts to produce a dataset with information on patient characteristics, pre-fracture function, process of inpatient care, and longitudinal follow-up on function and other outcomes; b) to better characterize the mortality and functional outcomes of subgroups of hip fracture patients; c) to test how pre-fracture function, patient characteristics, and co-morbid conditions affect functional outcomes for patients as a whole and for major subgroups; and d) to test the impact of early surgery for patients with hip fracture. Our research methods include: a) assembling the dataset and creating and testing common definitions of study variables from the 3 cohorts; b) using cluster analysis to identify clinically important subgroups and to examine differences in mortality and functional outcomes among the subgroups; and c) analyzing the determinants of mortality and functional outcome, including the effect of early surgery. In the course of doing this, we will extend the methodological work on a) how mortality can be incorporated into analyses of functional outcome and b) how observational data can be analyzed to assess the effectiveness of interventions that are not likely to be evaluated in randomized trials. These 2 latter topics are critical issues to a series of other clinical topics in aging. The methodologies we propose to develop and test has wide applicability to other clinical problems of aging where functional status is an important outcome and mortality is also high.