Impact of Discordant Patient-Surgeon Expectations on Joint Arthroplasty Outcomes

描述（由申请人提供）：全关节置换术（TJA）的使用率急剧增加（1998-2005年翻了一番），伴随着患者人口统计学特征的变化。TJA越来越多地被年轻和功能较弱的人使用，他们对手术期望更高。了解未满足的期望与不满和潜在的功能差相关，解决这些不断增加的期望并为手术设定现实的可实现目标成为真实的挑战。虽然外科医生的目标是通过与患者的讨论来引导期望，以便外科医生和患者就手术的目标达成一致，他们的一致程度以及不一致对结果的影响以及对患者亚群的了解仍然很少。因此，拟议的研究将评估不一致的预期对TJA的即时和长期功能结果的影响。本建议书的指导阶段将评估不一致现象存在的程度及其相关因素。独立阶段将开发预测模型，以检查这种不一致对即时以及短期和长期结果的影响。这项研究将使用来自特殊外科医院（HSS）CERT TJA登记处的数据，该登记处于2007年在AHRQ的支持下成立，迄今已招募了8000多名患者。术前对受试者进行评估，并在6个月和2年时进行随访，以评估满意度和功能变化。术前将使用经确认的HSS TJA预期调查来衡量预期。 公共卫生相关性：本研究的结果将有助于识别患者亚群，如果他们的期望与他们的外科医生的期望不一致，他们的期望可能会对他们的结局产生临床意义的影响，并将这些信息反馈到有针对性的干预措施中，例如术前教育课程，以便实际实现期望。

DESCRIPTION (provided by applicant): The dramatic increase in utilization of total joint arthroplasty (TJA) (doubling from 1998-2005) has been accompanied by a change in patients' demographic profile. TJA is increasingly being utilized by younger and less functionally debilitated individuals who expect more from the surgery. Knowing that unmet expectations are associated with dissatisfaction and potentially inferior function, addressing these increasing expectations and setting realistically achievable goals for the surgery becomes a real challenge. While surgeons aim to guide expectations through discussions with their patients so surgeons and patients agree on the goals of surgery, the degree to which they are aligned and what impact that discordance has on outcomes and in which subpopulations of patients remains poorly understood. Therefore, the proposed research will evaluate the impact of discordance in expectations on TJA immediate and long-term functional outcomes. The mentored phase of this proposal will evaluate the degree to which the phenomenon of discordance exists and what its correlates are. The independent phase will develop predictive models to examine the effect of this discordance on immediate as well as short and long-term outcomes. This study will use data from the Hospital for Special Surgery (HSS) CERT TJA registry, which was established in 2007 with support from AHRQ and has thus far enrolled more than 8000 patients. Subjects are evaluated preoperatively and followed up at 6 months and 2 years to assess satisfaction and changes in function. Expectations will be measured preoperatively using the validated HSS TJA expectations surveys. PUBLIC HEALTH RELEVANCE: Results of this study will help identify subpopulations of patients whose expectations may have a clinically meaningful effect on their outcomes, if they were discordant with those of their surgeons, and feed this information into targeted interventions such as the preoperative educational class so that expectations are realistically achievable.