The broad objective of the proposed research is to provide clinical comparative effectiveness evidence aimed at identifying the most effective approaches to post-fracture care with a focus on secondary fracture prevention. While there has been much interest in improving post-fracture bisphosphonate use, the incidence of second fracture is greatest early after the first fracture?a time period in which pharmacological osteoporosis treatment will have little impact. We currently lack evidence regarding which post-fracture practices will reduce both short- and long-term secondary fracture incidence. We also lack evidence on interventions that might mitigate poor outcomes among the sub-group of elders who may not survive long enough to benefit from osteoporosis treatment. These knowledge gaps will be addressed by evaluating alternative post-fracture care strategies, encompassing the full spectrum of care delivery and medication use, across health systems and regions where differences in post-fracture care exist. By studying the large national population of fracture patients cared for in diverse settings (using Medicare claims data and Centers for Medicare &Medicaid Assessment files for inpatient rehabilitation, skilled nursing facilities, nursing homes and home health, all linked to Part D pharmaceutical data), we will be able to identify correlates of safe, effective post-fracture care. A multidisciplinary team expert in comparative effectiveness research will characterize the impact of variation in care patterns on secondary fracture, mortality, and health care costs.
Aim 1 will address 6-month risk of secondary fracture considering rehabilitation characteristics and use of drugs that increase fall risk.
Aim 2 will extend examination of secondary fracture incidence to 1 -year when access and adherence to osteoporosis treatment will become important.
Aim 3 will study outcomes among those at high-risk for mortality (e.g. nursing homes residents).
Aim 4 will use decision-analytic modeling to quantify the potential clinical and economic value of alternative interventions to improve post-fracture care. By evaluating the impact of alternative post-fracture care strategies in this proposal, the long-term health and economic consequences of specific interventions in post-fracture care can be more fully understood.

Public Health Relevance

Fractures lead to significant morbidity, mortality, and costs among the elderly. As the baby-boomer generation ages, it is critical that fracture prevention and effective treatment be undertaken aggressively, especially among people who have already had at least one fracture. We will identify targets for intervention that have the potential to improve outcomes for the large population of older adults who experience a fracture.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Comprehensive Center (P60)
Project #
1P60AR062799-01
Application #
8293838
Study Section
Special Emphasis Panel (ZAR1-KM (M1))
Project Start
Project End
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
1
Fiscal Year
2012
Total Cost
$327,130
Indirect Cost
$124,153
Name
Dartmouth College
Department
Type
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755
Prohaska, Matthew G; Keeney, Benjamin J; Beg, Haaris A et al. (2017) Preoperative body mass index and physical function are associated with length of stay and facility discharge after total knee arthroplasty. Knee 24:634-640
Keeney, Benjamin J; Koenig, Karl M; Paddock, Nicholas G et al. (2017) Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population? J Arthroplasty 32:3583-3590
Massaro, Joseph M; Murabito, Joanne M; Au, Rhoda et al. (2017) Evidence on the Validity of a Comprehensive Health Risk Index and Implications for Ambulatory Care and Population Health Management. J Ambul Care Manage 40:297-304
Mata-Fink, Ana; Philipson, Daniel J; Keeney, Benjamin J et al. (2017) Patient-Reported Outcomes After Revision of Metal-on-Metal Total Bearings in Total Hip Arthroplasty. J Arthroplasty 32:1241-1244
Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E et al. (2017) Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013. J Bone Joint Surg Am 99:402-407
Lurie, Jon D; Tosteson, Tor D; Tosteson, Anna A N et al. (2017) TO THE EDITOR. Spine (Phila Pa 1976) 42:E1214
Gerling, Michael C; Leven, Dante; Passias, Peter G et al. (2017) Risk Factors for Reoperation in Patients Treated Surgically for Degenerative Spondylolisthesis: A Subanalysis of the 8-year Data From the SPORT Trial. Spine (Phila Pa 1976) 42:1559-1569
Marfeo, Elizabeth E; Ni, Pengsheng; McDonough, Christine et al. (2017) Improving Assessment of Work Related Mental Health Function Using the Work Disability Functional Assessment Battery (WD-FAB). J Occup Rehabil :
Lin, Timothy J; Bendich, Ilya; Ha, Alex S et al. (2017) A Comparison of Radiographic Outcomes After Total Hip Arthroplasty Between the Posterior Approach and Direct Anterior Approach With Intraoperative Fluoroscopy. J Arthroplasty 32:616-623
Skolasky, Richard L; Scherer, Emily A; Wegener, Stephen T et al. (2017) Does reduction in sciatica symptoms precede improvement in disability and physical health among those treated surgically for intervertebral disc herniation? Analysis of temporal patterns in data from the Spine Patient Outcomes Research Trial. Spine J :

Showing the most recent 10 out of 78 publications