Total hip replacement (THR) is a highly effective, frequently performed and costly surgery. While purchases of care seek centers of excellence for THR, at present there are no validated measures of the quality of THR. Further, it is not clear whether easily accessible administrative data provide adequate information to rate THR quality, or whether more expensive data sources such as chart review and patient interview are necessary.
The aim of this study is to validate indicators of the quality of elective primary and revision total hip replacement. The proposal takes advantage of a study already funded by NIH which examines the association between hospital and surgeon procedure volume and the outcomes of THR. The parent study analyzes Medicare claims of over 100,000 patients undergoing THR in 1995. Also, on a random 2000 of these subjects, we 1) review medical records to ascertain case severity, process of care and complications; 2) interview patients to assess satisfaction and functional status; and 3) survey hospitals to evaluate structural aspects of the setting in which surgery was done. An indicator of quality is valid if it is associated with the principal outcomes of THR--mortality, complications, and functional status only. Thus, we propose in this application to examine associations between process and structural indicators and these principal outcomes of THR in our rich dataset, adjusting for measures of case severity. We will also create and validate a cumulative index of the quality of THR which THR aggregates individual indicators identified both with statistical analyses of our data along with recommendations of an expert panel. We will assess the marginal benefit of using various sources of data for assessing quality of THR. Thus, this study will delineate the optimal data sources and data elements for measuring and ultimately improving the quality of THR.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS009775-02
Application #
6030998
Study Section
Special Emphasis Panel (ZHS1-CQA-G (01))
Program Officer
Sangl, Judith
Project Start
1998-07-01
Project End
2000-06-30
Budget Start
1999-07-01
Budget End
2000-06-30
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02115
de Pablo, Paola; Losina, Elena; Mahomed, Nizar et al. (2006) Extent of followup care after elective total hip replacement. J Rheumatol 33:1159-66
de Pablo, Paola; Losina, Elena; Phillips, Charlotte B et al. (2004) Determinants of discharge destination following elective total hip replacement. Arthritis Rheum 51:1009-17
Mahomed, Nizar N; Barrett, Jane A; Katz, Jeffrey N et al. (2003) Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am 85-A:27-32
Katz, Jeffrey N; Phillips, Charlotte B; Baron, John A et al. (2003) Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum 48:560-8
Escalante, Agustin; Barrett, Jane; del Rincon, Inmaculada et al. (2002) Disparity in total hip replacement affecting Hispanic Medicare beneficiaries. Med Care 40:451-60
Mandl, Lisa A; Solomon, Daniel H; Smith, Ellison L et al. (2002) Using antineutrophil cytoplasmic antibody testing to diagnose vasculitis: can test-ordering guidelines improve diagnostic accuracy? Arch Intern Med 162:1509-14
Solomon, Daniel H; Losina, Elena; Baron, John A et al. (2002) Contribution of hospital characteristics to the volume-outcome relationship: dislocation and infection following total hip replacement surgery. Arthritis Rheum 46:2436-44
Katz, J N (2001) Patient preferences and health disparities. JAMA 286:1506-9
Katz, J N; Losina, E; Barrett, J et al. (2001) Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am 83-A:1622-9
Katz, J N; Solomon, D H; Schaffer, J L et al. (2000) Outcomes of care and resource utilization among patients with knee or shoulder disorders treated by general internists, rheumatologists, or orthopedic surgeons. Am J Med 108:28-35

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