Improving Orthopedic Outcomes Through a National TJR Registry

通过国家 TJR 登记改善骨科治疗效果

• 批准号: 7940017
• 负责人: PATRICIA D FRANKLIN
• 金额: $ 299.68万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7940017
• 关键词: Improving; Orthopedic; Outcomes; Through; National

DESCRIPTION (provided by applicant): Each year, more than 700,000 US adults elect total joint replacement (TJR) surgery to restore physical function and eliminate the pain of advanced knee or hip arthritis that persists despite comprehensive medical treatment. Despite broad use, wide variation persists in surgical practice and outcomes. Furthermore, there is a lack of comparative effectiveness data to guide surgeon and patient decisions on optimal implant timing, surgical approach, implant selection, and peri-operative management to prevent adverse sequelae and revision. Therefore, the National Orthopedic Outcome Registry (NOOR) and Cohort Study will establish a national registry of over 33,000 diverse patients of 130 orthopedic surgeons representing all regions of the country and varied hospital and surgeon practice settings. As such, the registry is designed to reflect typical US clinical practice, rather than focusing exclusively on high-volume academic centers. Data will include baseline patient attributes; procedure approach and technology; hospital course; surgeon and institutional characteristics; longitudinal patient function, post-procedure complications and revisions, and serum/DNA samples. Web-based data collection will enhance efficient data gathering. The research team will develop new outcome measures and will determine the relative contributions of patient factors, technology use, and delivery factors to (1) early functional failure and (2) adverse post-arthroplasty events; (3) examine disparities in TJR use and outcome, seeking to elucidate root causes; and (4) conduct economic analyses to determine the personal and societal value of TJR in working aged adults. A national network of orthopedists will partner with innovative scientists with expertise in large-scale registry development and implementation, web-based technology, outcome measurement, and statistical techniques to assure success. Sound governance principles will ensure efficient implementation. The registry will actively encourage ancillary research to assure optimal use of all data and biomaterials. We propose to transform the network of clinical centers and orthopedic offices into a research laboratory that will serve as a national model for comparative effectiveness research. PUBLIC HEALTH RELEVANCE: The proposed national orthopedic outcome registry will collect important patient, surgical, and delivery setting data to answer critical patient and surgeon questions about optimal implant selection, surgical timing and approach, and peri-operative care for the large number of patients who undergo total joint replacement and other procedures each year. Research will also address TJR value in young patients and use disparities,

描述（由申请人提供）：每年，超过70万名美国成年人选择全面的关节置换（TJR）手术以恢复身体机能，并消除尽管全面的医疗治疗，但仍能持续进行晚期膝盖或髋关节炎的疼痛。尽管广泛使用，但在手术实践和结果中仍然存在广泛的变化。此外，缺乏比较有效性数据，可以指导外科医生和患者对最佳植入时间，手术方法，植入物选择和围手术治疗的决定，以防止不良后遗症和修订。因此，国家骨外科登记册（NOOR）和队列研究将建立一个国家登记处，由33,000多名代表该国所有地区以及各种医院和外科医生实践环境的130名骨科医生的患者组成33,000多名患者。因此，该注册表旨在反映典型的美国临床实践，而不是专注于高批量的学术中心。数据将包括基线患者属性；程序方法和技术；医院课程；外科医生和机构特征；纵向患者功能，过程后并发症和修订以及血清/DNA样品。基于Web的数据收集将增强有效的数据收集。研究小组将制定新的结果指标，并将确定患者因素，技术使用和交付因子对（1）早期功能失败以及（2）不良后孕造成事件的相对贡献； （3）检查TJR使用和结果的差异，试图阐明根本原因； （4）进行经济分析以确定TJR在工作老年人中的个人和社会价值。国家骨科医生网络将与具有创新的科学家合作，具有大规模注册开发和实施，基于Web的技术，结果测量和统计技术以确保成功的专业知识。合理的治理原则将确保有效的实施。注册中心将积极鼓励辅助研究，以确保所有数据和生物材料的最佳使用。我们建议将临床中心和骨科办公室的网络转变为研究实验室，该实验室将作为比较有效性研究的国家模型。 公共卫生相关性：拟议的国家骨科结果登记处将收集重要的患者，外科手术和分娩设置数据，以回答有关最佳植入物选择，手术时间和方法的关键患者和外科医生的问题，以及每年接受全部联合替代者和其他程序的大量患者的戏剧护理。研究还将解决年轻患者的TJR价值并使用差异，