National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Arthritis (3)
- Chronic Conditions (2)
- Decision Making (3)
- Diabetes (1)
- Electronic Health Records (EHRs) (2)
- Evidence-Based Practice (1)
- Healthcare Costs (3)
- Health Information Technology (HIT) (3)
- Health Insurance (1)
- Health Services Research (HSR) (1)
- Health Systems (1)
- Hospitals (2)
- Medication (1)
- Opioids (1)
- (-) Orthopedics (20)
- Outcomes (4)
- Pain (3)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient and Family Engagement (1)
- Payment (3)
- Provider (1)
- Provider: Physician (1)
- Quality of Care (1)
- Quality of Life (1)
- Racial and Ethnic Minorities (1)
- Rehabilitation (2)
- Research Methodologies (2)
- Simulation (1)
- Surgery (17)
- Training (1)
- Women (1)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 20 of 20 Research Studies DisplayedNa A, Middleton A, Haas A
Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries.
This study examined the impact of diabetes on 90-day episodes of care after elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) in the United States. Complication (n = 521,230) and readmission (n = 515,691) data was extracted on Medicare beneficiaries using files from 2013 and 2014. Diabetes status was identified with ICD-9 codes. The odds ratio (OR) of TKA complications was significantly higher for patients with uncontrolled diabetes than those with no diabetes. The OR of THA complications was also significantly higher for controlled-complicated diabetes. OR of readmission was significantly higher for all diabetes groups.
AHRQ-funded; HS026133.
Citation: Na A, Middleton A, Haas A .
Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries.
J Bone Joint Surg Am 2020 Dec 16;102(24):2157-65. doi: 10.2106/jbjs.20.00203..
Keywords: Diabetes, Chronic Conditions, Orthopedics, Surgery
Bell KM, Onyeukwu C, Smith CN
A portable system for remote rehabilitation following a total knee replacement: a pilot randomized controlled clinical study.
The authors have developed and previously validated the accuracy of a remote (wearable) rehabilitation monitoring platform (interACTION). The present study's objective was to assess the feasibility of utilizing interACTION for the remote management of rehabilitation after total knee replacement (TKR) and to determine a preliminary estimate of the effects of the interACTION system on the value of rehabilitation. Findings showed that all patients and physical therapists in the interACTION Group indicated that they would use the system again in the future. Therefore, the next steps are to address the concerns identified in this pilot study and to expand the platform to include behavioral change strategies prior to conducting a full-scale randomized controlled trial.
Citation: Bell KM, Onyeukwu C, Smith CN .
A portable system for remote rehabilitation following a total knee replacement: a pilot randomized controlled clinical study.
Sensors 2020 Oct 27;20(21). doi: 10.3390/s20216118..
Keywords: Orthopedics, Rehabilitation, Health Information Technology (HIT)
Hsieh CJ, DeJong G, Vita M
AHRQ Author: Hsieh CJ
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
Researchers compared post-total knee arthroplasty (TKA) functional mobility outcomes among 3 newly-developed physical therapy protocols with a standard-of-care post-TKA rehabilitation protocol. They found no statistically or clinically significant differences in outcomes across the 4 study arms (control, treadmill, neuromuscular stimulation device, and combination intervention). As outcomes were similar among arms, they recommended that clinicians instead consider relative cost in tailoring TKA rehabilitation.
AHRQ-authored.
Citation: Hsieh CJ, DeJong G, Vita M .
Effect of outpatient rehabilitation on functional mobility after single total knee arthroplasty: a randomized clinical trial.
JAMA Netw Open 2020 Sep;3(9):e2016571. doi: 10.1001/jamanetworkopen.2020.16571..
Keywords: Rehabilitation, Orthopedics, Surgery, Outcomes, Evidence-Based Practice
Giardina JC, Cha T, Atlas SJ
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
The purpose of this study was to develop and validate an algorithm to identify patients receiving four elective orthopedic surgeries to promote shared decision-making. The surgeries included were: 1) knee arthroplasty to treat knee osteoarthritis (KOA); 2) hip arthroplasty to treat hip osteoarthritis (HOA); 3) spinal surgery to treat lumbar spinal stenosis (SpS); and 4) spinal surgery to treat lumber herniated disc (HD). Electronic medical records were reviewed to ascertain a “gold standard” determination of the procedure and primary indication status. Each case had electronic algorithms consisting of ICD-10 and CPT codes for each combination and indication applied to their record. A total of 790 procedures were included in the study. The sensitivity of the algorithms ranged from 0.70 (HD) to 0.92 (KOA). Specificity ranged from 0.94 (SpS) to 0.99 (HOA, KOA).
AHRQ-funded; HS000055.
Citation: Giardina JC, Cha T, Atlas SJ .
Validation of an electronic coding algorithm to identify the primary indication of orthopedic surgeries from administrative data.
BMC Med Inform Decis Mak 2020 Aug 12;20(1):187. doi: 10.1186/s12911-020-01175-1.
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Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Orthopedics, Surgery, Arthritis, Decision Making
Thomas GW, Long S, Tatum M
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
In this paper, a vision is presented to elevate community orthopedic practice and improve patient safety by advancing the use of simulators for training and assessing surgical skills. Key elements of this vision included 1) methods for the objective and rigorous assessment of the performance of practicing surgeons now exist, 2) simulators are sufficiently mature and sophisticated that practicing surgeons will use them, and 3) practicing surgeons can improve their performance with appropriate feedback and coaching.
AHRQ-funded; HS022077; HS025353.
Citation: Thomas GW, Long S, Tatum M .
A vision for using simulation & virtual coaching to improve the community practice of orthopedic trauma surgery.
Iowa Orthop J 2020;40(1):25-34..
Keywords: Orthopedics, Surgery, Simulation, Training, Provider: Physician, Provider
Machta RM, Reschovsky J, Jones DJ
AHRQ Author: Furukawa MF
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
The authors sought to assess whether system providers perform better than non-system providers under an alternative payment model that incentivizes high-quality, cost-efficient care. Using CMS data linked to AHRQ’s Compendium of US Health Systems, along with secondary sources, they found that when operating under alternative payment model incentives, vertical integration may enable hospitals to lower costs with similar quality scores.
AHRQ-authored; AHRQ-funded; 290201600001C.
Citation: Machta RM, Reschovsky J, Jones DJ .
Can vertically integrated health systems provide greater value: the case of hospitals under the comprehensive care for joint replacement model?
Health Serv Res 2020 Aug;55(4):541-47. doi: 10.1111/1475-6773.13313..
Keywords: Health Systems, Hospitals, Orthopedics, Healthcare Costs, Payment, Quality of Care
Kittelson AJ, Elings J, Colborn K
Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.
This study’s goal was to develop and validate a reference chart for monitoring recovery of knee flexion following total knee arthroplasty surgery. The researchers conducted a retrospective analysis of data collected for routine rehabilitation practice of post-TKA surgical patients. They concluded that a reference chart developed with clinically collected data offers a new approach to monitoring knee flexion following total knee arthroplasty.
AHRQ-funded; HS024316; HS025692.
Citation: Kittelson AJ, Elings J, Colborn K .
Reference chart for knee flexion following total knee arthroplasty: a novel tool for monitoring postoperative recovery.
BMC Musculoskelet Disord 2020 Jul 22;21(1):482. doi: 10.1186/s12891-020-03493-x..
Keywords: Orthopedics, Surgery
Goz V, Martin BI, Donnally CJ
Potential selection bias in observational studies comparing cervical disc arthroplasty to anterior cervical discectomy and fusion.
This retrospective cohort study looked at potential selection bias for spinal patients undergoing cervical disc arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF). A total of ACDF or CDA 290,419 procedures were identified in adults from 2004-2014 using ICD-9-CM diagnosis and procedure codes. The vast majority (98.2%) underwent ACDF. CDA patients were younger and healthier with a higher socioeconomic status than ACDF patients. CDA was also $574 more expensive in the fully specified model. There was no statistically significant difference in terms of complications between the two procedures.
AHRQ-funded; HS024714.
Citation: Goz V, Martin BI, Donnally CJ .
Potential selection bias in observational studies comparing cervical disc arthroplasty to anterior cervical discectomy and fusion.
Spine 2020 Jul 15;45(14):960-67. doi: 10.1097/brs.0000000000003427..
Keywords: Surgery, Orthopedics, Research Methodologies
Loyd BJ, Kittelson AJ, Forster J
Development of a reference chart to monitor postoperative swelling following total knee arthroplasty.
The purpose of this study was to develop a reference chart to monitor postoperative swelling following total knee arthroplasty. Until recently, there was no reliable way to accurately measure swelling in clinical settings, but bioelectrical impedance assessment has shown promise. The authors worked with 56 participants who were followed for the first 7 weeks following total knee arthroplasty. Frequent lower extremity bioelectrical impedance assessment data was collected from the first 40 patients rolled in the study with the remaining 16 patients preliminarily tested. The first 3 days following surgery showed an approximately 10% per day increase with peak swelling occurring 6-8 days after surgery, with a range of 25% for the 10th percentile and 47% for the 90th percentile. It is hoped this monitoring will improve clinical decision making at the individual level.
AHRQ-funded; HS024316.
Citation: Loyd BJ, Kittelson AJ, Forster J .
Development of a reference chart to monitor postoperative swelling following total knee arthroplasty.
Disabil Rehabil 2020 Jun;42(12):1767-74. doi: 10.1080/09638288.2018.1534005..
Keywords: Surgery, Orthopedics
Weng Y, Tian L, Tedesco D
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Postoperative pain scores are widely monitored and collected in the electronic health record, yet current methods fail to fully leverage the data with fast implementation. This article describes a trajectory analysis for postoperative pain using electronic health records. A robust linear regression was fitted to describe the association between the log-scaled pain score and time from discharge after total knee replacement.
AHRQ-funded; HS024096.
Citation: Weng Y, Tian L, Tedesco D .
Trajectory analysis for postoperative pain using electronic health records: a nonparametric method with robust linear regression and K-medians cluster analysis.
Health Informatics J 2020 Jun;26(2):1404-18. doi: 10.1177/1460458219881339..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Pain, Surgery, Orthopedics, Research Methodologies, Health Services Research (HSR)
Dekhne MS, Nuliyalu U, Schoenfeld AJ
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
This study examined “surprise” out-of-network billing in orthopedic surgery. Data was analyzed from the Clinformatics DataMart on commercial insured patients undergoing 4 different elective orthopedic procedures from 2012 to 2017: arthroscopic meniscal repair, lumbar discectomy, total knee replacement and total hip replacement. They defined surprise bills as out-of-network bills for procedures done at in-network hospitals. The rate of potential surprise bills was 24.8% for total knee replacement, 24.5% lumbar discectomy, 23.5% for total hip replacement, and 12.5% for meniscal repair. The largest number of surprise bills came from anesthesiologists (39% of all episodes), and durable medical equipment (15%). Per episode, the largest bills came from nonphysician surgical assistants, neurologists, and physician assistants.
AHRQ-funded; HS000053; HS023597.
Citation: Dekhne MS, Nuliyalu U, Schoenfeld AJ .
"Surprise" out-of-network billing in orthopedic surgery: charges from surprising sources.
Ann Surg 2020 May;271(5):e116-e18. doi: 10.1097/sla.0000000000003825..
Keywords: Orthopedics, Surgery, Payment, Healthcare Costs, Health Insurance
Gaskin DJ, Karmarkar TD, Maurer A
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
This study examined whether using a decision-making tool would aid Latina and African-American women over age 45 years with arthritic knee pain in making more informed treatment decisions. The researchers conducted 4 focus groups of Latina and African-American women and 2 focus groups with primary care providers who treated them for knee pain. They found that minority women and primary care providers all endorsed the use of a decision-making tool that provided information on the impact of treatment on quality of life, medical care costs, and work productivity.
AHRQ-funded; HS000029.
Citation: Gaskin DJ, Karmarkar TD, Maurer A .
Potential role of cost and quality of life in treatment decisions for arthritis-related knee pain in African American and Latina women.
Arthritis Care Res 2020 May;72(5):692-98. doi: 10.1002/acr.23903..
Keywords: Arthritis, Orthopedics, Pain, Quality of Life, Healthcare Costs, Decision Making, Racial and Ethnic Minorities, Women
Whitebird RR, Solberg LI, Norton RR, Solberg LI, Norton CK
What outcomes matter to patients after joint or spine surgery?
In this study, semi-structured interviews were conducted with 65 patients undergoing hip or knee replacement, spinal discectomy/laminectomy, or a spinal fusion to examine what patient-reported outcome measures (PROMs) patients identified as most important. The investigators found that patients identified specific preferred outcomes from these surgical procedures that were important and meaningful to them and that framed whether they saw their surgery as a success. They also identified personal factors that they assumed their surgeons knew about, which affected their care and recovery.
AHRQ-funded; HS025618.
Citation: Whitebird RR, Solberg LI, Norton RR, Solberg LI, Norton CK .
What outcomes matter to patients after joint or spine surgery?
J Patient Cent Res Rev 2020 Spr;7(2):157-64. doi: 10.17294/2330-0698.1738..
Keywords: Surgery, Orthopedics, Patient-Centered Outcomes Research, Outcomes
Finch DJ, Martin BI, Franklin PD
Patient-reported outcomes following total hip arthroplasty: a multicenter comparison based on surgical approaches.
This study looked at patient-reported outcomes (PROs) from patients who underwent total hip arthroplasty (THA) in the United States. The cohort examined were participants in the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement study. The researchers compared PROs between posterior, transgluteal, and anterior surgical approaches to THA. Patients were surveyed on function, global health and pain at 1, 3, and 6 months postoperatively at 26 sites from the clinical trial. Outcomes from 3018 eligible participants were examined from December 2016 through August 2019. While there was lower improvement in hip disability and Osteoarthritis Outcomes Score at first with the transgluteal cohort, by 3 and 6 months there was no clinically significant differences between the three groups.
AHRQ-funded; HS024714.
Citation: Finch DJ, Martin BI, Franklin PD .
Patient-reported outcomes following total hip arthroplasty: a multicenter comparison based on surgical approaches.
J Arthroplasty 2020 Apr;35(4):1029-35.e3. doi: 10.1016/j.arth.2019.10.017..
Keywords: Orthopedics, Surgery
Finch DJ, Pellegrini VD, Franklin PD
The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes.
This study compared outcomes for patients undergoing hip and knee arthroplasty at hospitals participating in Medicare’s bundled payment programs with hospitals that do not. They performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee replacement trial. Differences through 6 months were observed. Outcomes were described using the brief Knee Injury and Osteoarthritis Outcomes Score or the brief Hip Disability and Osteoarthritis Outcomes Score, the Patient-Reported Outcomes Measurement Information System Physical Health Score, and the Numeric Pain Rating Scale. While there slightly lower improvement at nonbundled hospitals at first, overall the effects were small.
Citation: Finch DJ, Pellegrini VD, Franklin PD .
The effects of bundled payment programs for hip and knee arthroplasty on patient-reported outcomes.
J Arthroplasty 2020 Apr;35(4):918-25.e7. doi: 10.1016/j.arth.2019.11.028..
Keywords: Orthopedics, Surgery, Payment
Kittelson AJ, Hoogeboom TJ, Schenkman M
Person-centered care and physical therapy: a "people-like-me" approach.
In this article the authors propose developing "people-like-me" reference charts, generated with historical outcomes data, to provide real-time information on an individual's status relative to similar people, using as an example people rehabilitating after total knee arthroplasty. The authors propose this framework as a practical mechanism to advance person-centered decisions in physical therapy according to the ideals of evidence-based practice.
AHRQ-funded; HS024316; HS025692.
Citation: Kittelson AJ, Hoogeboom TJ, Schenkman M .
Person-centered care and physical therapy: a "people-like-me" approach.
Phys Ther 2020 Jan 23;100(1):99-106. doi: 10.1093/ptj/pzz139..
Keywords: Patient-Centered Healthcare, Surgery, Orthopedics
Chin KK, Carroll I, Desai K
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
This study evaluated adjuvant analgesic gabapentin use after total knee arthroplasty (TKA) surgery and its effects on opioid use, pain, and readmissions. This retrospective observational study included 4,046 TKA recipients from 2009 to 2017 using electronic health records from an academic tertiary care medical institute. Overall, there was an 8.72% annual increase in gabapentin use which was associated with a significant decrease in opioid consumption in modeled estimates. Patients receiving gabapentin had similar discharge and follow-up pain scores, and 30-day unplanned readmission rates compared with patients receiving no adjuvant analgesics.
AHRQ-funded; HS024096.
Citation: Chin KK, Carroll I, Desai K .
Integrating adjuvant analgesics into perioperative pain practice: results from an academic medical center.
Pain Med 2020 Jan;21(1):161-70. doi: 10.1093/pm/pnz053..
Keywords: Opioids, Medication, Pain, Surgery, Orthopedics
Carey K, Morgan JR, Lin MY
Patient outcomes following total joint replacement surgery: a comparison of hospitals and ambulatory surgery centers.
This study used a large claims database of non-Medicare patients to examine inpatient and outpatient total knee replacement and total hip replacement surgery performed on a near-elderly population during 2014-2016. Findings support the argument that outpatient total joint replacement is appropriate for select patients treated in both hospital outpatient departments and ambulatory surgery centers, although in the commercially insured population, the latter services may come at a cost. Until further study of outpatient total joint replacement in the Medicare population becomes available, how this will extrapolate to the Medicare population is unknown.
AHRQ-funded; HS022242.
Citation: Carey K, Morgan JR, Lin MY .
Patient outcomes following total joint replacement surgery: a comparison of hospitals and ambulatory surgery centers.
J Arthroplasty 2020 Jan;35(1):7-11. doi: 10.1016/j.arth.2019.08.041..
Keywords: Orthopedics, Surgery, Ambulatory Care and Surgery, Hospitals, Outcomes
Hurley VB, Rodriguez HP, Kearing S
The impact of decision aids on adults considering hip or knee surgery.
Investigators analyzed data for 2012-2015 about patients within the ten High Value Healthcare Collaborative member systems who were exposed to condition-specific decision aids in the context of consultations for hip and knee osteoarthritis, with the intention that the aids be used to support shared decision making. They found that, compared to matched patients not exposed to the decision aids, those exposed had two-and-a-half times the odds of undergoing hip replacement surgery and nearly twice the odds of undergoing knee replacement surgery within six months of the consultation. Their findings suggest that health care systems adopting decision aids developed for use in shared decisionmaking, and used in conjunction with hip and knee osteoarthritis consultations, should not expect reduced surgical utilization.
AHRQ-funded; HS024075.
Citation: Hurley VB, Rodriguez HP, Kearing S .
The impact of decision aids on adults considering hip or knee surgery.
Health Aff 2020 Jan;39(1):100-07. doi: 10.1377/hlthaff.2019.00100..
Keywords: Decision Making, Surgery, Orthopedics, Patient and Family Engagement
Lange JK, DiSegna ST, Yang W
Using cluster analysis to identify patient factors linked to differential functional gains after total knee arthroplasty.
This study used cluster analysis to identify patient factors linked to different outcomes following total knee arthroplasty (TKA). The study analyzed Short Form 36 Physical Component Score (PCS) trajectories of 656 patients at 3 time points over a 1-year period. The MultiExperiment View (MeV) built-in bootstrapping method was used to assess statistical significance of the clusters. They found two distinct clusters: Cluster 1 included 550 patients (84%) who demonstrated persistent improvement at 6 and 12 months. The remainder of patients consisted of Cluster 2 who demonstrated decline in PCS at 6 months but improved by 12 months. Cluster 1 was found to have higher baseline mental health scores, lower baseline PCS, and a significantly higher proportion of non-Hispanic Whites compared to Cluster 2.
AHRQ-funded; HS018910.
Citation: Lange JK, DiSegna ST, Yang W .
Using cluster analysis to identify patient factors linked to differential functional gains after total knee arthroplasty.
J Arthroplasty 2020 Jan;35(1):121-26.e6. doi: 10.1016/j.arth.2019.08.039..
Keywords: Orthopedics, Surgery, Arthritis, Outcomes, Chronic Conditions