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OCR for page 41
Conclusions
Aside from the recommendations already cited, the hip fracture com-
mittee reached three main conclusions. First, as in the breast cancer and
acute myocardial infarction clinical workshops, the committee believes that
the HCFA data sets, as presently constituted, can be best used to describe,
track, and compare broad patterns of care for hip fracture according to
subgroups of providers, practitioners, and patients. The committee fully
supports these goals of the Effectiveness Initiative.
The patient management areas identified as highest priority for effec-
tiveness research prevention, treatment options, and rehabilitation reach
beyond the capacity of the current HCFA databases. The scarcity of out-
come measures (other than mortality) and of health and functional status
information (both pre- and post-fracture) in the Medicare administrative
databases makes them inadequate to adjust for case mix, to ascertain risk,
or to determine the effectiveness of prevention, treatment, or rehabilitation
interventions. These limitations, among others, emphasize the importance
of developing strategies to acquire needed outcome and health and func-
tional status data, either for the standard data sets themselves or for special
projects and studies.
Second, the Medicare files pose problems of data reliability and va-
lidity. These limitations include inadequate descriptions of race, the im-
possibility of expressing which one of a paired body part is involved in
a procedure, and discrepancies between the numbers of identifiable cases
based on the diagnosis and those identified by summing over the appropri-
ate procedures. These and other difficulties obligate external users of these
files to consult experts within HCFA during extramural research projects
and to incorporate validity studies in all effectiveness research.
41
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42
EFFECTrVENESS INITL24TWE
Third, the committee emphasized the need for coordination among
DHHS agencies that are responsible for effectiveness research. This should
minimize duplication of efforts and maximize current knowledge (e.g., in
the development of a health and functional status measure that includes
the concept of frailty). DHHS should develop a mechanism (e.g., a task
force, requests for proposals, contracting, and grants) to accomplish this
coordination. DHHS should also consult widely and continuously with
clinicians and technical experts in these efforts. ~ this end, DHHS might
empanel a high-level advisory committee of experts to provide oversight
for effectiveness and outcomes research.
This workshop represents an important step in hip fracture effective-
ness research. Problems of patients, practitioners, and payers are addressed
from a very broad perspective. Effectiveness research, done well, will have
several benefits beyond its immediate scope: it will generate hypotheses
for clinical and biomedical studies; it will provide a focusing mechanism
for such research that is derived from the epidemiology of disease and its
treatment, not simply from the science base; and it will stimulate a more
comprehensive orientation to research that will in turn support clinical
practice.
Representative terms from entire chapter:
hip fracture
