Hip Fracture Setting Priorities for Effectiveness Research (1990) / Chapter Skim
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APPENDIX: BACKGROUND AND CONDUCT OF THE WORKSHOP
APPENDIX: BACKGROUND AND CONDUCT OF THE WORKSHOP
Pages 49-64
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From page 49... ...
Before the workshop, committee members were asked to list three patient management topics that should be given highest priority and, for each of the topics nominated, to specify the types of studies that should be undertaken or sponsored. The results of this exercise were presented at the outset of the meeting.
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From page 50... ...
The workshop featured four background presentations: Rose Connerton of HCFA, on the Medicaid/Medicare Decision Support System; Alfred Rimm of the Medical College of Wisconsin, on risk factors and incidence rates obtained from the administrative databases; Kenneth I Shine of UCLA (chair of the committee)
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From page 51... ...
The fifth main record group is the Provider Cost Report Record, which has cost, accounting, and other data from participating institutional providers. For effectiveness research, other "derivative" files may be important sources of information: MEDPAR (Medicare Provider Analysis and Review file)
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From page 52... ...
as part of the proposed Uniform Clinical Data Set. In 1987, HCFAs Health Standards and Quality Bureau began a complex project to develop a data set for use by the Medicare Peer Review Organizations (PROs)
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From page 53... ...
Preliminary results of a study designed to provide population-based estimates of the incidence of hip fractures by age, sex, and race among the elderly population of the United States and to estimate case-fatality rates for those people were discussed. The study uses discharge data, obtained from HCFA and the Department of Veterans Affairs, from all short-stay hospitals from 1984 to 1987.
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From page 54... ...
A second round of voting was held at the workshop itself. The committee reaffirmed prevention, treatment options, and rehabilitation as the three priority patient management issues in those with hip fractures that it would recommend to HCFN Able A2 provides a summary of these topics.
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From page 55... ...
Physiotherapy Occupational therapy Clinical nutrition Respiratory therapy Speech therapy Social work Clinical pharmacist Vocational services Palliative care (of hospice type) Prosthetics/orthotics Pastoral care Psychiatric counseling/care Patient education F F F F F F F F F F F F F SOURCE: Resource Manual for Uniform Clinical Data Set (UCDS)
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From page 56... ...
Prophylaxis of phlebitis and pulmonary embolus Use of readmission data to assess and improve quality of care Use of geriatric assessment to prevent secondary complications Adapting the hospital structure to meet the needs of the frail elderly E Rehabilitation (27 percent of responses)
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From page 57... ...
. practlcmg primary care provlc ers Detennine whether improvements in flexibility, cardiac endurance, and muscle strength for the frail elderly can be carried over to function in everyday life thereby reducing the incidence of hip fracture 1.
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From page 58... ...
Conduct larger clinical trials to determine whether thiazide diuretics decrease the incidence of hip fractures in this population D Collect data on estrogen replacement therapy in a large cohort to determine how long it must be administered to reduce the fracture incidence maximally
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From page 59... ...
Determine whether there is a subset of patients who sustain hip fractures who are so disabled that the usual operative intervention offers little functional gain; and therefore, nonoperative supportive treatment only should be considered D Determine the differences in long-tem~ functioning of total hip replacement compared with that of head replacement compared with that of internal fixation; determine the mortality implications E
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From page 60... ...
Monitor trends in the population for individuals receiving different forms of therapy; establish the relationship of the type of surgery performed to subsequent hospitalizations, recurrent fractures, length of stay in nursing homes, or time to death Monitor geographic variation 'end trends in procedures to determine the advantage in long-term functioning and mortality of total hip replacement over that of head replacement over that of internal fixation K Monitor trends in the population for individuals receiving different forms of therapy to determine the best approach for surgical management of the patient with femoral · neck or intertrochanteric fractures Analyze the relationship of the type of surgery performed to subsequent hospitalizations, recurrent fractures, length of stay in nursing homes, and time to death M
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From page 61... ...
Monitor trends and geographic variations in readmissions as an indicator of secondary complications 5. Through examination of medical records, determine whether the coded diagnosis indicates a problem readmission; compare readmissions to diagnosis mistakes found in abstracted medical records as a way to pinpoint problems III.
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From page 62... ...
Define "ideal situation" programs for various levels of expectation b. Implement "model" programs to test feasibility of defined programs Study a selected population of individuals with hip fracture to determine whether their outcomes differ on the basis of rehabilitation program intensity and comprehensiveness Study a selected population of individuals with hip fractures, by observing their return to the horns setting as a function of the intensity of rehabilitation services and any effect differences in intensity may have on later quality of life (1 year)
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From page 63... ...
Heterogeneous nature of patients with hip fractures must be recognized Stratify by prefecture: 1. Cognitive function 2.
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From page 64... ...
Research Strategy: A Using HCFA-Medieare files, identify the population of all individuals with hip fractures that were treated surgically; for a sample of these individuals, using casemix severity adjusters, determine 1.
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