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Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study

INTRODUCTION: Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measu...

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Autores principales: Bienstock, Dennis M., Snyder, Daniel J., Kroshus, Thomas R., Ahn, Amy, Koenig, Karl M., Molloy, Ilda B., Jevsevar, David S., Poeran, Jashvant, Moucha, Calin S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553630/
https://www.ncbi.nlm.nih.gov/pubmed/31321372
http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00039
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author Bienstock, Dennis M.
Snyder, Daniel J.
Kroshus, Thomas R.
Ahn, Amy
Koenig, Karl M.
Molloy, Ilda B.
Jevsevar, David S.
Poeran, Jashvant
Moucha, Calin S.
author_facet Bienstock, Dennis M.
Snyder, Daniel J.
Kroshus, Thomas R.
Ahn, Amy
Koenig, Karl M.
Molloy, Ilda B.
Jevsevar, David S.
Poeran, Jashvant
Moucha, Calin S.
author_sort Bienstock, Dennis M.
collection PubMed
description INTRODUCTION: Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measured preoperatively with the commonly used Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) questionnaires. We aim to identify (1) the preoperative relationship between HOOS/KOOS and VR-12 scores and several demographic, psychosocial, and clinical patient characteristics and (2) the best modifiable factors for optimization, which may result in improved baseline PROs before TJR. METHODS: All TJR cases performed in 2017 at the two highest-volume hospitals within an urban academic health system were queried. Preoperative HOOS/KOOS and VR-12 surveys were administered through an e-collection platform. VR-12 physical and mental component scores (PCS, MCS) were generated. Patient information was extracted from the electronic health record. Bivariate and multivariate regression analyses were performed. Odds ratios (ORs) and 95% confidence intervals were reported. RESULTS: In univariate analysis, patients with HOOS/KOOS, VR-12 PCS, and MCS in the ≤25th percentile group were more likely to have an ASA score of ≥3 compared with those with higher scores. In multivariate analysis, increased and decreased odds of low HOOS/KOOS were associated with a one-unit increase in Charlson Comorbidity Index (OR, 1.16) and VR-12 MCS (OR, 0.97), respectively. Increased odds of low baseline VR-12 PCS and MCS were associated with ASA class ≥3 (OR, 1.65 and 1.40). Decreased odds of a low MCS were associated with an increase in HOOS/KOOS (OR, 0.98) (P ≤ 0.05 for all). CONCLUSION: Of the factors that are associated with low baseline PRO scores, preoperatively addressing mismanaged comorbidities, mental health, and physical function were identified as the best modifiable factors for optimization, which may result in improved baseline PROs before TJR.
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spelling pubmed-65536302019-07-18 Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study Bienstock, Dennis M. Snyder, Daniel J. Kroshus, Thomas R. Ahn, Amy Koenig, Karl M. Molloy, Ilda B. Jevsevar, David S. Poeran, Jashvant Moucha, Calin S. J Am Acad Orthop Surg Glob Res Rev Research Article INTRODUCTION: Alternative payment models in total lower extremity joint replacement (TJR) increasingly emphasize patient-reported outcomes (PROs) to link the latter to value-based payments. It is unclear to what extent demographic, psychosocial, and clinical characteristics are related to PROs measured preoperatively with the commonly used Hip/Knee Osteoarthritis Outcome Scores (HOOS/KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) questionnaires. We aim to identify (1) the preoperative relationship between HOOS/KOOS and VR-12 scores and several demographic, psychosocial, and clinical patient characteristics and (2) the best modifiable factors for optimization, which may result in improved baseline PROs before TJR. METHODS: All TJR cases performed in 2017 at the two highest-volume hospitals within an urban academic health system were queried. Preoperative HOOS/KOOS and VR-12 surveys were administered through an e-collection platform. VR-12 physical and mental component scores (PCS, MCS) were generated. Patient information was extracted from the electronic health record. Bivariate and multivariate regression analyses were performed. Odds ratios (ORs) and 95% confidence intervals were reported. RESULTS: In univariate analysis, patients with HOOS/KOOS, VR-12 PCS, and MCS in the ≤25th percentile group were more likely to have an ASA score of ≥3 compared with those with higher scores. In multivariate analysis, increased and decreased odds of low HOOS/KOOS were associated with a one-unit increase in Charlson Comorbidity Index (OR, 1.16) and VR-12 MCS (OR, 0.97), respectively. Increased odds of low baseline VR-12 PCS and MCS were associated with ASA class ≥3 (OR, 1.65 and 1.40). Decreased odds of a low MCS were associated with an increase in HOOS/KOOS (OR, 0.98) (P ≤ 0.05 for all). CONCLUSION: Of the factors that are associated with low baseline PRO scores, preoperatively addressing mismanaged comorbidities, mental health, and physical function were identified as the best modifiable factors for optimization, which may result in improved baseline PROs before TJR. Wolters Kluwer 2019-05-09 /pmc/articles/PMC6553630/ /pubmed/31321372 http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00039 Text en Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons. This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0 (CC BY-ND) (http://creativecommons.org/licenses/by-nd/4.0/) which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
spellingShingle Research Article
Bienstock, Dennis M.
Snyder, Daniel J.
Kroshus, Thomas R.
Ahn, Amy
Koenig, Karl M.
Molloy, Ilda B.
Jevsevar, David S.
Poeran, Jashvant
Moucha, Calin S.
Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title_full Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title_fullStr Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title_full_unstemmed Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title_short Relationship Between Baseline Patient-reported Outcomes and Demographic, Psychosocial, and Clinical Characteristics: A Retrospective Study
title_sort relationship between baseline patient-reported outcomes and demographic, psychosocial, and clinical characteristics: a retrospective study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6553630/
https://www.ncbi.nlm.nih.gov/pubmed/31321372
http://dx.doi.org/10.5435/JAAOSGlobal-D-19-00039
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