title: Database and Registry Research in Orthopaedic Surgery: Part I: Claims-Based Data.
abstract: The use of large-scale national databases for observational research in orthopaedic surgery has grown substantially in the last decade, and the data sets can be grossly categorized as either administrative claims or clinical registries. Administrative claims data comprise the billing records associated with the delivery of health-care services. Orthopaedic researchers have used both government and private claims to describe temporal trends, geographic variation, disparities, complications, outcomes, and resource utilization associated with both musculoskeletal disease and treatment. Medicare claims comprise one of the most robust data sets used to perform orthopaedic research, with >45 million beneficiaries. The U.S. government, through the Centers for Medicare & Medicaid Services, often uses these data to drive changes in health policy. Private claims data used in orthopaedic research often comprise more heterogeneous patient demographic samples, but allow longitudinal analysis similar to that offered by Medicare claims. Discharge databases, such as the U.S. National Inpatient Sample, provide a wide national sampling of inpatient hospital stays from all payers and allow analysis of associated adverse events and resource utilization. Administrative claims data benefit from the high patient numbers obtained through a majority of hospitals. Using claims, it is possible to follow patients longitudinally throughout encounters irrespective of the location of the institution delivering health care. Some disadvantages include lack of precision of ICD-9 (International Classification of Diseases, Ninth Revision) coding schemes. Much of these data are expensive to purchase, complicated to organize, and labor-intensive to manipulate--often requiring trained specialists for analysis. Given the changing health-care environment, it is likely that databases will provide valuable information that has the potential to influence clinical practice improvement and health policy for years to come.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely: Andrew-pugely@uiowa.edu.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely: Andrew-pugely@uiowa.edu.
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Martin
authors.affiliation: Department of Orthopaedics, The Ohio State University Hospital, 376 West 10th Avenue, Suite 725, Columbus, OH 43210.
authors.forename: Jared
authors.initials: J
authors.lastname: Harwood
authors.affiliation: Exponent, Inc., 3440 Market Street, Suite 600, Philadelphia, PA 19104.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Ong
authors.affiliation: Department of Orthopaedic Surgery, University of California San Francisco, 3333 California Street, Suite 265, Box 0936, San Francisco, CA 94118.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Bozic
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA 52242. E-mail address for A.J. Pugely: Andrew-pugely@uiowa.edu.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000328:Adult; D000368:Aged; D003625:Data Collection; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D006278:Medicare / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000191:economics* / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data*; D014481:United States