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The Application of Medicare Data for Musculoskeletal Research in the United States

A Systematic Review

Mahmoudi, Elham PhD; Malay, Sunitha MPH; Maroukis, Brianna L. BS; Sarsour, Tiana BS; Chung, Kevin C. MD, MS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 1, 2019 - Volume 27 - Issue 13 - p e622–e632
doi: 10.5435/JAAOS-D-17-00297
Research Article
SDC

Introduction: Musculoskeletal conditions disproportionately affect the lives of aging adults. We aimed to examine the literature using Medicare claims data in the United States for musculoskeletal surgical procedures.

Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we searched the PubMed and Medline databases for peer-reviewed articles published between 1990 and 2015. We included the studies that (1) reported primary Medicare claims data use, (2) involved musculoskeletal surgery, and (3) were original peer-reviewed studies. We abstracted the types of surgical procedure and aims, and evaluated outcomes, and strengths and weaknesses of each included article. We assessed the quality of included articles with Newcastle Ottawa Assessment Scale.

Results: The literature search returned 3,233 articles, of which 119 met our inclusion criteria. These studies focused on different outcomes: epidemiology and treatment variation (26), cost of care (15), hospital-level analyses (30), health outcomes (31), the validity and accuracy of Medicare claims data (4), disparities in health care (10), and policy evaluation (3).

Discussion: Medicare claims data provide a unique way for researchers to study a nationally representative patient population longitudinally. A significant limitation of using claims data has been a lack of granularity on defining severity of a condition.

Level of Evidence: Therapeutic level III

From the Department of Family Medicine (Dr. Mahmoudi), University of Michigan Medical School, the Department of Surgery (Ms. Malay and Ms. Maroukis), Section of Plastic Surgery, University of Michigan Medical School, the Michigan Health Science Undergraduate Research Academy (Ms. Sarsour), Office of Health Equity and Inclusion, University of Michigan, Ann Arbor, MI, the University of Toledo, College of Natural Sciences, Toledo, OH (Ms. Sarsour), and the Section of Plastic Surgery, Faculty Affairs, University of Michigan Medical School, Ann Arbor, MI (Dr. Chung).

Correspondence to Dr. Mahmoudi: Mahmoudi@med.umich.edu

Supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (2R01 AR047328-06), and a Midcareer Investigator Award in Patient-Oriented Research (2K24 AR053120-06) to Dr. Chung. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ms. Sarsour or an immediate family member has stock or stock options held in Amgen, Norvartis, and Sanofi-Aventis. None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Mahmoudi, Ms. Malay, Ms. Maroukis, and Dr. Chung.

© 2019 by American Academy of Orthopaedic Surgeons
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