Kevin J. Bozic, MD, MBA
Kevin J. Bozic, M.D., M.B.A., William R. Murrary Professor and Vice Chair, Department of Orthopaedic Surgery and Core Faculty of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco (UCSF), has been spear-heading multiple investigations on the relationship between economics, health policy, and the practice of orthopaedic surgery. The results show there is much to be gained when orthopaedic surgeons collaborate with behavioral and social scientists, and collectively bring their knowledge and clinical experience to bear on the policy-making process.
Highlights: Dr. Bozic received a 2011 Robert Wood Johnson Foundation (RWJF) Targeted Solicitation Award on Quality Improvement and Performance Measurement for his work entitled “Shared Decision Making in Patients with Osteoarthritis of the Hip and Knee.” Dr. Bozic and his multi-center, multi-stakeholder research group will assess the impact of decision support interventions on key patient, surgeon, and purchaser priorities, assess patient, surgeon, purchaser level of interest, willingness-to-pay, and facilitators to barriers to adoption on decision support interventions, and develop and evaluate specific programs and financial incentives to address facilitators and barriers to adoption of SDM strategies.
Dr. Bozic received the 2006 OREF Clinical Research Award for his work entitled "Using Clinical and Economic Outcome Data to Influence Health Policy in the United States: The Case of Total Joint Replacement." Dr. Bozic and his multi-center research group used patient–specific outcomes data from total joint replacement procedures to influence health policy. Additional diagnosis and procedure codes for joint replacement were developed based on Dr. Bozic′s research and by creating more detailed, accurate, and descriptive codes they were able to assist public health efforts, such as the American Joint Replacement Registry Project (AJRR), and pay–for–performance initiatives that are intended to improve the overall quality of care for joint replacement patients.
Variability in Costs Associated with Total Hip and Hip Knee Replacement Implants: Dr. Bozic and his collaborators at the University of California, Berkeley, Berkeley Center for Health Technology studies the patient, hospital, and market characteristic associated with variation in implant and total procedure costs for hip and knee arthroplasty. The results from their study found there are substantial variations in total hip replacement and total knee replacement implant costs within and across hospitals after controlling for patient diagnoses and comorbidities. This variation is responsible for the majority of variation in the overall cost of total hip and knee replacement surgery.
Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients: Dr. Bozic and the Multi Total Joint Arthroplasty Health Services Research Group studied the specific patient comorbidities associated with an increased risk of periprosthetic joint infection and of ninety-day postoperative mortality in U.S. Medicare patients undergoing total hip arthroplasty. Comorbid conditions associated with an increased risk of periprosthetic joint infection in Medicare patients who under total hip arthroplasty included were rheumatologic disease, obesity, coagulopathy, and preoperative anemia. Comorbid conditions associated with an increase adjusted risk of ninety-day postoperative mortality were congestive heart failure, metastatic cancer, pyschoses, renal disease, dementia, hemiplegia or paraplegia, cerebrovascular disease, and chronic pulmonary disease. This information is important when counseling elderly patients regarding the risks of periprosthetic joint infection and mortality following total hip arthroplasty, as well as for risk adjustment of publicly reported total hip arthroplasty outcomes.
The Impact of Direct-to-Consumer Advertising in Orthopaedics: Dr. Bozic and his colleagues received the 2007 ABJS Marshall Urist Award for their work entitled “The Impact of Direct-to-consumer advertising in Orthopaedic.” This study evaluated the influence of direct-to-consumer advertising on surgeon and patient opinions and behavior in orthopaedics by surveying orthopaedic surgeons who perform hip and knee arthroplasties and patients who were scheduled to have hip or knee arthroplasty. Based on his research findings, Dr. Bozic was invited to testify on behalf of the American Academy of Orthopaedic Surgeons (AAOS) and the American Association of Hip and Knee Surgeons (AAHKS) at a Senate Special Committee on Aging hearing on medical device direct-to-consumer advertising to express concern over the direct-to-consumer advertising (DTCA) of restricted medical products. Also on behalf of AAOS and AAHKS, Dr. Bozic offered specific recommendations to the Committee as it examines the consequences of the DTCA of medical devices.
The Role for Aspirin in Venous Thromboembolism Prophylaxis After Total Knee Replacement: Dr. Bozic colleagues received the 2007 James. Rand Award for their study entitled “Is There a Role for Aspirin in Venous Thromboembolism Prophylaxis After Total Knee Replacement?” Dr. Bozic and colleagues compared the risk of venous thromboembolism (VTE), bleeding, surgical site infection, and mortality in patients receiving aspirin or guideline approved VTE prophylactic therapies (warfarin, low-molecular weight, heparins, synthetic pentasaccharides) in total knee arthroplasty (TKA). The results suggest that aspirin, when used in conjunction with other clinical care protocols, may be effective against VTEP for certain TKA patients. The findings from this study have been used by policy makers when developing clinical practice guidelines for TKA patients.
Epidemiology of Total Joint Replacement Using Administrative Data: The American Association of Hip and Knee Surgeons honored Dr. Bozic with the 2008 Lawrence D. Dorr Award on his study “The Epidemiology of Revision Total Hip Arthroplasty in the United States,” which evaluated the mechanisms of failure and the types of revision total hip arthroplasty procedures performed in the United States with use of newly implemented ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis and procedure codes specifically to revision total hip arthroplasty in a large, nationally representative population. Dr. Bozic and his colleagues have done extensive research over the past 3 years using these new administrative codes to evaluate causes of failure in both hip and knee replacement patients. This type of information is proving increasing valuable in directing research objectives, implant design, and clinical decision making.
The Impact of Volume and Adherence to Evidence Based Practice Guidelines on Quality and Cost in Orthopaedic Surgery: The Orthopaedic Research Society (ORS) honored Dr. Bozic with the 2010 William Harris Award for his work entitled “The Influence of Procedure Volumes and Adherence to Evidence-Based Processes of Care on Quality and Efficiency in Total Joint Arthroplasty.” This study evaluated the independent contributions of surgeon procedure volume, hospital procedure volume, and standardization of care on short-term post-operative outcomes and resource utilization in lower extremity total joint arthroplasty. The findings from this study indicated that hospitals and surgeons who adhere to standardized processes of care have improved total joint arthroplasty patient outcomes, independent of hospital and surgeon procedure volume.
Shared Decision Making in Total Joint Replacement
Identification of Risk Factors for periprosthetic joint infection and mortality
Price Transparency and Utilization of Disposable Supplies in the Operating Room
Factors Determining Patient Selection of an Orthopaedic Surgeon
Episode of Care "Bundled" Payments
Development of an Electronic Risk Calculator