Kevin J. Bozic, MD, MBA is William R. Murray Professor, M.D. Endowed Chair in Orthopaedic Surgery and Professor and Vice Chair of the Department of Orthopaedic Surgery and a member of the core faculty of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco (UCSF). He is also a Visiting Scholar in the Institute for Strategy and Competitiveness at the Harvard Business School. Dr. Bozic is a graduate of the UCSF School of Medicine and the Harvard Combined Orthopaedic Residency Program. Additionally, he holds a Bachelor of Science degree in Biomedical Engineering from Duke University and a Masters of Business Administration from Harvard Business School. Dr. Bozic has fellowship training in Adult Reconstructive Surgery from Rush University Medical Center in Chicago.
Dr. Bozic’s clinical interests are in adult reconstructive surgery of the hip and knee, with an emphasis on primary and revision hip and knee replacement. His research interests are broadly in the fields of health policy and health care services research, and specifically in the areas of healthcare technology assessment, cost-effectiveness analysis, shared medical decision making, and the implementation and evaluation of value-based payment and delivery models. In addition to his clinical and research activities, Dr. Bozic is actively involved in numerous regional and national health policy initiatives, including the University of California Center for Health Quality and Innovation, the American Joint Replacement Registry, the Integrated Healthcare Association’s Episode of Care Payment Program, and the Institute for Healthcare Improvement/Harvard Business School’s collaborative Joint Replacement Learning Community.
Dr. Bozic also holds both regional and national leadership positions, member of the Board of Trustees of the Orthopaedic Research and Education Foundation, Chair of the American Academy of Orthopaedic Surgeons Council on Research and Quality, and Chair of the California Joint Replacement Registry.
Dr. Bozic has been the recipient of numerous awards and honors, including the Orthopaedic Research and Education Foundation’s Clinical Research Award, the American Academy of Orthopaedic Surgeon’s Clinician-Scientist Traveling Fellowship Award, the American Orthopaedic Association’s American-British-Canadian Traveling Fellowship, the American Association of Hip and Knee Surgeon’s James A. Rand Young Investigator Award, and the Orthopaedic Research Society’s William Harris Award.
Since arriving at UCSF, Dr. Bozic has received extramural funding for his research from the OREF, AHRQ, National Institutes of Health (NIH), Robert Wood Johnson Foundation (RWJF), the California HealthCare Foundation, and the University of California Center for Health Quality and Innovation.
Causes and Frequency of Unplanned Hospital Readmission After Total Hip Arthroplasty.
Total hip arthroplasty (THA) is a beneficial and cost-effective procedure for patients with osteoarthritis. Recent initiatives to improve hospital quality of care include assessing unplanned hospital readmission rates. Patients presenting for THA have different indications and medical comorbidities that may impact rates of readmission.
This study measured (1) the unplanned hospital readmission rate in primary THA, revision THA, and antibiotic-spacer staged revision THA to treat infection. Additionally, we determined (2) the medical and surgical causes of readmission; and (3) the risk factors associated with unplanned readmission.
A total of 1415 patients (988 primary THA, 344 revision THA, 82 antibiotic-spacer staged revision THA to treat infection) from a single institution were included. All hospital readmissions within 90 days of discharge were reviewed. Patient demographics and medical comorbidities were included in a Cox proportional hazards model to assess risk of readmission.
The overall unplanned readmission rate was 4% at 30 days and 7% at 90 days. At 90 days, primary THA (5%) had a lower unplanned readmission rate than revision THA (10%, p < 0.001) and antibiotic-spacer staged revision THA (18%, p < 0.001). Medical diagnoses were responsible for almost one-fourth of unplanned readmissions, whereas over half of surgical readmissions were the result of dislocation, surgical site infection, and postoperative hematoma. Type of procedure, hospital stay greater than 5 days, cardiac valvular disease, diabetes with end-organ complications, and substance abuse were each associated with increased risk of unplanned readmission.
Higher rates of unplanned hospital readmissions in revision THA rather than primary THA suggest that healthcare quality measures that incorporate readmission rates as a proxy for quality of care should distinguish between primary and revision procedures. Failure to do so may negatively impact tertiary referral hospitals that often care for patients requiring complex revision procedures.
Trends in Hip Arthroscopy Utilization in the United States.
INTRODUCTION: The purpose of this study was to evaluate the changing incidence of hip arthroscopy procedures among newly trained surgeons in the United States, the indications for hip arthroscopy, and the reported rate of post-operative complications.
The ABOS database was used to evaluate the annual incidence of hip arthroscopy procedures between 2006-2010. Procedures were categorized by indication and type of procedure. The rate of surgical complications was calculated and compared between the published literature and hip arthroscopy procedures performed for femoroacetabular impingement (FAI)/osteoarthritis (OA) and for labral tears among the newly trained surgeon cohort taking the ABOS Part II Board exam.
The overall incidence of hip arthroscopy procedures performed by ABOS Part II examinees increased by over 600% during the 5-year period under study from approximately 83 in 2006 to 636 in 2010. The incidence of hip arthroscopy for FAI/OA increased steadily over the time period under study, while the incidence of hip arthroscopy for labral tears was variable over time. The rate of surgical complications was 5.9% for hip arthroscopy procedures for a diagnosis of FAI/OA vs. 4.4% for a diagnosis of labral tear (P=0.36).
The incidence of hip arthroscopy has increased dramatically over the past 5 years, particularly for the indication of FAI/OA. Reported surgical complication rates are relatively low, but appear higher than those rates reported in previously published series. Appropriate indications for hip arthroscopy remain unclear.
Barriers to Completion of Patient Reported Outcome Measures
Patient Reported Outcomes Measures (PROMs) are commonly used in total joint arthroplasty (TJA) to assess surgical outcomes. However certain patient populations may be underrepresented due to lower survey completion rates. The purpose of this study is to evaluate factors that influence PROM completion rates for 1997 TJA patients between 7/1/2007 and 12/31/2010. Completion rates were lower among patients who were over 75, Hispanic or Black, had Medicare or Medicaid, TKA patients and revision TJA patients (P < 0.05 for all comparisons). Having multiple risk factors further reduced completion rates (P < 0.001). Overall participation increased significantly during the study period, after electronic data capture methods were introduced. Awareness of these factors may help physicians and researchers improve participation of all patient populations so they are well represented in TJA outcomes research.
Keywords: patient reported outcome measures;
total joint arthroplasty;
Equality and Inequality;
Health Care and Treatment;
Three-dimensional Finite Element Modeling of a Cervical Vertebra: An Investigation of Burst Fracture Mechanism
Finite element modeling was used to study the mechanical behavior of a cervical vertebra under axial compressive loading. A three-dimensional (3-D) finite element (FE) model of a mid-cervical vertebra using inhomogeneous material properties was generated from quantitative computed tomographic (CT) scan data. This model improved upon previous vertebral FE models by using a highly refined mesh to represent the 3-D variation in material properties of vertebral bone. Traumatic loading of the vertebra was simulated by applying an axial compressive displacement through linear spring elements. Bone strength was computed from the CT scan data and compared with predicted stress. Based on the maximum shear stress theory of failure, the model predicts initiation of failure in the central cancellous region of the vertebral body. The type of fracture pattern predicted by the model is consistent with the typical cervical burst fracture that is seen clinically after compressive loading of the cervical spine. As such, we have developed a tool that can be useful for validating proposed fracture mechanisms in the cervical spine.
Keywords: Performance Expectations;
Strength and Weakness;
Bozic, Kevin J., J H Keyak, H B Skinner, H U Bueff, and David Bradford. "Three-dimensional Finite Element Modeling of a Cervical Vertebra: An Investigation of Burst Fracture Mechanism." Journal of Spinal Disorders & Techniques
7, no. 2 (1994): 102–110. View Details
Selected current projects:
Shared Decision Making and Patient Engagement in Orthopaedic Surgery
Identification of Risk Factors for Revision Surgery Following Primary THA and TKA
Integrated Care Delivery and Episode of Care Payments in Hip and Knee Arthroplasty
The Impact of Reference Pricing on Cost and Quality in Orthopaedics