Brook I. Martin- PhD MPH
- Associate Professor at University of Utah
Brook I. Martin
- PhD MPH
- Associate Professor at University of Utah
About
123
Publications
19,718
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
10,762
Citations
Introduction
Dr. Martin is a Research Associate Professor at the University of Utah's Department of Orthopaedics. He is an expert in analyzing claims databases and has distinguished himself with publications concerning spinal care costs and safety.
With R01 grant support from the Agency for Healthcare Research and Quality (AHRQ), his current research focuses on evaluating how coverage and reimbursement policies, including bundled payment programs, impact health care utilization, quality and patient care.
Current institution
Publications
Publications (123)
Background
Outcomes following sacral lateral branch radiofrequency neurotomy (SLBRFN) likely depend on patient selection criteria; however, commonly used criteria vary considerably. Refinement of selection criteria for SLBRFN may improve treatment outcomes. This study investigated common prognostic block-based selection criteria and treatment succe...
Study Design
Observational cohort study.
Objective
To examine the effects of the Comprehensive Addition and Recovery Act (CARA) on buprenorphine prescribing and opioid use disorder (OUD) among Medicare beneficiaries with back pain.
Summary of Background Data
Enacted in January 2017, CARA extended buprenorphine prescribing authority to Nurse Pract...
of background data
Lumbar medial branch radiofrequency ablation (LMBRFA) is an effective treatment for facet joint pain. LMBRFA efficacy was originally demonstrated using a parallel technique. Newly developed RFA probes (e.g., Trident) allow a perpendicular approach (P-LMBRFA), which may simplify the RFA technique and lead to superior treatment suc...
Background
Thoracic medial branch radiofrequency neurotomy (TMBRFN) is used to treat chronic thoracic facet joint pain, but research on its technique and effectiveness is still needed. The current International Pain and Spine Intervention Society Practice Guidelines do not describe a technique for TMBRFN.
Objectives
Evaluate the effectiveness of T...
Background
Considerable variability exists in the literature record regarding patient selection criteria for cervical medial branch radiofrequency neurotomy (CMBRFN). Few prior studies have assessed the correlation between different prognostic block paradigms and treatment outcomes for this procedure.
Objectives
Examine the association between var...
Background
Cervical medial branch radiofrequency neurotomy (CMBRFN) with a parallel approach has been proven to be an effective treatment for zygapophyseal joint-mediated cervical pain. Technological advancements in radiofrequency probe design have allowed for a perpendicular approach to electrode placement. However, the effectiveness of the perpen...
Category
Ankle Arthritis; Other
Introduction/Purpose
Ankle arthrodesis (AA) remains a reliable treatment option to address end-stage ankle pathology in appropriately selected patients. When successful, AA surgeries can yield high patient satisfaction and marked improvements in patient-reported outcomes. AA can be performed by orthopedic surgeons (...
Background
Previous study of spinal neurotomy procedures indicates that stringent block selection improves outcomes. However, this pattern is not established for sacral lateral branch radiofrequency neurotomy (SLBRFN). Few SLBRFN studies have used stringent block selection criteria such as ≥80 % pain reduction following dual sacral lateral branch b...
Study Design
A retrospective review.
Objective
The purpose of this study is to trend PROMIS PF scores following lumbar fusion surgery, and to investigate how the presence of functional comorbidities affects PROMIS PF scores. Additionally, we compare trends in PROMIS PF scores to the Oswestry Disability Index (ODI) and to PROMIS Pain Interference (...
Introduction
Distal femur fractures (DFFs) are associated with high complication and mortality rates in the elderly. Using the National Inpatient Sample and Medicare data, we describe trends in the incidence of DFFs by fixation type and associated healthcare costs.
Methods
Annual population rates and volume of inpatient DFFs were estimated using P...
Introduction/Purpose
Increasing data has highlighted the safety and cost-effectiveness of outpatient hip, knee, and shoulder arthroplasty. However, limited evidence – mainly small, single institution case series – has explored complication rates and costs between outpatient and inpatient total ankle arthroplasty (TAA) surgeries.
Methods
Utilizing...
Introduction/Purpose
Total ankle arthroplasty (TAA) remains an attractive surgical option to address end-stage ankle pathology in appropriately selected patients. When successful, TAA can yield high patient satisfaction and marked improvements in patient- reported outcomes. However, surgical complications can lead to significant clinical impairment...
Objectives
To evaluate the effectiveness of cervical transforaminal epidural steroid injection (CTFESI) for the treatment of unilateral cervical radicular pain.
Design
Single-group prospective cohort study.
Methods
Outcomes included ≥50% reductions in Numeric Rating Scale (NRS) for arm pain, ≥30% Neck Disability Index (NDI-5) improvement, health-...
Objectives
This study examined the association between hospital participation in Bundled Payments for Care Improvement (BPCI) or Comprehensive Care for Joint Replacement (CJR) and the timely initiation of home health rehabilitation services for lower extremity joint replacements. Furthermore, this study examined the association between the timely i...
Previously published animal studies have shown positive skeletal effects with local or systemic administration of beta blockers (BBs). However, population studies have shown mixed effects on bone mineral density (BMD) and fracture risk with BB use. The goal of this study was to evaluate whether exposure to BB is associated with fracture nonunion.
F...
Objective:
Compare mortality and complications of distal femur fracture repair among elderly patients who receive operative fixation versus distal femoral replacement (DFR).
Design:
Retrospective comparison.
Setting:
Medicare beneficiariesPatients/Participants: Distal femur fracture patients 65 years of age and older identified using Center fo...
Study design:
Retrospective Cohort Study.
Objective:
To clarify the association between preoperative albumin status and mortality and morbidity in lumbar spine surgery.
Summary of background data:
Hypoalbuminemia is a known marker of inflammation and is associated with frailty. Hypoalbuminemia is an identified risk factor for mortality followi...
Background:
The diagnosis of a fragility fracture represents an important intervention event for the initiation of medical osteoporosis treatments. However, it is unclear if osteoporosis medications increase the risk of nonunion if administered in the setting of acute fracture. The purpose of the present study was to investigate whether bisphospho...
Background:
Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using multicentered data,, we compared baseline and early post-operative global and condition-specific PROs between patients undergoing cem...
Background:
The Center for Medicare and Medicaid Innovation revised the comprehensive Care for Joint Replacement (CJR) program, a mandatory 90-day bundled payment for lower extremity joint replacement, in December 2017, retaining 34 of the original 67 metropolitan statistical areas with higher volume and historic episode payments.
Objectives:
We...
Background:
Improving pain management for persons with chronic low back pain (LBP) undergoing surgery is an important consideration to improve patient-centered outcomes and reduce the risk for persistent opioid use following surgery. Nonpharmacologic treatments, including physical therapy and mindfulness, are beneficial for non-surgical LBP throug...
Background:
Racial health disparities across orthopaedic surgery subspecialties, including spine surgery, are well established. However, the underlying causes of these disparities, particularly relating to social determinants of health, are not fully understood.
Questions/purposes:
(1) Is there a racial difference in 90-day mortality, readmissio...
Background: Existing studies of patient-reported outcomes (PRO) following total knee arthroplasty (TKA) based on fixation methods (cemented vs cementless) are limited to single centers with small sample sizes. Using data from the large, multicenter Comparative Effectiveness of Pulmonary Embolism Prevention After Hip and Knee Replacement (PEPPER) tr...
Objective
The purpose of this study was to evaluate whether physical therapy use influenced subsequent use of musculoskeletal-related surgeries, injections, magnetic resonance imaging (MRI), and other imaging.
Methods
We conducted a retrospective cohort study of patients aged 18 to 64 years who had an ambulatory care visit at the University of Uta...
Background:
Spine surgery and its corresponding costs have increased in recent years and are variable across geographic regions. Discretionary care is the component of spending variation that is independent of illness severity, age, and regional pricing. It is unknown whether greater discretionary care is associated with improved safety for patien...
Background
The benefit of total hip arthroplasty (THA) for treatment osteoarthritis (OA) and femoral neck fractures (FNF) in the geriatric population is well established. We compare perioperative complications and cost of THA for treatment of OA to hemiarthroplasty (HA) and THA for treatment of FNF.
Methods
Data from the Center for Medicare & Medi...
Objective:
To understand whether the Comprehensive Care for Joint Replacement (CJR) program induces participating hospitals to (1) preferentially select lower risk patients, (2) reduce 90-day episode-of-care costs, (3) improve quality of care, and (4) achieve greater cost reduction during its second year, when downside financial risk was applied....
Objective
The purpose of this study was to identify factors that influence a patient’s decision to use physical therapy (PT) services for a low back pain (LBP) complaint.
Methods
Semi-structured qualitative phone interviews were conducted with patients who were offered an early outpatient PT visit secondary to patients’ primary appointment for LBP...
Background:
In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions.
Objectives:
To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, a...
Background
Musculoskeletal conditions are common and cause high levels of disability and costs. Physical therapy is recommended for many musculoskeletal conditions. Past research suggests that referral rates appear to have increased over time, but the rate of accessing a physical therapist appears unchanged.
Objective
Our retrospective cohort stud...
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform clinical decision-makers, we conducted a cost-effectiveness analysis comparing proximal row carpectomy (PRC) and four-corner arthrodesis (FCA).
Methods: A Markov microsimulation model was use...
Background:
Minimal clinically important differences (MCIDs) for different patient outcome scores have been reported for various shoulder diseases, including shoulder arthroplasty and the nonoperative treatment of rotator cuff disease. The purpose of this study was to assess the MCID for the American Shoulder and Elbow Surgeons Standardized Should...
Study design:
Retrospective study using a national administrative database.
Objective:
To define the cohort differences in patient characteristics between patients undergoing cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) in a large national sample, and to describe the impact of those baseline patient charact...
Procedure rates and costs for lumbar fusion are increasing, especially for age-related pathology such as spondylolisthesis. The high cost and wide geographic variation makes fusion a common target for state and national payment reforms. The effects of such policy are best understood by summarizing state and national discharge databases, such as the...
Background:
There is a concern that the Oncology Care Model (OCM), a voluntary bundled payment program, may incentivize mergers and acquisitions among physician practices leading to reduced competition and price increases. These concerns are heightened if OCM is preferentially adopted in competitive health care markets because it could result in r...
Background:
Patient-reported outcomes are essential to demonstrate the value of hip and knee arthroplasty, a common target for payment reforms. We compare patient-reported global and condition-specific outcomes after hip and knee arthroplasty based on hospital participation in Medicare's bundled payment programs.
Methods:
We performed a prospect...
Background:
Comparisons of patient-reported outcomes (PROs) based on surgical approach for total hip arthroplasty (THA) in the United States are limited to series from single surgeons or institutions. Using prospective data from a large, multicenter study, we compare preoperative to postoperative changes in PROs between posterior, transgluteal, an...
Study design:
Surgeon survey.
Objective:
To examine factors influencing surgeons' definition of instability in grade 1 degenerative spondylolisthesis (DS) and assess treatment preferences for both stable and unstable DS.
Summary of background data:
DS treatment options are broadly classified as decompression with or without fusion. In surgical...
Study design:
Analysis of National Inpatient Sample (NIS), 2004-2015.
Objective:
Describe recent trends in U.S. rates of lumbar fusion procedures and associated costs, by surgical indication.
Summary of background data:
Spinal fusion is appropriate for spinal deformity and instability, but evidence of effectiveness is limited for primary disc...
BACKGROUND CONTEXT
Surgical treatment for lumbar spondylolisthesis is often considered for those who have failed nonoperative care, especially with persistent or recurrent symptoms, progressive displacement, or worsening functional decline. Criteria for selecting surgical candidates are variable, and decisions about what type of operation to perfor...
BACKGROUND CONTEXT
Cervical disc arthroplasty (CDA) and anterior cervical discectomy and fusion (ACDF) are two common procedures performed for a number of cervical disorders recalcitrant to conservative management. While the initial pivotal studies that led to FDA approval of CDA were randomized, subsequent studies to expand surgical indications ha...
BACKGROUND CONTEXT
Lumbar fusion surgery for degenerative disease has been subject to increased scrutiny by payers. The procedure is not indicated for primary disc herniation or spinal stenosis without segmental instability, and is controversial for chronic back pain attributed to degenerative disc disease. Evidence has supported fusion for spondyl...
Background:
Instability is the most common complication after reverse total shoulder arthroplasty (rTSA). In the native glenohumeral joint, in addition to full dislocations, more subtle forms of instability exist. However, the incidence of more subtle forms of instability, the factors associated with instability, and the effect of instability on v...
Study design:
Retrospective analysis of Medicare claims linked to hospital participation in the Center for Medicare and Medicaid Innovation's episode-based Bundled Payment for Care Improvement (BPCI) program for lumbar fusion.
Objectives:
To describe the early effects of BPCI participation for lumbar fusion on 90-day reimbursement, procedure vol...
Background context:
Minimally invasive lumbar spinal stenosis procedures have uncertain long-term value.
Purpose:
This study sought to characterize factors affecting the long-term cost-effectiveness of such procedures using interspinous spacer devices ("spacers") relative to decompression surgery as a case study.
Study design:
Model-based cost...
SPINEDEF is a user-written Stata program designed to identify spine-related medical encounters using inpatient and/or outpatient administrative data the contain ICD-9/ICD-10 codes. For each visit the program groups these visits into clinically meaningful categories by diagnoses and vertebral region (SPINEDEF). The program does this by evaluating an...
Background:
Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by d...
Study design:
Retrospective analysis of patients undergoing elective lumbar fusion operations, comparing rates of repeat spine surgery based on method of ascertainment.
Objective:
We report the accuracy of a claims-based approach for reporting repeat surgery compared with medical records abstraction as the "gold standard."
Summary of background...
Background:
Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis.
Methods:
Within the linked Surveillance, Epidemiology, and End...
Background
Cervical 2 (C2) fractures in the elderly are common, and the incidence of these fractures has been increasing. Surgical and nonoperative treatments are associated with high complication and mortality rates, and these rates have not been evaluated at the population level, to our knowledge. The purpose of this study was to use the Medicare...
Study design:
Analysis of the State Inpatient Database of North Carolina, 2005-2012, and the Nationwide Inpatient Sample, including all inpatient lumbar fusion admissions from non-federal hospitals.
Objective:
To examine the influence of a major commercial policy change that restricted lumbar fusion for certain indications, and to forecast the p...
This study by Ganduglia et al provides empirical data to show that publicly reporting the rate of potentially unnecessary MR imaging examinations, as measured with the Medicare OP-8 metric, did not lead to an appreciable change among Texas hospital regions.
Retrospective review of medical records and administrative data.
Validate a claims-based algorithm for classifying surgical indication and operative features in lumbar surgery.
Administrative data are valuable to study rates, safety, outcomes, and costs in spine surgery. Previous research evaluates outcomes by procedure, not indications and operati...
Use of Bone Morphogenetic Protein (BMP) as an adjunct to spinal fusion surgery proliferated following Food and Drug Administration (FDA) approval in 2002. Major safety concerns emerged in 2008.
To examine whether published concerns about the safety of BMP altered clinical practice.
Analysis of the National Inpatient Sample from 2002 through 2012.
A...
Description: Technical specifications for characterizing spine-related medical encounters. Stata programs designed to examine inpatient and/or outpatient administrative data of medical encounters and identify those that a related to spine problems. For each visit the program groups these visits into clinically meaningful categories by diagnoses and...
Safety information in spine surgery is important for informed patient choice and performance-based payment incentives, but measurement methods for surgical safety assessment are not standardized. Published reports of complication rates for common spinal procedures show wide variation. Factors influencing variation may include differences in safety...
Study Design. Retrospective analysis of Medicare claims linked to a multi-center clinical trial.Objective. The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenos...
In response to increasing use of lumbar fusion for improving back pain, despite unclear efficacy, particularly among injured workers, some insurers have developed limited coverage policies. Washington State's workers' compensation (WC) program requires imaging confirmation of instability and limits initial fusions to a single level. In contrast, Ca...
Purpose: There is no universally accepted standard of care for lumbar spinal stenosis. Several studies suggest surgical care results in better outcomes than conservative care, but the type of surgery (decompression vs. fusion) remains controversial. Interspinous spacer devices (“spacers”) have emerged as a new initial treatment alternative. Our obj...
Description: Stata program designed to examine inpatient and/or outpatient administrative data of medical encounters and identify those that a related to hip problems. For each visit the program groups these visits into clinically meaningful categories by diagnoses, treatments received, and safety indicators. The program does this by evaluating and...
Description: Stata program designed to examine inpatient and/or outpatient administrative data of medical encounters and identify those that a related to knee problems. For each visit the program groups these visits into clinically meaningful categories by diagnoses, treatments received, and safety indicators. The program does this by evaluating an...
Description: Stata program designed to examine inpatient and/or outpatient administrative data of medical encounters and identify those that a related to knee problems. For each visit the program groups these visits into clinically meaningful categories by diagnoses, treatments received, and safety indicators. The program does this by evaluating an...
The clinical entity "discogenic back pain" remains controversial at fundamental levels, including its pathophysiology, diagnostic criteria, and optimal treatment. This is true despite availability of four randomized trials comparing the efficacy of surgical and nonsurgical treatments. One trial showed benefit for lumbar fusion compared with unstruc...
Background:
The efficacy of arthroscopic debridement or lavage for knee osteoarthritis (OA) was cast into doubt after publication of several randomized controlled trials beginning in 2002.
Purpose:
The authors set out to determine whether evidence of ineffectiveness, along with subsequent changes in reimbursement, were followed by changes in uti...
Study design:
Retrospective cohort analysis of Medicare claims for 2006-2009.
Objective:
To examine whether interspinous distraction procedures are used selectively in patients with more advanced age or comorbidity, and whether they are associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery...
Complementary and alternative medicine services in the United States are an approximately $9 billion market each year, equal to 3 percent of national ambulatory health care expenditures. Unlike conventional allopathic health care, complementary and alternative medicine is primarily paid for out of pocket, although some services are covered by most...
Background:
Health care costs associated with use of complementary and alternative medicine (CAM) by patients with spine problems have not been studied in a national sample.
Objectives:
To estimate the total and spine-specific medical expenditures among CAM and non-CAM users with spine problems.
Research design:
Analysis of the 2002-2008 Medic...
To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery.
Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007.
We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identi...
To retrospectively examine the association between the inclusion of epidemiologic information in lumbar spine magnetic resonance (MR) imaging reports regarding findings in asymptomatic individuals and the rates of subsequent cross-sectional imaging and treatments in patients with low back pain or radiculopathy referred for imaging by primary care p...
Surgical site infection after spine surgery is a well-known complication that can result in poor outcomes, arthrodesis-site nonunion, and neurological injury. We hypothesized that a higher surgical invasiveness score will increase the risk for surgical site infection following spine surgery.
Data were examined from patients undergoing any type of s...
Repeat lumbar spine surgery is generally an undesirable outcome. Variation in repeat surgery rates may be because of patient characteristics, disease severity, or hospital- and surgeon-related factors. However, little is known about population-level variation in reoperation rates.
To examine hospital- and surgeon-level variation in reoperation rate...
For carefully selected patients with lumbar stenosis, decompression surgery is more efficacious than nonoperative treatment. However, some patients undergo repeat surgery, often because of complications, the failure to achieve solid fusion following arthrodesis procedures, or persistent symptoms. We assessed the probability of repeat surgery follow...
Acromioplasty for impingement syndrome of the shoulder is one of the most common orthopaedic surgical procedures. The rate with which this procedure is performed has increased dramatically. This investigation sought high levels of evidence in the published literature related to five hypotheses pertinent to the concept of the impingement syndrome an...
Retrospective cohort study of Medicare claims.
Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP.
Small, randomized trials have demonstrated higher rates of solid fusion with BMP...
Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction.
To determine the feasibility of a randomized clinical trial comparing the clinical effectiveness and costs of ventral vs dorsal decompression with fusion surgery for treating CSM.
A nonrandomized, prospective, clinical pilot trial was conducted. Patients ages...
