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BMC Med Inform Decis Mak. 2018 Jan 31;18(1):10. doi: 10.1186/s12911-018-0588-8.

Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository.

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Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, San Antonio, TX, 78234, USA.
Baylor University, 3630 Stanley Road, Bldg 2841, Suite 1301; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA.
Division of Physical Therapy, Department of Orthopedics, Duke University, 2200 W. Main Street, Durham, NC, 27701, USA.
Department of Physical Therapy, Arizona School of Health Sciences, 5850 E. Still Circle, Mesa, AZ, 85206, USA.
Headquarters, U.S. Army Medical Command, Analysis & Evaluation Division, 3630 Stanley Road; Joint Base San Antonio - Fort Sam Houston, San Antonio, TX, 78234, USA.



Large healthcare databases, with their ability to collect many variables from daily medical practice, greatly enable health services research. These longitudinal databases provide large cohorts and longitudinal time frames, allowing for highly pragmatic assessment of healthcare delivery. The purpose of this paper is to discuss the methodology related to the use of the United States Military Health System Data Repository (MDR) for longitudinal assessment of musculoskeletal clinical outcomes, as well as address challenges of using this data for outcomes research.


The Military Health System manages care for approximately 10 million beneficiaries worldwide. Multiple data sources pour into the MDR from multiple levels of care (inpatient, outpatient, military or civilian facility, combat theater, etc.) at the individual patient level. To provide meaningful and descriptive coding for longitudinal analysis, specific coding for timing and type of care, procedures, medications, and provider type must be performed. Assumptions often made in clinical trials do not apply to these cohorts, requiring additional steps in data preparation to reduce risk of bias. The MDR has a robust system in place to validate the quality and accuracy of its data, reducing risk of analytic error. Details for making this data suitable for analysis of longitudinal orthopaedic outcomes are provided.


Although some limitations exist, proper preparation and understanding of the data can limit bias, and allow for robust and meaningful analyses. There is the potential for strong precision, as well as the ability to collect a wide range of variables in very large groups of patients otherwise not captured in traditional clinical trials. This approach contributes to the improved understanding of the accessibility, quality, and cost of care for those with orthopaedic conditions.


The MDR provides a robust pool of longitudinal healthcare data at the person-level. The benefits of using the MDR database appear to outweigh the limitations.


Database research; arthroscopic surgery; healthcare utilization; hip

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