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Kobayashi N. CORR Insights®: Elective THA for Indications Other Than Osteoarthritis Is Associated With Increased Cost and Resource Use: A Medicare Database Study of 135,194 Claims. Clin Orthop Relat Res 2024; 482:1171-1172. [PMID: 38149673 PMCID: PMC11219167 DOI: 10.1097/corr.0000000000002955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/29/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, Yokohama, Japan
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2
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Myles PS, Liew SM. Analgesic effectiveness after total hip arthroplasty. THE LANCET. RHEUMATOLOGY 2024; 6:e190-e191. [PMID: 38458209 DOI: 10.1016/s2665-9913(24)00030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 01/31/2024] [Indexed: 03/10/2024]
Affiliation(s)
- Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health and Monash University, Melbourne, VIC 3004, Australia.
| | - Susan M Liew
- Department of Orthopaedic Surgery, Alfred Health and Monash University, Melbourne, VIC 3004, Australia
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Spiering TJ, Firth AD, Mousoulis C, Hallstrom BR, Gagnier JJ. Establishing the Minimally Important Difference for the KOOS-Joint Replacement and PROMIS Global-10 in Patients After Total Knee Arthroplasty. Orthop J Sports Med 2024; 12:23259671231218260. [PMID: 38313752 PMCID: PMC10838042 DOI: 10.1177/23259671231218260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/29/2023] [Indexed: 02/06/2024] Open
Abstract
Background Despite the overall prevalence and success of total knee arthroplasty (TKA), a significant portion of patients are dissatisfied with their outcomes. Purpose To assess the responsiveness and determine the minimally important difference (MID) of 2 patient-reported outcome measures (PROMs)-the Knee injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR) and the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS 10)-in patients after TKA. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods Included were patients who underwent TKA from August 2015 through August 2019 and completed baseline and postoperative KOOS-JR and PROMIS 10 surveys. The PROMIS 10 consists of 2 domains: physical health and mental health. Estimates for the reliable change index (RCI) and MID, using anchor-based and distribution-based methods, were calculated for each PROM. Regression modeling was used to determine whether patient and clinical factors predicted MID thresholds or MID achievement. Results A total of 1315 patients were included. Distribution-based MIDs, calculated using various methods from baseline scores, ranged from 19.3 to 31 for the KOOS-JR, and the RCI was 4.38. Of these patients, 293 (22.3%) demonstrated small or moderate improvement, and this cohort was included in the calculation of anchor-based MIDs. The anchor-based MIDs were 16.9 and 24.3 at 3-month and 1-year follow-up, respectively, and 66% of patients achieved the MID at 12 months. Higher preoperative PROM score, male sex, non-White race, and current smoker status were predictive of failing to achieve the anchor-based MID for KOOS-JR at 1 year postoperatively (P < .05). Higher preoperative PROM score and any 90-day adverse event predicted lower thresholds of important change in anchor-based MIDs. Higher baseline PROM scores, younger age, male sex, non-White ethnicity, higher American Society of Anesthesiologists classification, preoperative narcotics use, not smoking, and longer hospital stay were all associated with lower odds of achieving the MID on the KOOS-JR or either of the PROMIS 10 subscales. Conclusion The study results demonstrated relevant values for interpretation of the KOOS-JR and PROMIS 10. While patient demographics did not accurately predict which patients would achieve the MID, some potential factors predicting successful patient-reported outcomes after TKA were identified.
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Affiliation(s)
- Tyler J Spiering
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew D Firth
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Christos Mousoulis
- Division of Experimental Surgery, Centre for Outcomes Research and Evaluation, McGill University, Montreal, Quebec, Canada
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel J Gagnier
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Oka T, Wada O, Mizuno K. Comparison of time courses in postoperative functional outcomes between simultaneous bilateral and unilateral total knee arthroplasty with propensity score matching. Arch Orthop Trauma Surg 2024; 144:369-375. [PMID: 37750909 DOI: 10.1007/s00402-023-05065-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/03/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION/OBJECTIVES No consensus has been reached on which is better in terms of functional outcomes between simultaneous bilateral and unilateral total knee arthroplasty (TKA). As patient characteristics, such as age, sex, and body mass index, have significant effects on functional outcomes after TKA, these factors should be matched before comparisons are made. This study aimed to compare time courses in functional outcomes between simultaneous bilateral TKA and unilateral TKA after matching the patient characteristics. MATERIALS AND METHODS In this retrospective study, the clinical records of patients admitted to a hospital were reviewed. Of 425 patients, 43 underwent simultaneous bilateral TKA, whereas 382 underwent unilateral TKA. Propensity score matching was performed for age, sex, and body mass index between simultaneous bilateral and unilateral TKA patients. Therapists measured pain intensity, knee extensor strength, and knee-specific functional outcomes by using the new knee society score, including total score, symptoms, patient satisfaction, patient expectations, and functional activities preoperatively and 3 and 12 months postoperatively. Two-way repeated analysis of variance was performed to compare the time courses in functional outcomes between simultaneous bilateral and unilateral TKA. RESULTS After propensity score matching, 40 patients each for underwent bilateral TKA and unilateral TKA were selected. Knee extensor strength in simultaneous bilateral TKA patients was significantly lower than that in unilateral TKA patients at 3 months postoperatively (p = 0.04). A significant interaction was observed between the effects of time and group on knee extensor strength (F [1, 78] = 3.338; interaction: p = 0.042; η2 = 0.052). No significant interactions were found among the other variables measured. CONCLUSIONS Patients who underwent simultaneous bilateral TKA should undergo postoperative rehabilitation focused on alleviating delayed recovery in knee extensor strength during the acute phase.
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Affiliation(s)
- Tomohiro Oka
- Department of Rehabilitation Science, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka, 530-0043, Japan.
- Department of Public Health, Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo, Japan.
| | - Osamu Wada
- Department of Rehabilitation, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
| | - Kiyonori Mizuno
- Department of Orthopedics, Anshin Hospital, 1-4-12, Minatojima Minamimachi, Chuo-ku, Kobe City, Hyogo, Japan
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5
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Abdel Khalik H, Wood TJ, Tushinski DM, Gazendam A, Petruccelli DT, Bali K, Winemaker M, Avram V, de Beer J, Williams D, Puri L, Piccirillo L. Routine use of antibiotic-laden bone cement in total knee arthroplasty is a cost-effective practice in the single-payer healthcare system. Knee Surg Sports Traumatol Arthrosc 2023; 31:3847-3853. [PMID: 36905414 DOI: 10.1007/s00167-023-07364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE The purpose of this study was to determine the cost-effectiveness of antibiotic-laden bone cement (ALBC) in primary total knee arthroplasty (TKA) from the perspective of a single-payer healthcare system. METHODS A cost-utility analysis (CUA) was performed over a 2-year time horizon comparing primary TKA with either ALBC or regular bone cement (RBC) from the perspective of the single-payer Canadian healthcare system. All costs were in 2020 Canadian dollars. Health utilities were in the form of quality-adjusted life years (QALYs). Model inputs for cost, utilities and probabilities were derived from the literature as well as regional and national databases. One-way deterministic sensitivity analysis was performed. RESULTS Primary TKA with ALBC was found to be more cost-effective compared to primary TKA with RBC with an incremental cost-effectiveness ratio (ICER) of -3,637.79 CAD/QALY. The use of routine ALBC remained cost-effective even with cost increases of up to 50% per bag of ALBC. TKA with ALBC was no longer cost-effective if the rate of PJI following this practice increased 52%, or the rate of PJI following the use of RBC decreased 27%. CONCLUSIONS The routine use of ALBC in TKA is a cost-effective practice in the single-payer Canadian healthcare system. This remains to be the case even with a 50% increase in the cost of ALBC. Policy makers and hospital administrators of single-payer healthcare systems can leverage this model to inform their local funding policies. Future prospective reviews and randomized controlled trials from the perspective of various healthcare models can further shed light on this issue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hassaan Abdel Khalik
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
| | - Thomas J Wood
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Complex Care and Orthopaedics Program, Hamilton Health Sciences Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Daniel M Tushinski
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Complex Care and Orthopaedics Program, Hamilton Health Sciences Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - Danielle T Petruccelli
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Complex Care and Orthopaedics Program, Hamilton Health Sciences Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
| | - Kamal Bali
- Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
- Complex Care and Orthopaedics Program, Hamilton Health Sciences Juravinski Hospital, 711 Concession St, Hamilton, ON, L8V 1C3, Canada
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Gandhi N, Qadeer AS, Meher A, Rachel J, Patra A, John J, Anilkumar A, Dutta A, Nanda L, Rout SK. Costs and models used in the economic analysis of Total Knee Replacement (TKR): A systematic review. PLoS One 2023; 18:e0280371. [PMID: 37490490 PMCID: PMC10368258 DOI: 10.1371/journal.pone.0280371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVES The main objective of this review is to summarize the evidence on the core modelling specifications and methodology on the cost-effectiveness of TKR compared to non-surgical management. Another objective of this study is to synthesize evidence of TKR cost and compare it across countries using purchasing power parity (PPP). METHODOLOGY The electronic databases used for this review were MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), HTAIn repository, Cost effectiveness Analysis (CEA) registry, and Google Scholar. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) was used to assess the validity of the methods and transparency in reporting the results. The Quality of Health Economic Studies (QHES) was used to check the quality of economic evaluation models of the studies included. The cost of TKR surgery from high income and low- or middle-income countries were extracted and converted to single USD ($) using purchasing power parities (PPP) method. RESULT Thirty-two studies were included in this review, out of which eight studies used Markov model, five used regression model, one each reported Marginal structure model, discrete simulation model, decision tree and Osteoarthritis Policy Model (OAPol) respectively to assess the cost-effectiveness of TKR. For PPP, twenty-six studies were included in the analysis of TKR cost. The average cost of TKR surgery was the lowest in developing country-India ($3457) and highest in USA ($19568). CONCLUSION The findings of this review showed that the Markov model was most widely used in the analysis of the cost effectiveness of TKR. Our review also concluded that the cost of TKR was higher in the developed countries as compared to the developing countries.
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Affiliation(s)
- Naline Gandhi
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Amatullah Sana Qadeer
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Ananda Meher
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Jennifer Rachel
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Abhilash Patra
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Jebamalar John
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Aiswarya Anilkumar
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Ambarish Dutta
- Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India, New Delhi, India
| | - Lipika Nanda
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, New Delhi, India
| | - Sarit Kumar Rout
- Indian Institute of Public Health-Bhubaneswar, Public Health Foundation of India, New Delhi, India
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Pereira DE, Kamara E, Krueger CA, Courtney PM, Austin MS, Rana A, Hannon CP. Prior Authorization in Total Joint Arthroplasty: A Survey of the American Association of Hip and Knee Surgeons Membership. J Arthroplasty 2023:S0883-5403(23)00042-6. [PMID: 36708936 DOI: 10.1016/j.arth.2023.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study surveyed the impact that prior authorization has on the practices of total joint arthroplasty (TJA) members of the American Association of Hip and Knee Surgeons (AAHKS). METHODS A 24-question survey was approved by the AAHKS Advocacy Committee and distributed to all 2,802 board-certified members of AAHKS. RESULTS There were 353 survey responses (13%). Ninety-five percent of surgeons noted a 5-year increase in prior authorization. A majority (71%) of practices employ at least 1 staff member to exclusively work on prior authorization. Average time spent on prior authorization was 15 h/wk (range, 1 to 125) and average number of claims peer week was 18 (range, 1 to 250). Surgeries (99%) were the most common denial. These were denied because nonoperative treatment had not been tried (71%) or had not been attempted for enough time (67%). Most (57%) prior authorization processes rarely/never changed the treatment provided. Most (56%) indicated that prior authorization rarely/never followed evidence-based guidelines. A majority (93%) expressed high administrative burden as well as negative clinical outcomes (87%) due to prior authorization including delays to access care (96%) at least sometimes. DISCUSSION Prior authorization has increased in the past 5 years resulting in high administrative burden. Prior authorizations were most common for TJA surgeries because certain nonoperative treatments were not attempted or not attempted for enough time. Surgeons indicated that prior authorization may be detrimental to high-value care and lead to potentially harmful delays in care without ultimately changing the management of the patient.
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Affiliation(s)
- Daniel E Pereira
- Department of Orthopaedic Surgery, Washington University, Saint Louis, Missouri
| | - Eli Kamara
- Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York
| | - Chad A Krueger
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - P Maxwell Courtney
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Adam Rana
- Maine Medical Partners Orthopedics and Sports Medicine, South Portland, Maine
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Washington University, Saint Louis, Missouri
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Li G, Yu F, Liu S, Weng J, Qi T, Qin H, Chen Y, Wang F, Xiong A, Wang D, Gao L, Zeng H. Patient characteristics and procedural variables are associated with length of stay and hospital cost among unilateral primary total hip arthroplasty patients: a single-center retrospective cohort study. BMC Musculoskelet Disord 2023; 24:6. [PMID: 36600222 PMCID: PMC9811718 DOI: 10.1186/s12891-022-06107-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 12/20/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) is a successful treatment for many hip diseases. Length of stay (LOS) and hospital cost are crucial parameters to quantify the medical efficacy and quality of unilateral primary THA patients. Clinical variables associated with LOS and hospital costs haven't been investigated thoroughly. METHODS The present study retrospectively explored the contributors of LOS and hospital costs among a total of 452 unilateral primary THA patients from January 2019 to January 2020. All patients received conventional in-house rehabilitation services within our institute prior to discharge. Outcome parameters included LOS and hospital cost while clinical variables included patient characteristics and procedural variables. Multivariable linear regression analysis was performed to assess the association between outcome parameters and clinical variables by controlling confounding factors. Moreover, we analyzed patients in two groups according to their diagnosis with femur neck fracture (FNF) (confine THA) or non-FNF (elective THA) separately. RESULTS Among all 452 eligible participants (266 females and 186 males; age 57.05 ± 15.99 year-old), 145 (32.08%) patients diagnosed with FNF and 307 (67.92%) diagnosed with non-FNF were analyzed separately. Multivariable linear regression analysis revealed that clinical variables including surgery duration, transfusion, and comorbidity (stroke) among the elective THA patients while the approach and comorbidities (stoke, diabetes mellitus, coronary heart disease) among the confine THA patients were associated with a prolonged LOS (P < 0.05). Variables including the American Society of Anesthesiologists classification (ASA), duration, blood loss, and transfusion among the elective THA while the approach, duration, blood loss, transfusion, catheter, and comorbidities (stoke and coronary heart disease) among the confine THA were associated with higher hospital cost (P < 0.05). The results revealed that variables were associated with LOS and hospital cost at different degrees among both elective and confine THA. CONCLUSIONS Specific clinical variables of the patient characteristics and procedural variables are associated the LOS and hospital cost, which may be different between the elective and confine THA patients. The findings may indicate that evaluation and identification of detailed perioperative factors are beneficial in managing perioperative preparation, adjusting patients' anticipation, decreasing LOS, and reducing hospital cost.
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Affiliation(s)
- Guoqing Li
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Fei Yu
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Su Liu
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Jian Weng
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Tiantian Qi
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Haotian Qin
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Yixiao Chen
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Fangxi Wang
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Ao Xiong
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Deli Wang
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
| | - Liang Gao
- Center for Clinical Medicine, Huatuo Institute of Medical Innovation (HTIMI), 10787 Berlin, Germany ,Sino Euro Orthopaedics Network (SEON), Berlin, Germany
| | - Hui Zeng
- grid.440601.70000 0004 1798 0578Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036 ,grid.440601.70000 0004 1798 0578National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Peking University Shenzhen Hospital, Shenzhen, People’s Republic of China 518036
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van Schie P, van Bodegom-Vos L, Zijdeman TM, Nelissen RGHH, Marang-van de Mheen PJ. Effectiveness of a multifaceted quality improvement intervention to improve patient outcomes after total hip and knee arthroplasty: a registry nested cluster randomised controlled trial. BMJ Qual Saf 2023; 32:34-46. [PMID: 35732486 DOI: 10.1136/bmjqs-2021-014472] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To assess the effectiveness of a prospective multifaceted quality improvement intervention on patient outcomes after total hip and knee arthroplasty (THA and TKA). DESIGN Cluster randomised controlled trial nested in a national registry. From 1 January 2018 to 31 May 2020 routinely submitted registry data on revision and patient characteristics were used, supplemented with hospital data on readmission, complications and length of stay (LOS) for all patients. SETTING 20 orthopaedic departments across hospitals performing THA and TKA in The Netherlands. PARTICIPANTS 32 923 patients underwent THA and TKA, in 10 intervention and 10 control hospitals (usual care). INTERVENTION The intervention period lasted 8 months and consisted of the following components: (1) monthly updated feedback on 1-year revision, 30-day readmission, 30-day complications, long (upper quartile) LOS and these four indicators combined in a composite outcome; (2) interactive education; (3) an action toolbox including evidence-based quality improvement initiatives (QIIs) to facilitate improvement of above indicators; and (4) bimonthly surveys to report on QII undertaken. MAIN OUTCOME MEASURES The primary outcome was textbook outcome (TO), an all-or-none composite representing the best outcome on all performance indicators (ie, the absence of revision, readmissions, complications and long LOS). The individual indicators were analysed as secondary outcomes. Changes in outcomes from pre-intervention to intervention period were compared between intervention versus control hospitals, adjusted for case-mix and clustering of patients within hospitals using random effect binary logistic regression models. The same analyses were conducted for intervention hospitals that did and did not introduce QII. RESULTS 16,314 patients were analysed in intervention hospitals (12,475 before and 3,839 during intervention) versus 16,609 in control hospitals (12,853 versus 3,756). After the intervention period, the absolute probability to achieve TO increased by 4.32% (95% confidence interval (CI) 4.30-4.34) more in intervention than control hospitals, corresponding to 21.6 (95%CI 21.5-21.8), i.e., 22 patients treated in intervention hospitals to achieve one additional patient with TO. Intervention hospitals had a larger increase in patients achieving TO (ratio of adjusted odds ratios 1.24, 95%CI 1.05-1.48) than control hospitals, a larger reduction in patients with long LOS (0.74, 95%CI 0.61-0.90) but also a larger increase in patients with reported 30-day complications (1.34, 95%CI 1.00-1.78). Intervention hospitals that introduced QII increased more in TO (1.32, 95%CI 1.10-1.57) than control hospitals, with no effect shown for hospitals not introducing QII (0.93, 95%CI 0.67-1.30). CONCLUSION The multifaceted QI intervention including monthly feedback, education, and a toolbox to facilitate QII effectively improved patients achieving TO. The effect size was associated with the introduction of (evidence-based) QII, considered as the causal link to achieve better patient outcomes. TRIAL REGISTRATION NUMBER NCT04055103.
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Affiliation(s)
- Peter van Schie
- Orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Tristan M Zijdeman
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Rob G H H Nelissen
- Orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
| | - Perla J Marang-van de Mheen
- Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
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Abbott JH, Wilson R, Pryymachenko Y, Sharma S, Pathak A, Chua JYY. Economic evaluation: a reader's guide to studies of cost-effectiveness. Arch Physiother 2022; 12:28. [PMID: 36517825 PMCID: PMC9753355 DOI: 10.1186/s40945-022-00154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Understanding what an economic evaluation is, how to interpret it, and what it means for making choices in a health delivery context is necessary to contribute to decisions about healthcare resource allocation. The aim of this paper to demystify the working parts of a health economic evaluation, and explain to clinicians and clinical researchers how to read and interpret cost-effectiveness research. MAIN BODY This primer distils key content and constructs of economic evaluation studies, and explains health economic evaluation in plain language. We use the PICOT (participant, intervention, comparison, outcome, timeframe) clinical trial framework familiar to clinicians, clinical decision-makers, and clinical researchers, who may be unfamiliar with economics, as an aide to reading and interpreting cost-effectiveness research. We provide examples, primarily of physiotherapy interventions for osteoarthritis. CONCLUSIONS Economic evaluation studies are essential to improve decisions about allocating resources, whether those resources be your time, the capacity of your service, or the available funding across the entire healthcare system. The PICOT framework can be used to understand and interpret cost-effectiveness research.
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Affiliation(s)
- J. Haxby Abbott
- grid.29980.3a0000 0004 1936 7830Centre for Musculoskeletal Outcomes Research, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ross Wilson
- grid.29980.3a0000 0004 1936 7830Health Economist & Research Fellow, Otago Medical School, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Yana Pryymachenko
- grid.29980.3a0000 0004 1936 7830Health Economist & Postdoctoral Fellow, Otago Medical School, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Saurab Sharma
- grid.29980.3a0000 0004 1936 7830Otago Medical School, Postdoctoral Fellow, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Anupa Pathak
- grid.29980.3a0000 0004 1936 7830Graduate Research Student, Otago Medical School, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
| | - Jason Y. Y. Chua
- grid.29980.3a0000 0004 1936 7830Graduate Research Student, Otago Medical School, Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
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Abbott JH, Keenan R, Billing-Bullen G, Pask A, O'Brien D, Hudson B, Darlow B. Guest Editorial: Most people waiting for osteoarthritis care never get it – it’s time to try a different approach. J Prim Health Care 2022; 14:93-95. [PMID: 35771699 DOI: 10.1071/hc22063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, New Zealand
| | - Rawiri Keenan
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
| | | | - Alison Pask
- Independent Dietitian, Wellington, New Zealand
| | - Daniel O'Brien
- Auckland University of Technology, Auckland, New Zealand
| | - Ben Hudson
- Department of General Practice, University of Otago Christchurch, New Zealand
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago Wellington, New Zealand
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