Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions

PURPOSE

The high cost of orthopaedic care has attracted criticism in the current value-based health care environment. The objective of this work was to assess the properties of a willingness to pay (WTP)-based approach to estimate the monetary value that patients place on health improvements in chronic knee conditions following orthopaedic treatment.

METHODS

A sample of patients with a chronic knee condition were surveyed between January and May of 2018 at a large orthopaedic practice. Each patient provided their WTP for restoration to ideal knee health and completed the Single Assessment Numerical Evaluation (SANE) to describe their baseline knee state. Average WTP was calculated for the total sample and stratified by income, age, and baseline SANE (for which 0 is the worst and 100 is the best) levels. The patient-perceived monetary value of each unit of SANE improvement was assessed.

RESULTS

The study sample included 86 patients seeking orthopaedic care for a chronic knee condition. Mean baseline SANE score was 45.5 (standard deviation: 25.0). Mean WTP to obtain ideal knee function from baseline was $18,704 (standard deviation: $18,040). For the full sample, patients valued a 1-unit improvement in SANE score at $291.1 (β: 291.1; P<0.05). The amount of money patients were willing to pay to achieve ideal knee function varied with age, income, and baseline knee state.

CONCLUSIONS

Patients appear to highly value improvement in chronic knee conditions. Willingness-to-pay survey results appear to track expected variation in patient outcome valuation by income and baseline knee condition and could be a valuable approach to assess value-based care in orthopaedics.

Home care in dementia: The views of informal carers from a co-designed consultation

BACKGROUND

In the United Kingdom, there is a current priority for high-quality dementia care provided at home. However, home care or domiciliary care is an area where problems have been reported, in terms of a lack of consistency, coordination and appropriate responses to the specific needs of those with dementia. The views of informal carers, who often must respond to these problems when supporting relatives, are crucial in shedding light on the issues and in seeking to promote solutions.

METHODS

This study explored the views of informal carers of those with dementia concerning home care, through a consultation using an electronic survey. The survey questions were designed by informal carers, through a public involvement group within an existing programme of dementia research. The survey elicited responses from 52 informal carers in 2017/18. The data were analysed qualitatively using framework analysis.

FINDINGS

Carers' views focused on the need for investment into meaningful personalisation, recognising the value of providing care and valuing formal carers, systemic failings of care coordination and provision and the importance of ongoing collaboration and care planning.

CONCLUSION

Based on a framework drawn from the views of informal carers themselves, this study articulated issues of concern for home care and its delivery for people with dementia. Attempts should be made to make dementia home care more consistently personalised, inclusive and collaborative with informal carers and key others involved. Further areas to explore include working conditions of formal carers and current models utilised in homecare provision.

The ethics of refusing to care for patients during the coronavirus pandemic: A Chinese perspective

As a result of the coronavirus (COVID-19) pandemic, health professionals are faced with situations they have not previously encountered and are being forced to make difficult ethical decisions. As the first group to experience challenges of caring for patients with coronavirus, Chinese nurses endure heartbreak and face stressful moral dilemmas. In this opinion piece, we examine three related critical questions: Whether society has the right to require health professionals to risk their lives caring for patients; whether health professionals have the right to refuse to care for patients during the coronavirus pandemic; and what obligations there are to protect health professionals? Value of care, community expectations, legal obligations, professional and codes of practice may compel health professionals to put themselves at risks in emergency situations. The bioethical principles of autonomy, justice, beneficence and non-maleficence, as well as public health ethics, guide nurses to justify their decisions as to whether they are entitled to refuse to treat COVID-19 patients during the pandemic. We hope that the open discussion would support the international society in addressing similar ethical challenges in their respective situations during this public health crisis.

Time to Talk: Can Radiologists Improve Follow-Up of Abdominal Imaging Findings Indeterminate for Malignancy by Initiating Verbal Communication?

PURPOSE

The aims of this study were to examine the association between radiologist-initiated verbal communication for abdominal imaging findings indeterminate for malignancy and receipt of relevant outpatient follow-up imaging and to evaluate the proportion of findings that progress from indeterminate to suspicious for malignancy.

METHODS

Using a mandatory standardized assessment coding system, 727 eligible outpatient abdominal CT, MRI, and ultrasound studies performed between July 1, 2013, and January 31, 2014, were identified. Multivariate logistic regression was used to evaluate the association between radiologist-initiated verbal communication and receipt of relevant outpatient imaging follow-up, adjusted for patient, ordering physician, interpreting radiologist, and imaging variables.

RESULTS

Sixty-two percent of patients (451 of 727) with imaging findings indeterminate for malignancy received relevant outpatient imaging follow-up. Radiologist-initiated verbal communication occurred in 4.8% of cases (35 of 727). Radiologist-initiated verbal communication (odds ratio [OR], 2.45; 95% confidence interval [CI], 1.02-5.87) and existing cancer diagnosis (OR, 3.00; 95% CI, 2.11-4.26) were associated with a higher likelihood of receiving relevant imaging follow-up. Compared with those whose imaging studies were ordered by clinicians in a medical specialty, patients with studies ordered by clinicians in surgical (OR, 0.70; 95% CI, 0.49-0.99) or other (OR, 0.44; 95% CI, 20.24-0.83) specialties were less likely to receive relevant imaging follow-up. Progression of findings from indeterminate to suspicious for malignancy occurred in 5.4% of cases and was not associated with radiologist-initiated verbal communication.

CONCLUSIONS

Radiologist-initiated verbal communication increases the likelihood that patients receive outpatient imaging follow-up for abdominal findings indeterminate for malignancy. Progression of these findings is relatively infrequent.

"Phenotyping" hospital value of care for patients with heart failure

OBJECTIVE

To characterize hospitals based on patterns of their combined financial and clinical outcomes for heart failure hospitalizations longitudinally.

DATA SOURCE

Detailed cost and administrative data on hospitalizations for heart failure from 424 hospitals in the 2005-2011 Premier database.

STUDY DESIGN

Using a mixture modeling approach, we identified groups of hospitals with distinct joint trajectories of risk-standardized cost (RSC) per hospitalization and risk-standardized in-hospital mortality rate (RSMR), and assessed hospital characteristics associated with the distinct patterns using multinomial logistic regression.

PRINCIPAL FINDINGS

During 2005-2011, mean hospital RSC decreased from $12,003 to $10,782, while mean hospital RSMR declined from 3.9 to 3.2 percent. We identified five distinct hospital patterns: highest cost and low mortality (3.2 percent of the hospitals), high cost and low mortality (20.4 percent), medium cost and low mortality (34.6 percent), medium cost and high mortality (6.2 percent), and low cost and low mortality (35.6 percent). Longer hospital stay and greater use of intensive care unit and surgical procedures were associated with phenotypes with higher costs or greater mortality.

CONCLUSIONS

Hospitals vary substantially in the joint longitudinal patterns of cost and mortality, suggesting marked difference in value of care. Understanding determinants of the variation will inform strategies for improving the value of hospital care.