A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Rietbergen, Tessa; Mheen, P.J. Marang-van de; Graaf, J de; Diercks, Ron L.; Zwaag, Henrica M. J. van der Linden–van der; Marle, M.E. van den Akker-van; Nelissen, Rob G H H; Bodegom‐Vos, Leti van

doi:10.1007/s00167-022-06949-w

Cited by 3 publications

(5 citation statements)

References 40 publications

(66 reference statements)

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“…A limitation of our study is that we have no data on specific symptoms, such as patients with locking symptoms or with knee complaints due to trauma, for whom, respectively, arthroscopy and MRI are warranted. However, it seems unlikely that the percentage of these patients would be distributed differently between GHs and ITCs as it was similar in a previous study by Rietbergen et al [ 15 ]. So, it seems unlikely to affect our conclusions on differences between GHs and ITCs.…”

Section: Discussionsupporting

confidence: 68%

“…So far, adherence to these CW recommendations has been limited [ 12 , 13 ]. In the Netherlands, about one-third of all arthroscopies performed among patients with degenerative knee disease were considered low-value care [ 14 ] with a gradual decrease in MRI and arthroscopy use between 2016 and 2018, likely due to a secular trend [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

“…In the Netherlands, ITCs are specifically focused to treat low-risk patients with degenerative knee disease who are able to go home on the same day after surgery, whereas GHs also treat higher-risk patients who might require ICU stay or those experiencing complications after surgery in ITCs. In this context, a shift towards these ITCs may have occurred of patients not receiving MRI or arthroscopy in GHs, particularly in case of procedures done at the patient’s request, suggesting that the reduction from a societal perspective may be much smaller than shown for GHs [ 15 ].Therefore, this study aimed to assess: (i) whether the trend in MRI and arthroscopy use in patients aged ≥50 years with degenerative knee disease differed between ITCs and GHs, and (ii) whether raising awareness on CW recommendations in the Netherlands was associated with a change in the trend for both provider types.…”

Section: Introductionmentioning

confidence: 99%

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Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis

Kuhrij,

Marang-van de Mheen,

van Lier

et al. 2024

International Journal for Quality in Health Care

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Background The use of MRI and arthroscopy are considered low-value care in most patients with degenerative knee disease. To reduce these modalities, there have been multiple efforts to increase awareness. Reductions have been shown for general hospitals (GH), but it is unclear whether this may be partly explained by a shift of patients receiving these modalities in independent treatment centers (ITCs). The aims of this study were to assess 1. whether the trend in use of MRI and arthroscopy in patients with degenerative knee disease differs between ITC’s and GH. and 2. whether the Dutch efforts to raise awareness on these recommendations was associated with a change in the trend for both types of provider. Methods All patients insured by a Dutch healthcare insurer aged 50 years or older with degenerative knee disease who were treated in a GH or ITC between July 2014 and December 2019 were included. Linear regression was used with the quarterly percentage of patients receiving an MRI or knee arthroscopy weighted by center volume, as the primary outcome. Interrupted time series analysis was used to evaluate the effect of the Dutch efforts to raise awareness. Results 14,702 patients were included treated in 90 GHs (n=13,303, 90.5%) and 29 ITCs (n = 1399, 9.5%). Across the study period, ITCs on average had a 16% higher MRI use (p<0.001) and 9% higher arthroscopy use (p=0.003). MRI-use did not change in both provider types, but arthroscopy use significantly decreased and stronger in ITCs (p=0.01). The Dutch efforts to increase awareness did not significantly influence either MRI- or arthroscopy-use in ITCs (p = 0.55 and p = 0.84) and GHs (p = 0.13 and p = 0.70). Conclusion MRI- and arthroscopy-use was higher in ITCs than GHs. MRI-use did not change significantly among patients ≥ 50 years with degenerative knee disease in both provider types between 2014 and 2019. Arthroscopy-use -did decrease with ITCs on average having higher rates for both modalities, but also showing a stronger decrease in arthroscopy use. The Dutch efforts to increase awareness did not accelerate the already declining trend in the Netherlands.

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Section: Discussionsupporting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis

Kuhrij,

Marang-van de Mheen,

van Lier

et al. 2024

International Journal for Quality in Health Care

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“…All project teams performed a structured process evaluation, and all projects obtained ethical approval before the start of their study. Several projects are described in more detail in other papers 14–23…”

Section: Methodsmentioning

confidence: 99%

“…Several projects are described in more detail in other papers. [14][15][16][17][18][19][20][21][22][23]…”

Section: The Projects' Structurementioning

confidence: 99%

Reducing low-value care: what can we learn from eight de-implementation studies in the Netherlands?

et al. 2022

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BackgroundReducing the overuse of care that is proven to be of low value increases the quality and safety of care. We aimed to identify lessons for reducing low-value care by looking at: (1) The effects of eight de-implementation projects. (2) The barriers and facilitators that emerged. (3) The experiences with the different components of the projects.MethodsWe performed a process evaluation of eight multicentre projects aimed at reducing low-value care. We reported the quantitative outcomes of the eight projects on the volume of low-value care and performed a qualitative analysis of the project teams’ experiences and evaluations. A total of 40 hospitals and 198 general practitioners participated.ResultsFive out of eight projects resulted in a reduction of low-value care, ranging from 11.4% to 61.3%. The remaining three projects showed no effect. Six projects monitored balancing measures and observed no negative consequences of their strategy. The most important barriers were a lack of time, an inability to reassure the patient, a desire to meet the patient’s wishes, financial considerations and a discomfort with uncertainty. The most important facilitators were support among clinicians, knowledge of the harms of low-value care and a growing consciousness that more is not always better. Repeated education and feedback for clinicians, patient information material and organisational changes were valued components of the strategy.ConclusionsSuccessfully reducing low-value care is possible in spite of the powerful barriers that oppose it. The projects managed to recruit many hospitals and general practices, with five of them achieving significant results without measuring negative consequences. Based on our findings, we offer practical recommendations for successfully reducing low-value care.

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Use of Implementation Strategies to Promote the Uptake of Knee Osteoarthritis Practice Guidelines and Improve Patient Outcomes: A Systematic Review

Ramirez,

Fillipo,

Allen

et al. 2024

Arthritis Care & Research

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OBJECTIVETranslation of knee osteoarthritis (KOA) clinical practice guidelines (CPGs) to practice remains suboptimal. The primary purpose of this systematic review was to describe the use of implementation strategies to promote KOA CPG recommended care.METHODSMEDLINE (via PubMed), Embase, CINAHL, and Web of Science were searched from inception to February 23, 2023, and subsequently updated and expanded on January 16, 2024. Implementation strategies were mapped per the Expert Recommendations for Implementing Change taxonomy. Risk of bias (RoB) was assessed using the Cochrane Effective Practice and Organization of Care criteria. The review was registered prospectively (CRD42023402383).RESULTSNineteen studies were included in the final review. All (100% (n=4) studies that included the domains of provide interactive assistance, train and educate stakeholders (89%(n=18)), engage consumers (87%(n=15)) and support clinicians (79%(n=14)) reported change to provider adherence. Studies that reported a change to disability included train and educate stakeholders, engage consumers and adapt and tailor to context. Studies that used train and educate stakeholders, engage consumers, and support clinicians reported a change in pain and quality of life. Most studies had a low to moderate RoB.CONCLUSIONImplementation strategies have the potential to impact clinician uptake of CPG's and patient reported outcomes (PROs). The implementation context, using an active learning strategy with a patient partner, restructuring funding models, and integrating taxonomies to tailor multifaceted strategies should be prioritized. Further experimental research is recommended to determine which implementation strategies are most effective.image

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A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

Cited by 3 publications

References 40 publications

Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis

Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis

Reducing low-value care: what can we learn from eight de-implementation studies in the Netherlands?

Use of Implementation Strategies to Promote the Uptake of Knee Osteoarthritis Practice Guidelines and Improve Patient Outcomes: A Systematic Review

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