Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

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

doi:10.1007/s00167-019-05708-8

Cited by 8 publications

(13 citation statements)

References 43 publications

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“…These clinical guidelines are based on evidence showing that a knee arthroscopy for these patients has no benefit compared to non-surgical treatment [4,8,10,18]. Moreover, undergoing a knee arthroscopy can cause harm for patients and waste resources [4,14], and are, therefore, considered as low value care in Dutch Choosing Wisely recommendations and similarly by medical societies in other countries [2,12,21,22].…”

Section: Introductionmentioning

confidence: 99%

Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

Rietbergen

Mheen

Diercks

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose The purpose of this study was to assess in which proportion of patients with degenerative knee disease aged 50+ in whom a knee arthroscopy is performed, no valid surgical indication is reported in medical records, and to explore possible explanatory factors. Methods A retrospective study was conducted using administrative data from January to December 2016 in 13 orthopedic centers in the Netherlands. Medical records were selected from a random sample of 538 patients aged 50+ with degenerative knee disease in whom arthroscopy was performed, and reviewed on reported indications for the performed knee arthroscopy. Valid surgical indications were predefined based on clinical national guidelines and expert opinion (e.g., truly locked knee). A knee arthroscopy without a reported valid indication was considered potentially low value care. Multivariate logistic regression analysis was performed to assess whether age, diagnosis (“Arthrosis” versus “Meniscal lesion”), and type of care trajectory (initial or follow-up) were associated with performing a potentially low value knee arthroscopy. Results Of 26,991 patients with degenerative knee disease, 2556 (9.5%) underwent an arthroscopy in one of the participating orthopedic centers. Of 538 patients in whom an arthroscopy was performed, 65.1% had a valid indication reported in the medical record and 34.9% without a reported valid indication. From the patients without a valid indication, a joint patient–provider decision or patient request was reported as the main reason. Neither age [OR 1.013 (95% CI 0.984–1.043)], diagnosis [OR 0.998 (95% CI 0.886–1.124)] or type of care trajectory [OR 0.989 (95% CI 0.948–1.032)] were significantly associated with performing a potentially low value knee arthroscopy. Conclusions In a random sample of knee arthroscopies performed in 13 orthopedic centers in 2016, 65% had valid indications reported in the medical records but 35% were performed without a reported valid indication and, therefore, potentially low value care. Patient and/or surgeons preference may play a large role in the decision to perform an arthroscopy without a valid indication. Therefore, interventions should be developed to increase adherence to clinical guidelines by surgeons that target invalid indications for a knee arthroscopy to improve care. Level of evidence IV.

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Section: Introductionmentioning

confidence: 99%

Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

Rietbergen

Mheen

Diercks

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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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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“…The reasons for this are complex and some of them have been discussed in this article. Despite published evidence questioning the effectiveness, personal experiences of surgeons with a given procedure may encourage them to continue and has been shown to reduce implementation of Choosing Wisely recommendations against knee arthroscopy 12. Similarly, experiences from others may influence patients and their preference for a particular treatment 12.…”

mentioning

confidence: 99%

“…Despite published evidence questioning the effectiveness, personal experiences of surgeons with a given procedure may encourage them to continue and has been shown to reduce implementation of Choosing Wisely recommendations against knee arthroscopy 12. Similarly, experiences from others may influence patients and their preference for a particular treatment 12. Implementation of evidence into practice may thus be delayed by several years and further studies maybe needed to ‘convince’ surgeons, and sometimes patients.…”

mentioning

confidence: 99%

Best evidence, but does it really change practice?

Steiger

2020

BMJ Qual Saf

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Preferences and beliefs of Dutch orthopaedic surgeons and patients reduce the implementation of “Choosing Wisely” recommendations in degenerative knee disease

Cited by 8 publications

References 43 publications

Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

Performing a knee arthroscopy among patients with degenerative knee disease: one-third is potentially low value care

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

Best evidence, but does it really change practice?

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