Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

Sambare, Tanmaya D.; Bozic, Kevin J.

doi:10.1016/j.arth.2020.09.028

Cited by 12 publications

(9 citation statements)

References 39 publications

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“…Several studies describe patient satisfaction with telehealth programs [ 68 , 69 , 70 , 71 , 72 , 73 ]. Buvik et al [ 74 ] found, in a randomized controlled trial, that 86% of patients having remote consultations preferred a video-assisted consultation for the next visit.…”

Section: Resultsmentioning

confidence: 99%

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty

Kamecka

Rybarczyk-Szwajkowska

Staszewska

et al. 2021

IJERPH

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The importance of telemedicine technologies around the world has been growing for many years, and it turned out to be a particularly important issue for conducting some medical procedures during the SARS-CoV-2 pandemic. It is necessary to create interdisciplinary teams to design and implement improved procedures using telemedicine tools. The aim of the article is to develop original, improved posthospital patient care process after total hip arthroplasty (THA) with the use of telemedicine technologies. In the study, a literature review and empirical research were used. The conducted research resulted in the designing an original posthospital patient care process after THA that uses telematics technologies. Due to the use of analyzed telemedicine technologies, the designed patient care process brings a possibility to increase the patient′s safety by monitoring life parameters, allowing for regular, remote contact with specialists and to be supervised remotely. All this may contribute to shortening the convalescence time, reducing the risk of complications, as well as reducing treatment costs. The designed model is ready for further clinical research with the participation of medical staff, patients after THA and patient caregivers.

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Section: Resultsmentioning

confidence: 99%

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty

Kamecka

Rybarczyk-Szwajkowska

Staszewska

et al. 2021

IJERPH

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show abstract

“…Although assessing these goals is challenging, PROMs are vital as they present a validated and quantifiable measure of the quality of a patient's subjective health experience. As incentives to understand value are increased with rising health-care costs, value-based repayment programs, and employers directing patients toward "higher-value" surgeons 31 , the need for the standardization of PROM reporting is especially apparent. The American Joint Replacement Registry and other cohorts currently publish hospital-level and site-specific PROM results 32 , and this aggregation of PROMs in clinical data registries will allow for comparison among providers and health-care centers.…”

Section: Overviewmentioning

confidence: 99%

A Call for a Standardized Approach to Reporting Patient-Reported Outcome Measures

Orr

Klika

Gagnier

et al. 2021

Journal of Bone and Joint Surgery

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A shift toward a value-driven health-care model has made prospective collection of patient-reported outcome measures (PROMs) inextricably tied to measuring the success of orthopaedic surgery and patient satisfaction. While progress has been made in optimizing the utilization of PROM data, including establishing appropriate PROMs for a procedure and determining the clinical importance of unique tools, if these PROMs are not accurately analyzed and reported, a proportion of patients who do not reach the clinical thresholds may go unnoticed. Furthermore, parameters are unclear for setting a statistically and clinically important PROM threshold along with a minimum period for follow-up data collection.In this forum, we walk through simulated data sets modeling PROMs with the example of total joint arthroplasty. We discuss how the commonly used method of reporting PROMs by mean change can overestimate the treatment effects for the cohort as a whole and fail to capture distinct populations that are below a clinically relevant threshold. We demonstrate that when a study's outcome is PROMs, clinical importance should be reported using clinical thresholds such as the minimum clinically important difference (MCID), the smallest change in the treatment outcome that a patient perceives as beneficial, and the patient acceptable symptom state (PASS), the highest level of symptoms beyond which a patient considers himself or herself well. Finally, we propose a standardized reporting of PROMs that incorporates both the MCID and the PASS, and introduce a "clinical relevance ratio," which relies on a clinically relevant threshold to dichotomize outcomes and reports the number of patients achieving clinical importance at a given time point divided by the total number of patients included in the study. Unlike other common PROM-reporting approaches, the clinical relevance ratio is not skewed by patients who are lost to follow-up with increased time. Trends in health care demonstrate a rise in the dynamic of patients and clinicians sharing available evidence to support treatment decisions and improve care 1 . The 2016 Medicare Access and CHIP (Children's Health Insurance Program) Reau-thorization Act (MACRA) changed the way clinicians are rewarded, with reimbursement based on metrics of value rather than volume 2 . Importance has been placed on patient-reported outcome measures (PROMs), survey-based instruments that Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/G532).

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“…Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis, with the aims of reducing pain levels and ameliorating articular function and quality of life [ 1 ]. Furthermore, it has become widely utilized due to population aging [ 2 ]. Nevertheless, THA is generally considered to be a traumatic surgical procedure and it has been associated with intraoperative blood loss, intense postoperative pain, requirement for intensive care unit (ICU) use, and prolonged immobilization.…”

Section: Introductionmentioning

confidence: 99%

Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study

2021

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Background Total hip arthroplasty (THA) has been used for over five decades for treating hip osteoarthritis. THA is a surgical procedure associated with prolonged hospital length of stay (LOS). The aim of this study was to analyze whether a protocol developed for fast-track THA could decrease the time taken to reach functional recovery after surgery and the hospital LOS. Blood transfusion and critical care requirements and the complication rate were evaluated as secondary endpoints. Methods Ninety-eight patients underwent THA at the University Hospital of the Federal University of Maranhão (São Luís, Brazil). The control group included 51 patients who underwent THA through the conventional method. The fast-track surgery (FTS) group included 47 patients who underwent THA through the FTS approach. The inclusion criteria were that the subjects needed to present hip osteoarthritis and at least one clinical indication for THA, and that their risk classification was in ASA category I or II. The following factors were evaluated: age, sex, diagnosis, laterality, type of arthroplasty, blood transfusion, critical care requirement, complications, LOS, and need for re-hospitalization for any reason. For spinal anesthesia, an opioid-free protocol was used. Comparison of categorical variables between the groups was performed using the chi-square test, Shapiro-Wilk test, Student t test, and Poisson regression approach. Results The FTS and control groups were similar in age and sex distribution (p > 0.05). The majority of the patients in the control group required both blood transfusion and use of the critical care unit, thus differing from the patients who underwent FTS (p < 0.001). The mean hospital LOS in the FTS group was 2.3 ± 0.8 days, compared with 6.4 ± 1.5 days in the control group (p < 0.001). Conclusion Use of FTS was associated with decreased LOS, compared with conventional THA. Trial registration https://www.researchsquare.com/article/rs-369025/v1.

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Preparing for an Era of Episode-Based Care in Total Joint Arthroplasty

Cited by 12 publications

References 39 publications

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty

Process of Posthospital Care Involving Telemedicine Solutions for Patients after Total Hip Arthroplasty

A Call for a Standardized Approach to Reporting Patient-Reported Outcome Measures

Fast-track versus conventional surgery in relation to time of hospital discharge following total hip arthroplasty: a single-center prospective study

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