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

Abstract

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.