Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

Lin, Eugenia; Bozic, Kevin J.; Ibrahim, Said A.; O’Connor, Mary I.; Nelson, Charles L.

doi:10.2106/jbjs.21.01332

Cited by 9 publications

(6 citation statements)

References 49 publications

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“…Future plans to link reimbursement to PROM collection could disproportionately affect safety-net hospitals that care for vulnerable patients, further worsening access to care and financial viability of these institutions. 16…”

Section: Discussionmentioning

confidence: 99%

Disconnected: Electronic Patient‐ReportedOutcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

Tucker

Shah

Hammerberg

et al. 2023

J Am Acad Orthop Surg

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Introduction: Collection of patient-reported outcome measures (PROMs) in orthopaedic patients at safety-net hospitals is challenging. The purpose of this study was to evaluate the success of electronic PROM (E-PROM) collection in this setting. Methods: A retrospective review identified 207 consecutive orthopaedic patients undergoing 77 elective arthroplasty procedures and 130 trauma procedures. E-PROMs were collected through automated e-mails from an online patient engagement platform (PatientIQ) at 2 weeks, 6 weeks, and 3 months postoperatively. Patients with trauma received the percentage of normal Single Assessment Numerical Evaluation (SANE) and Patient-Reported Outcomes Measurement Information System–Physical Function (PROMIS-PF). Arthroplasty patients received the Hip/Knee SANE, Hip/Knee Disability and Osteoarthritis Outcome Score-Joint Replacement (HOOS Jr/KOOS Jr), PROMIS Global Physical Health (PROMIS-G-PH), and Veterans RAND 12-Item (VR-12) Health Survey. Results: Compared with patients with trauma, arthroplasty patients were older (median difference 18.0 years; 95% confidence interval [CI] 12.0-22.0; P < 0.0001), more likely to be Hispanic/Black (proportional difference 16.9%; CI 2.8-30.3%; P = 0.02), more likely to have noncommercial or no insurance (proportional difference 34.0%; CI 23.2-43.0%; P < 0.001), and did not differ in Area Deprivation Index or E-PROM completion at each time point. E-PROMs were completed at 2 weeks, 6 weeks, and 3 months by 25.1% (52 of 207), 24.6% (51 of 207), and 21.7% (45 of 207) of all patients, respectively. Trauma and arthroplasty patients had a similar rate of partial E-PROM completion. Patients who completed 3-month E-PROMs were less likely to be Hispanic/Black (PD −16.4%; CI −31.0 to −0.2%; P < 0.04); less likely to have noncommercial/no insurance (PD −20.0%; CI −35.5 to −4.5%; P = 0.01); and did not differ in age, sex, Area Deprivation Index, or procedure type. Discussion: The low collection rate of E-PROMs from orthopaedic patients at safety-net hospitals should be weighed against their costs. E-PROM collection may exacerbate disparities in PROM collection among certain patient populations. Level of evidence: Diagnostic Level III.

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Section: Discussionmentioning

confidence: 99%

Disconnected: Electronic Patient‐ReportedOutcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

Tucker

Shah

Hammerberg

et al. 2023

J Am Acad Orthop Surg

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“…Considering the high lost to follow-up rate and nonparticipation with E-PROMs, future plans to link reimbursement to PROM collection could disproportionately affect the safety net trauma centers that care for these patients, which could negatively affect the already tenuous finances of these institutions and limit access to care. 12…”

Section: Discussionmentioning

confidence: 99%

Disconnected: Electronic Patient-Reported Outcome Measure Collection in Orthopaedic Patients is Less Successful Than In-Person Collection at an Urban Safety Net Trauma Center

Tucker,

Shah,

Mauffrey

et al. 2023

Journal of Orthopaedic Trauma

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Objectives: Electronic patient-reported outcome measure (E-PROM) collection is a technological advancement that has the potential to facilitate PROM collection in orthopaedic trauma. The purpose of this study was to compare E-PROM versus in-person PROM collection. Design: This is a retrospective comparative study. Setting: Urban Level I trauma center. Patients/Participants: One hundred and fifty consecutive operative orthopaedic trauma patients. Intervention: The Percent of Normal single assessment numerical evaluation and patient-reported outcomes measurement information system physical function were collected through automated e-mails from an online patient-engagement platform (PatientIQ, Chicago, IL) 2-week, 6-week, 3-month, and 6-month postoperatively. The Percent of Normal was also administered to patients in clinic at the same time intervals. Main Outcome Measurements: Completion of PROMs; Loss to follow-up. Results: The median clinical follow-up time was 4 months (interquartile range: 1.3–6 months), and 42.7% (64/150) were lost to follow-up. Loss to follow-up was associated with a more disadvantaged area deprivation index [observed difference, 7.0, 95% confidence interval, 1.0 to 13.0; P = 0.01] and noncommercial/no insurance (observed difference 34.8%, confidence interval, 20.9%–45.5%; P < 0.0001). In-person PROM collection was more successful than E-PROM collection at all intervals [2-week (51.3% vs 20.7), 6-week (46.7% vs 20.0%), 3-month (50.0% vs 18.7%), and 6-month (38.0% vs 18.7%), P < 0.0001]. Patients who completed 3-month E-PROMs had longer clinical follow-up (5.2 vs. 3.0 months, P = 0.004) and a trend of being less likely to be lost to follow-up (28.6% vs 45.9%, P = 0.13). Conclusion: E-PROMs were less successful than in-person PROM collection in trauma patients at an urban safety net trauma center. Level of Evidence: Diagnostic Level III.

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“…The transition to bundled payments from fee-for-service incentive structures may place certain care systems at disadvantages. For example, systems that treat patient populations suffering from high energy traumas or high rates of postoperative complication have increased financial pressure in providing comprehensive care under bundled payment constraints [25][26][27]. Similarly, given recent advances to create performance-based reimbursement systems based on quality from CMS and private payers, it is vital to have information that informs how specific comorbidities impact postoperative outcomes and quality measures after pilon fracture [28].…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

Panton¹,

Ranson²,

DeBaun³

et al. 2023

Cureus

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Background Studies demonstrate that metabolic syndrome (MetS) negatively impacts surgical outcomes. This study sought to identify how metabolic syndrome affects outcomes after open reduction and internal fixation (ORIF) of traumatic pilon fractures. Methods Patients who underwent ORIF for pilon fractures from 2012 to 2019 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with MetS were compared to non-MetS patients for rates of adverse events, prolonged stay, readmission, discharge location, and operative time in the 30-day postoperative period. All statistical analyses were conducted using SPSS version 26.0 (IBM Corp., Armonk, NY, USA). Paired student t-tests were used to assess continuous variables. Pearson’s Chi-square and odds ratios were used for categorical variables. Results A total of 1,915 patients met this study’s inclusion criteria, and 127 MetS patients were identified in the cohort. The MetS cohort was older (62.7 vs 49.5 years old, p-value <0.01), with a greater proportion of female patients (59.1% vs 50.2%, p=0.054). MetS patients experienced significantly higher rates of infectious complications (7.9% vs 3.9% OR 2.75 (CI 1.36-5.53), p=0.008), major adverse events (11% vs 4.3%, OR 2.79 (CI 1.53-5.09) p=0.002), and readmissions. MetS patients also had longer lengths of stay (7 days vs 3.8 days, p-value<0.001), and were more likely to be discharged to a non-home location (51.2% vs 19.5%, p-value<0.01, OR 4.32 (CI=3.0-6.24) p<0.001). Conclusion Patients with MetS have an increased risk of 30-day major complications, infection, readmissions, discharge to a non-home location, and prolonged operative time, and therefore warrant additional consideration for perioperative monitoring.

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Does Value-Based Care Threaten Joint Arthroplasty Access for Vulnerable Patient Populations?

Cited by 9 publications

References 49 publications

Disconnected: Electronic Patient‐ReportedOutcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

Disconnected: Electronic Patient‐ReportedOutcome Measure Collection In Orthopaedic Patients at an Urban Safety-Net Hospital

Disconnected: Electronic Patient-Reported Outcome Measure Collection in Orthopaedic Patients is Less Successful Than In-Person Collection at an Urban Safety Net Trauma Center

Metabolic Syndrome Increases Risk of Readmission and Complications in Operative Fixation of Pilon Fractures

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