Hip and Knee Replacements

Lam, Vanessa; Teutsch, Steven M.; Fielding, Jonathan E.

doi:10.1001/jama.2018.2310

Cited by 32 publications

(16 citation statements)

References 9 publications

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“…They may have felt that the risks of surgery outweighed the benefits, or found that non-surgical treatments effectively managed their symptoms 1 . In relative terms, the potential reduction in use of joint replacement observed in this study is small, however given the number joint replacements performed annually this could translate into substantial costs avoided 2,5 . These resources could be re-allocated to populations who are less likely to undergo surgery as a means of reducing disparities in access and outcomes.…”

Section: Osteoarthritis Andcartilagementioning

confidence: 74%

“…While joint replacements are highly effective in relieving pain and improving function for most patients, up to 30% of recipients report insignificant symptom improvement and/or dissatisfaction with results 1 . Shared decision-making (SDM) supported by patient decision aids may improve the quality of care by helping patients set realistic expectations of surgery 2 . There is also considerable interest in the potential for decision aids to help contain costs 2 , as evidence from trials of decision aids in elective surgery suggests that patients exposed to decision aids are more likely to choose conservative treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Shared decision-making (SDM) supported by patient decision aids may improve the quality of care by helping patients set realistic expectations of surgery 2 . There is also considerable interest in the potential for decision aids to help contain costs 2 , as evidence from trials of decision aids in elective surgery suggests that patients exposed to decision aids are more likely to choose conservative treatment. 3 The impact of decision aids on joint replacement rates varies depending on the context in which they are delivered.…”

Section: Introductionmentioning

confidence: 99%

“…Cost reductions were driven primarily by fewer surgeries in those exposed to decision aids, but importantly this trial was not powered on this outcome (73.2% vs 80.5%; Relative Risk ¼ 0.91, 95% CI: 0.81 to 1.03). 6,7 Given the progressive nature of osteoarthritis, the long-term impact of decision aids on use of surgery is unclear, and this has been raised as an area for future research 2,7 . For instance, Arterburn et al stated "it is entirely possible, given the natural history of osteoarthritis, that patients who choose to forgo joint replacement will reverse their decision later."…”

Section: Introductionmentioning

confidence: 99%

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Long-term effect of patient decision aids on use of joint replacement and health care costs

Trenaman

Stacey

Bryan

et al. 2020

Osteoarthritis and Cartilage

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Objective: Shared decision-making supported by patient decisions aids may improve care and reduce healthcare costs for persons considering total joint replacement. Observational studies and randomized controlled trials (RCTs) have evaluated the short-term impact of decision aids on uptake of surgery and costs, however the long-term effects are unclear. This analysis aimed to evaluate the effect of patient decision aids on 1) use of joint replacement up to 7-years of follow-up, and 2) osteoarthritis-related health system costs. Methods: 324 participants in a Canadian RCT with 2-years follow-up who were randomized to either a decision aid (n ¼ 161) or usual care (n ¼ 163) had their trial and health administrative data linked. The proportion undergoing surgery up to 7-years were compared using cumulative incidence plots and competing risk regression. Mean per-patient costs were compared using two sample t-tests. Results: At 2-years, 119 of 161 (73.9%) patients in the decision aid arm and 129 of 163 (79.1%) patients in the usual care arm had surgery. Between two and 7-years, 17 additional patients in both the decision aid (of 42, 40.4%) and usual care (of 34, 50.0%) arms underwent surgery. At 7-years, patients exposed to decision aids had a similar likelihood of undergoing surgery (HR ¼ 0.92, 95% CI:0.73 to 1.17, p ¼ 0.49

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Section: Osteoarthritis Andcartilagementioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long-term effect of patient decision aids on use of joint replacement and health care costs

Trenaman

Stacey

Bryan

et al. 2020

Osteoarthritis and Cartilage

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“…More than one million joint replacements are performed every year in the United States and rates are increasing, including in patients under 65 years of age. 20 Primary joint replacements are expensive, 21 and implant failure incurs significant financial and personal cost for patients and the health care system. Recent recalls for metal-on-metal hip replacements 22 highlight the need for scalable, automated methods for implant surveillance.…”

Section: Introductionmentioning

confidence: 99%

Medical device surveillance with electronic health records

et al. 2019

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Post-market medical device surveillance is a challenge facing manufacturers, regulatory agencies, and health care providers. Electronic health records are valuable sources of real-world evidence for assessing device safety and tracking device-related patient outcomes over time. However, distilling this evidence remains challenging, as information is fractured across clinical notes and structured records. Modern machine learning methods for machine reading promise to unlock increasingly complex information from text, but face barriers due to their reliance on large and expensive hand-labeled training sets. To address these challenges, we developed and validated state-of-the-art deep learning methods that identify patient outcomes from clinical notes without requiring hand-labeled training data. Using hip replacements—one of the most common implantable devices—as a test case, our methods accurately extracted implant details and reports of complications and pain from electronic health records with up to 96.3% precision, 98.5% recall, and 97.4% F1, improved classification performance by 12.8–53.9% over rule-based methods, and detected over six times as many complication events compared to using structured data alone. Using these additional events to assess complication-free survivorship of different implant systems, we found significant variation between implants, including for risk of revision surgery, which could not be detected using coded data alone. Patients with revision surgeries had more hip pain mentions in the post-hip replacement, pre-revision period compared to patients with no evidence of revision surgery (mean hip pain mentions 4.97 vs. 3.23; t = 5.14; p < 0.001). Some implant models were associated with higher or lower rates of hip pain mentions. Our methods complement existing surveillance mechanisms by requiring orders of magnitude less hand-labeled training data, offering a scalable solution for national medical device surveillance using electronic health records.

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Medicare Bundled Payment Programs for Joint Replacement

Ryan

2018

JAMA

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Hip and Knee Replacements

Cited by 32 publications

References 9 publications

Long-term effect of patient decision aids on use of joint replacement and health care costs

Long-term effect of patient decision aids on use of joint replacement and health care costs

Medical device surveillance with electronic health records

Medicare Bundled Payment Programs for Joint Replacement

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