It Is All About Value Now: The Data You Need to Collect and How to Do It

Lieberman, Jay R.; Bozic, Kevin J.; Mallon, William J.; Goldfarb, Charles A.

doi:10.2106/jbjs.17.01539

Cited by 9 publications

(7 citation statements)

References 28 publications

(27 reference statements)

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“…T he shift toward value-based health care involving total joint arthroplasty (TJA) has necessitated the establishment of metrics that are aimed at determining whether a surgical outcome is satisfactory [1][2][3][4][5][6] . Quantification of such outcomes can be used to measure quality, allowing for a more comprehensive assessment of value 7,8 .…”

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confidence: 99%

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Kunze

Fontana

MacLean

et al. 2021

Journal of Bone and Joint Surgery

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Background: It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA.Methods: A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ‡70 years of age), sex (men or women), body mass index (BMI; <30 or ‡30 kg/m 2 ), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ‡50). Results:The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores ( ‡50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ‡70 years of age, but was equivalent for the KOOS JR. Conclusions:The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively.The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors.

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confidence: 99%

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Kunze

Fontana

MacLean

et al. 2021

Journal of Bone and Joint Surgery

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“…Patient-reported outcome measures (PROMs) are commonly used to evaluate the preoperative and postoperative pain and functional status of patients undergoing procedures such as THA and TKA [1,25,26,36,46]. Given that raw numeric values from these metrics are challenging to interpret [2,11,16,32,40], constructs to frame PROM scores in the context of improvement over time have been developed.…”

Section: Introductionmentioning

confidence: 99%

Defining Patient-relevant Thresholds and Change Scores for the HOOS JR and KOOS JR Anchored on the Patient-acceptable Symptom State Question

Dekhne,

Fontana,

Pandey

et al. 2023

Clin Orthop Relat Res

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Background When evaluating the results of clinical research studies, readers need to know that patients perceive effect sizes, not p values. Knowing the minimum clinically important difference (MCID) and the patient-acceptable symptom state (PASS) threshold for patient-reported outcome measures helps us to ascertain whether our interventions result in improvements that are large enough for patients to care about, and whether our treatments alleviate patient symptoms sufficiently. Prior studies have developed the MCID and PASS threshold for the Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR) and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) anchored on satisfaction with surgery, but to our knowledge, neither the MCID nor the PASS thresholds for these instruments anchored on a single-item PASS question have been described. Questions/purposes (1) What are the MCID (defined here as the HOOS/KOOS JR change score associated with achieving PASS) and PASS threshold for the HOOS JR and KOOS JR anchored on patient responses to the single-item PASS instrument? (2) How do patient demographic factors such as age, gender, and BMI correlate with MCID and PASS thresholds using the single-item PASS instrument? Methods Between July 2020 and September 2021, a total of 10,970 patients underwent one primary unilateral THA or TKA and completed at least one of the three surveys (preoperative HOOS or KOOS JR, 1-year postoperative HOOS or KOOS JR, and 1-year postoperative single-item anchor) at one large, academic medical center. Of those, only patients with data for all three surveys were eligible, leaving 13% (1465 total; 783 THAs and 682 TKAs) for analysis. Despite this low percentage, the overall sample size was large, and there was little difference between completers and noncompleters in terms of demographics or baseline patient-reported outcome measure scores. Patients undergoing bilateral total joint arthroplasty or revision total joint arthroplasty and those without all three surveys at 1 year of follow-up were excluded. A receiver operating characteristic curve analysis, leveraging a 1-year, single-item PASS (that is, “Do you consider that your current state is satisfactory?” with possible answers of “yes” or “no”) as the anchor was then used to establish the MCID and PASS thresholds among the 783 included patients who underwent primary unilateral THA and 682 patients who underwent primary unilateral TKA. We also explored the associations of age at the time of surgery (younger than 65 years or 65 years and older), gender (men or women), BMI (< 30 or ≥ 30 kg/m2), and baseline Patient-Reported Outcome Measure Information System-10 physical and mental component scores (< 50 or ≥ 50) for each of the MCID and PASS thresholds through stratified analyses. Results For the HOOS JR, the MCID associated with the PASS was 23 (95% CI 18 to 31), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 81 (95% CI 77 to 85), with an area under the receiver operating characteristic curve of 0.81. For the KOOS JR, the MCID was 16 (95% CI 14 to 18), with an area under the receiver operating characteristic curve of 0.75, and the PASS threshold was 71 (95% CI 66 to 73) with an area under the receiver operating characteristic curve of 0.84. Stratified analyses indicated higher change scores and PASS threshold for younger men undergoing THA and higher PASS thresholds for older women undergoing TKA. Conclusion Here, we demonstrated the utility of a single patient-centered anchor question, raising the question as to whether simply collecting a postoperative PASS is an easier way to measure success than collecting preoperative and postoperative patient-reported outcome measures and then calculating MCIDs and the substantial clinical benefit. Level of Evidence Level III, therapeutic study.

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“…Recent reports have increasingly focused on outcome metrics intended to evaluate health status from the patient's perspective, namely patient-reported outcome measures (PROMs) [2,26,30,37,40,41]. PROMs give providers and patients a single numeric score based on the patient's perception of their health status at a single timepoint [2,41].…”

Section: Introductionmentioning

confidence: 99%

Substantial Inconsistency and Variability Exists Among Minimum Clinically Important Differences for Shoulder Arthroplasty Outcomes: A Systematic Review

Kolin

Moverman

Pagani

et al. 2022

Clin Orthop Relat Res

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Background As the value of patient-reported outcomes becomes increasingly recognized, minimum clinically important difference (MCID) thresholds have seen greater use in shoulder arthroplasty. However, MCIDs are unique to certain populations, and variation in the modes of calculation in this field may be of concern. With the growing utilization of MCIDs within the field and value-based care models, a detailed appraisal of the appropriateness of MCID use in the literature is necessary and has not been systematically reviewed. Questions/purposes We performed a systematic review of MCID quantification in existing studies on shoulder arthroplasty to answer the following questions: (1) What is the range of values reported for the MCID in commonly used shoulder arthroplasty patient-reported outcome measures (PROMs)? (2) What percentage of studies use previously existing MCIDs versus calculating a new MCID? (3) What techniques for calculating the MCID were used in studies where a new MCID was calculated? Methods The Embase, PubMed, and Ovid/MEDLINE databases were queried from December 2008 through December 2020 for total shoulder arthroplasty and reverse total shoulder arthroplasty articles reporting an MCID value for various PROMs. Two reviewers (DAK, MAM) independently screened articles for eligibility, specifically identifying articles that reported MCID values for PROMs after shoulder arthroplasty, and extracted data for analysis. Each study was classified into two categories: those referencing a previously defined MCID and those using a newly calculated MCID. Methods for determining the MCID for each study and the variability of reported MCIDs for each PROM were recorded. The number of patients, age, gender, BMI, length of follow-up, surgical indications, and surgical type were extracted for each article. Forty-three articles (16,408 patients) with a mean (range) follow-up of 20 months (0.75 to 68) met the inclusion criteria. The median (range) BMI of patients was 29.3 kg/m 2 (28.0 to 32.2 kg/m 2 ), and the median (range) age was 68 years (53 to 84). There were 17 unique PROMs with MCID values. Of the 112 MCIDs reported, the most common PROMs with MCIDs were the American One of the authors (AJ) certifies receipt of personal payments or benefits, during the study period, in an amount of less than USD 10,000 from DJO Global; in an amount of less than USD 10,000 from Ignite Orthopedics; in an amount of less than USD 10,000 from DePuy Synthes. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Ethical approval for this study was not sought.

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It Is All About Value Now: The Data You Need to Collect and How to Do It

Cited by 9 publications

References 28 publications

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Defining Patient-relevant Thresholds and Change Scores for the HOOS JR and KOOS JR Anchored on the Patient-acceptable Symptom State Question

Substantial Inconsistency and Variability Exists Among Minimum Clinically Important Differences for Shoulder Arthroplasty Outcomes: A Systematic Review

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