Patient-reported outcomes among patients undergoing total hip replacement in an integrated care system and in a standard care system in Region Stockholm, Sweden

Abstract

Background Coordination, cooperation and efficient use of resources is vital for the health- and social care sector if it is to meet the needs of an aging population. Integrated care is a patient-centred approach to provision of care aiming to improve quality of care and overcome fragmented care through co-productive partnerships and may positively affect quality of care and health outcomes, especially among those in need of highly coordinated care services. Aim To compare patient-reported outcomes (PROs) among patients undergoing total hip replacement (THR) in the integrated care system in Norrtälje Municipality and in the standard care system in other municipalities in Region Stockholm, Sweden. Methods Swedish Hip Arthroplasty Register PRO data during 2008–2015 were compared 1 year after THR among patients (≥50 years) in integrated care (n = 407) and standard care (n = 3501) systems using linear (EQ VAS score), logistic (EQ-5D-3L dimensions) and negative binomial (hip pain VAS score) regressions. Analyses were adjusted for the preoperative factors age, sex, BMI, ASA class and type of incision. Results 1-year postoperatively, patients in the integrated care system did not report their health significantly different from patients receiving standard care. Exceptions: Female patients in integrated care reported less problems with self-care (OR:0.52; 0.29–0.96) and patients above 70 years reported more problems with mobility (OR: 1.37; 1.01–1.87). Conclusion No significant differences were found between the two care systems for postoperative PROs. A longer follow-up time and analyses by socioeconomic groups would be valuable.

Effectiveness of integrated person‐centered interventions for older people's care: Review of Swedish experiences and experts’ perspective

“… One publication on nurse‐led heart failure clinics in primary care settings reported that this intervention significantly reduced the number of heart failure‐related hospital admissions, hospital days, and emergency room visits [91]. According to two publications assessing the integrated care model for people aged over 65 years implemented by the TioHundra organization, the care model was associated with a decrease in the rate of emergency department visits [92] and the rate of hospitalization for ambulatory care sensitive conditions [93], compared to pre‐intervention levels. However, the difference was not statistically significant when compared to changes in the rest of Stockholm county [92] and a matched control area [93].…”

“…According to two publications assessing the integrated care model for people aged over 65 years implemented by the TioHundra organization, the care model was associated with a decrease in the rate of emergency department visits [92] and the rate of hospitalization for ambulatory care sensitive conditions [93], compared to pre‐intervention levels. However, the difference was not statistically significant when compared to changes in the rest of Stockholm county [92] and a matched control area [93]. Another article examining TioHundra found that patients undergoing total hip replacement in the integrated care system showed no differences across studied health outcomes compared to those receiving standard care [94].…”

“…However, the difference was not statistically significant when compared to changes in the rest of Stockholm county [92] and a matched control area [93]. Another article examining Tio-Hundra found that patients undergoing total hip replacement in the integrated care system showed no differences across studied health outcomes compared to those receiving standard care [94].…”

“…Nurse-led heart failure clinics in primary care [91] TioHundra integrated healthcare organization [92][93][94] Note: The row shading implies that interventions belong to the same IPCHS thematic cluster. Abbreviations: IC, integrated care; PCC, person-centered care; CHF, chronic heart failure; CGA, comprehensive geriatric assessment: ADL, activities of daily living, ICOPE: Integrated Care of Older People, IPCHS: Integrated People-Centered Health Services.…”

Comparative analysis of the quality of life regarding patients who underwent hip replacement in public versus private hospitals in Hungary

“…compared Swedish integrated care and standard care in terms of patient-reported outcomes (EQ VAS score, EQ-5D-3L, hip pain VAS score). Their results showed that 1 year after total hip replacement, the health status of patients in integrated care did not differ significantly from patients in standard care 44 .…”