The Alberta hip and knee replacement project: A model for health technology assessment based on comparative effectiveness of clinical pathways

Abstract

The Alberta Hip and Knee Replacement Project demonstrates the feasibility and advantages of applying a pragmatic randomized controlled trial to ascertain comparative effectiveness. This is a model for health technology assessment that incorporates how clinical pathways can be effectively evaluated.

Essay for the CIHR/CMAJ award: improving access to hip and knee replacement and its quality by adopting a new model of care in Alberta

“…8 The Alberta Orthopaedic Society provided clinical expertise and a frontline view of service, and the Society facilitated surgeon consensus on new processes. The health authorities provided administrative expertise, surgical facilities and teams, and hospital data, and served as agents of change for systems and processes.…”

“…Patients in the two groups had similar baseline characteristics, including demographics, comorbidity and health-related quality of life. 8 During the 12-month study, 1066 patients in the intervention group had surgery; 504 patients in the control group had surgery.…”

Prevalence and Costs of Rehabilitation and Physical Therapy After Primary TJA

“…With the aging population and expanding indications for younger and more active patients, the pressures to control these costs will increase. There are reasonable data on the in-hospital costs for these procedures and evolving strategies designed to reduce costs [5][6][7][8][9][10][11], but there is surprisingly little information on the events which form the post hospital experience. In addition, little data on the effectiveness of physical therapy (PT) regimens following total joint arthroplasty (TJA) are available [12][13][14][15][16], and minimal data on whether hip (THA) or knee (TKA) arthroplasty outcomes differ in their response to these treatments.…”

Healthcare Technology: Physician Collaboration in Reducing the Surgical Cost

“…These programs are increasingly popular because of the need for more thoughtful evaluation of new, expensive, and often unproven technologies [7,9]. When new, more expensive technology supposedly delivers superior results to patients, there is often a lack of evidence-based analysis to support the added expense [8,12]. The rapid innovation in the healthcare technology sector, a culture of minimal management of technology adoption practices within many hospitals, pervasive marketing pressure on physicians from manufacturers (through sales representatives and offers to participate in product development, speakers' bureaus, and other consulting activities), demand for state-of-the-art care from patients, and increased emphasis placed on evidencebased medical decision-making underlie the environment in which technology assessment programs are of increasing value [9,10,13].…”