The Effect of Payer Type on Patient-Reported Outcomes in Total Joint Arthroplasty Is Modulated by Baseline Patient Characteristics

Halawi, Mohamad J.; Cote, Mark P.; Savoy, Lawrence; Williams, Vincent; Lieberman, Jay R.

doi:10.1016/j.arth.2019.01.069

Cited by 22 publications

(34 citation statements)

References 7 publications

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“…As PROMs including QoL are increasingly recognized as an important consideration in clinical care, it is important these are routinely captured pre-and post-surgery using relevant tools to evaluate the effectiveness and value of intervening [56]. These findings also reinforce the need to encourage PROMs collection beyond the one-year post-surgery mark as delayed improvers (Traj 3) or diverging trends (e.g.…”

Section: Discussionmentioning

confidence: 98%

Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

et al. 2020

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As patient-reported outcome measures (PROMs) are increasingly integrated into clinical practice, there is a need to translate collected data into valuable information to guide and improve the quality and value of patient care. The purpose of this study was to investigate health-related quality-of-life (QoL) trajectories in the five years following total knee replacement (TKR) and the patient characteristics associated with these trajectories. The feasibility of translating QoL trajectories into valuable information for guiding patientcentered care was also explored. MethodsData on patients who underwent TKR between 2006 and 2011 from a single-institution registry were extracted including patient-reported QoL (captured using the Short Form Survey (SF-12) instrument) up to 5 years post-surgery. QoL trajectories were modelled using latent class growth analysis. Quality-adjusted life-years (QALYs) were calculated to illustrate longer term health benefit. Multinomial logistic regression analyses were performed to examine the association between trajectory groups and baseline patient characteristics. ResultsAfter exclusions, 1,553 patients out of 1,892 were included in the analysis. Six unique QoL trajectories were identified; with differing levels at baseline and improvement patterns postsurgery. Only 18.6% of patients were identified to be in the most positive QoL trajectory (low baseline, large sustainable improvement after surgery) associated with the greatest gain in QALY. These patients were likely to be younger, have no co-morbidities and report greater pain at pre-surgery than most in other QoL trajectories. ConclusionsOur findings demonstrate the importance of underlying heterogeneity in QoL trajectories, resulting in variable QALY gains. There is scope in translating routinely collected PROMs to improve shared decision making allowing for more patient engagement. However, further research is required to identify suitable approaches of its implementation into practice to guide clinical care and maximize patient outcomes.

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Section: Discussionmentioning

confidence: 98%

Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

et al. 2020

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“…Therefore, it has been argued that it is preferable to use distinct outcome measures as a proxy for quality instead of process measures [ 2 , 11 , 18 , 19 ]. In particular, patient reported outcome measures (PROM) have gained an important role in the assessment of quality of healthcare [ 20 ]. Still, research on the effect of linking reimbursement to PROM is limited [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures

Eriksson

Tropp

Wiréhn

et al. 2020

BMC Health Serv Res

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Background Value-based reimbursement programs have become increasingly common. However, little is known about the effect of such programs on patient reported outcomes. Thus, the aim of this study was to analyze the effect of introducing a value-based reimbursement program on patient reported outcome measures and to explore whether a selection bias towards less complicated patients occurred. Methods This is a retrospective observational study with a before and after design based on the introduction of a value-based reimbursement program in Region Stockholm, Sweden. We analyzed patient level data from inpatient and outpatient care of patients undergoing lumbar spine surgery during 2006–2015. Patient reported outcome measures used was Global Assessment, EQ-5D-3L and Oswestry Disability Index. The case-mix of surgically treated patients was analyzed using medical and socioeconomic factors. Results The value-based reimbursement program did not have any effect on targeted or non-targeted patient reported outcome measures. Moreover, the share of surgically treated patients with risk factors such as having comorbidities and being born outside of Europe increased after the introduction. Hence, the value-based reimbursement program did not encourage discrimination against sicker patients. However, the income was higher among patients surgically treated after the introduction of the value-based reimbursement. This indicates that a value-based reimbursement program may contribute to increased inequalities in access to healthcare. Conclusions The value-based reimbursement program did not have any effect on patient reported outcome measures. Our study contributes to the understanding of the effects of a value-based reimbursement program on patient reported outcome measures and to what extent cherry-picking arises.

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“… 50 Orthopedic arthroplasty literature has shown that patients with Medicaid have lower pre- and postoperative functional scores 51 and continue to have lower outcomes up to a year after surgery. 52 Although the reason for this relationship between expectation and Medicaid/Medicare payer status is unknown, it offers an opportunity for the surgeon to counsel these patients. Perhaps most importantly, these documented patterns encourage our field to implement ways in which to improve access in this population to mitigate these challenges and improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release

Rogers

Kazmers

2022

Plastic and Reconstructive Surgery - Global Open

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Background: Patient expectations before cubital tunnel release (CuTR), a common procedure that leads to incomplete symptom resolution for many patients, are unclear. Study purposes included (1) describing preoperative patient expectations, and (2) identifying factors affecting expectations. Methods: Included patients underwent isolated unilateral CuTR between 2015 and 2021 at a single tertiary academic medical center. Expectations regarding the level of symptomatic improvement were queried preoperatively. Univariate and multivariable binary logistic regression was performed to determine factors associated with expecting great improvement. Results: Of the 92 included patients, 43 (47%) patients expected great improvement, whereas 27 (29%), four (4%), and five patients (5%) expected some, little, and no improvement, respectively. The remainder (14%) had no expectations. Multivariable modeling demonstrated that retired or unemployed/disabled work status, and commercial insurance status (versus Medicare or Medicaid) were associated with lower expectations independent of the surgeon, surgical technique, revision versus primary CuTR, preoperative atrophy or constant numbness, diabetes, and all studied demographic factors, including social deprivation. Conclusions: Roughly half of the patients expect great relief, and a third expect lesser degrees of relief, following CuTR. Preoperative expectations are significantly higher in patients with Medicaid and Medicare insurance, representing an opportunity for education, given the association between public insurance payer status and worse health outcomes in general. Age, BMI, preoperative atrophy and/or numbness, and the presence of medical comorbidities do not influence expectations but have been shown to yield worse outcomes or influence need for revision CuTR, representing an opportunity for intervention to align patient and surgeon expectations.

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The Effect of Payer Type on Patient-Reported Outcomes in Total Joint Arthroplasty Is Modulated by Baseline Patient Characteristics

Cited by 22 publications

References 7 publications

Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?

A pain relieving reimbursement program? Effects of a value-based reimbursement program on patient reported outcome measures

Patient Expectations for Symptomatic Improvement before Cubital Tunnel Release

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