The High Value Healthcare Collaborative: Observational Analyses of Care Episodes for Hip and Knee Arthroplasty Surgery

Weeks, William B.; Schoellkopf, William J.; Sorensen, Lyle S.; Masica, Andrew L.; Nesse, Robert E.; Weinstein, James Neil

doi:10.1016/j.arth.2016.09.009

Cited by 17 publications

(17 citation statements)

References 21 publications

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“…Our findings confirmed that much of the variability in total episode costs is attributable to differences in postacute care costs 10,15. Although, other factors, such as differences in patient needs,16 could explain our findings, it is possible that regional differences in practice patterns (found even within health care delivery systems17) drove cost differentials.…”

Section: Discussionsupporting

confidence: 84%

“…As previously reported,10 an awardee of a CMMI award, the HVHC obtained 100% of the fee-for-service Medicare data for Dartmouth-Atlas defined hospital referral regions (HRRs) in which participating HVHC members had a market presence for calendar years 2012 and 2013. This evaluation was approved by CMS as well as by the centralized Institutional Review Board at Dartmouth College (CPHS #23820).…”

Section: Methodsmentioning

confidence: 99%

“…We used methods virtually identical to those reported elsewhere,10 but to give readers easy access to them, provide details here, using virtually the same wording. We examined cohorts of patients who received 1 of 2 procedures that occurred during an index admission: uncomplicated hip replacement (MSDRG 470, ICD-9-CM procedure code 81.51) and uncomplicated knee replacement (MSDRG 470, ICD-9-CM procedure code 81.54).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Weeks

Schoellkopf²,

Ballard

et al. 2017

Medical Care

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Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Weeks

Schoellkopf²,

Ballard

et al. 2017

Medical Care

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“…This may be related to the etiology of total knee replacement and the activity level in this population and is also comparable to other authors' observations 16,[45][46][47] The median of the total episode-of-care costs for TKA was USD$ 6,190, which suggests that this intervention is less expensive in Colombia than what has been reported in other countries. [48][49][50][51][52][53] In addition, large differences among regions and among insurers were found, which is very important for our health system given that these costs are incurred by the system. The multivariate analysis identified individual characteristics of the patients (age and comorbidities) and sociodemographic characteristics (insurer and geographic region) as independent predictors of total episode-of-care costs.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

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Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

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“…The HOOS and KOOS surveys have been well validated and demonstrated to be reliable in assessing both short-and long-term pain relating to osteoarthritis. 40 The Charlson Comorbidity Index (CCI) was calculated using encounter data to characterize the comorbidity burden of the hip and knee osteoarthritis patients included in our sample. The CCI is a continuous measure that weights the sum of 17 comorbid conditions.…”

Section: Independent Variablesmentioning

confidence: 99%

<p>Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative</p>

Hurley¹,

Wang²,

Rodríguez³

et al. 2020

PPA

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Background: Shared decision making (SDM) research has emphasized the role of decision aids (DAs) for helping patients make treatment decisions reflective of their preferences, yet there have been few collaborative multi-institutional efforts to integrate DAs in orthopedic consultations and primary care encounters. Objective: In the context of routine DA implementation for SDM, we investigate which patient-level characteristics are associated with patient preferences for surgery versus medical management before and after exposure to DAs. We explored whether DA implementation in primary care encounters was associated with greater shifts in patients' treatment preferences after exposure to DAs compared to DA implementation in orthopedic consultations. Design: Retrospective cohort study. Setting: 10 High Value Healthcare Collaborative (HVHC) health systems. Study participants: A total of 495 hip and 1343 adult knee osteoarthritis patients who were exposed to DAs within HVHC systems between July 2012 to June 2015. Results: Nearly 20% of knee patients and 17% of hip patients remained uncertain about their treatment preferences after viewing DAs. Older patients and patients with high pain levels had an increased preference for surgery. Older patients receiving DAs from three HVHC systems that transitioned DA implementation from orthopedics into primary care had lower odds of preferring surgery after DA exposure compared to older patients in seven HVHC systems that only implemented DAs for orthopedic consultations. Conclusion: Patients' treatment preferences were largely stable over time, highlighting that DAs for SDM largely do not necessarily shift preferences. DAs and SDM processes should be targeted at older adults and patients reporting high pain levels. Initiating treatment conversations in primary versus specialty care settings may also have important implications for engagement of patients in SDM via DAs.

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The High Value Healthcare Collaborative: Observational Analyses of Care Episodes for Hip and Knee Arthroplasty Surgery

Cited by 17 publications

References 21 publications

Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Episode-of-Care Characteristics and Costs for Hip and Knee Replacement Surgery in Hospitals Belonging to the High Value Healthcare Collaborative Compared With Similar Hospitals in the Same Health Care Markets

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

<p>Decision Aid Implementation and Patients’ Preferences for Hip and Knee Osteoarthritis Treatment: Insights from the High Value Healthcare Collaborative</p>

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