Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Keswani, Aakash; Koenig, Karl; Ward, Lorrayne; Bozic, Kevin J.

doi:10.1007/s11999-016-5064-0

Cited by 27 publications

(14 citation statements)

References 7 publications

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“…Meanwhile, radiographic templating showed good fit with a size-8 and size-7 femoral and tibial component, respectively radiographic templating has shown variable accuracy in predicting TKA component size [19][20][21]. Meanwhile, the concept of maximizing value in healthcare has grown with several studies examining methods of more efficient and affordable delivery of patient care [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Wallace

Murphy

Schiffman

et al. 2020

Knee Surg & Relat Res

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Background Preoperative radiographic templating for total knee arthroplasty (TKA) has been shown to be inaccurate. Patient demographic data, such as gender, height, weight, age, and race, may be more predictive of implanted component size in TKA. Materials and methods A multivariate linear regression model was designed to predict implanted femoral and tibial component size using demographic data along a consecutive series of 201 patients undergoing index TKA. Traditional, two-dimensional, radiographic templating was compared to demographic-based regression predictions on a prospective 181 consecutive patients undergoing index TKA in their ability to accurately predict intraoperative implanted sizes. Surgeons were blinded of any predictions. Results Patient gender, height, weight, age, and ethnicity/race were predictive of implanted TKA component size. The regression model more accurately predicted implanted component size compared to radiographically templated sizes for both the femoral (P = 0.04) and tibial (P < 0.01) components. The regression model exactly predicted femoral and tibial component sizes in 43.7 and 43.7% of cases, was within one size 90.1 and 95.6% of the time, and was within two sizes in every case. Radiographic templating exactly predicted 35.4 and 36.5% of cases, was within one size 86.2 and 85.1% of the time, and varied up to four sizes for both the femoral and tibial components. The regression model averaged within 0.66 and 0.61 sizes, versus 0.81 and 0.81 sizes for radiographic templating for femoral and tibial components. Conclusions A demographic-based regression model was created based on patient-specific demographic data to predict femoral and tibial TKA component sizes. In a prospective patient series, the regression model more accurately and precisely predicted implanted component sizes compared to radiographic templating. Level of evidence Prospective cohort, level II.

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Section: Discussionmentioning

confidence: 99%

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Wallace

Murphy

Schiffman

et al. 2020

Knee Surg & Relat Res

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“…A team approach forms the core component of the integrated care delivery systems that encompass an integrated practice unit model 18,19 . These contemporary models of care rely on combining the individual expertise of multidisciplinary team members who work synergistically, are collectively accountable for both costs and patientcentered health outcomes, and form decisions to deliver value to patients and populations served (Fig.…”

Section: Operative Treatmentsmentioning

confidence: 99%

Team Approach: A Multidisciplinary Approach to the Management of Hip and Knee Osteoarthritis

2019

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“…report on IPU development in orthopedics and mainly focus on design aspects and implementation barriers. 16 Organizational issues such as striving for comprehensive IPU’s versus the use of shared services with other pathways, technological issues such as a portal or application to register and provide automated feedback on Patient-Reported Outcome Measures (PROMs) and financing issues such as budget impact of aspects of care that are originally not within the coverage of the initial provider can hamper effective implementation. The latter could for instance be solved by bundled payments in which less restrictive rules are maintained considering the balance between inputs versus outcomes 17 ; however, a very recent review reported mixed results on guideline adherence and costs.…”

Section: Evidence On Added Value Of Integrated Practice Unitsmentioning

confidence: 99%

Turning teams and pathways into integrated practice units: Appearance characteristics and added value

van Harten

2018

International Journal of Care Coordination

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It has been 12 years after Porter and Teisberg published their landmark manuscript on “Redefining Health Care.” Apart from stressing the need for a fundamental change from fee-for-service to value or outcome-based financing and to a focus on reducing waste, they emphasized the need to work along patient pathways and in Integrated Practice Units to overcome function based and specialist group silos and promote working in multidisciplinary patient-oriented teams. Integrated Practice Units are defined as “organized around the patient and providing the full cycle of care for a medical condition, including patient education, engagement, and follow-up and encompass inpatient, outpatient and rehabilitative care as well as supporting services.” Although relatively few papers are published with empirical evidence on Integrated Practice Units development, some providers have impressively developed pathways and integrated care toward alignment with Integrated Practice Units criteria. From the field, we learn that possible advantages lay in improving patient centeredness, breaking through professional boundaries, and reducing waste in unnecessary duplications. A firm body of evidence on the added value of turning pathways into Integrated Practice Units is hard to find and this leaves room for much variation. Although intuitively attractive, this development requires staff efforts and costs and therefore cost-effectiveness and budget impact studies are much needed. Randomized controlled trials may be difficult to realize in organizational research, it is long known that turning to alternative designs such as larger case study series and before–after designs can be helpful. Thus, it can become clear what added value is achievable and how to reach that.

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Value-based Healthcare: Part 2—Addressing the Obstacles to Implementing Integrated Practice Units for the Management of Musculoskeletal Disease

Cited by 27 publications

References 7 publications

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Demographic data is more predictive of component size than digital radiographic templating in total knee arthroplasty

Team Approach: A Multidisciplinary Approach to the Management of Hip and Knee Osteoarthritis

Turning teams and pathways into integrated practice units: Appearance characteristics and added value

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