High variability in patient reported outcome utilization following hip fracture: a potential barrier to value-based care

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Nicholas Schraut ◽  
Jugert Bango ◽  
Alexandra Flaherty ◽  
Victoria Rossetti ◽  
Eric Swart
Keyword(s):  
Hip Fracture ◽  
Potential Barrier ◽  
Patient Reported Outcome ◽  
High Variability ◽  
Patient Reported ◽  
Value Based Care

scholarly journals Is arthroplaSty bEtter than interNal fixation for undiSplaced femoral nEck fracture? A national pragmatic RCT: the SENSE trial

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038442
Author(s):  
Bjarke Viberg ◽  
Søren Kold ◽  
Ole Brink ◽  
Morten Schultz Larsen ◽  
Kristoffer Borbjerg Hare ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Internal Fixation ◽  
Rating Scale ◽  
Patient Reported Outcome Measures ◽  
Primary Outcome Measure ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Posterior Tilt ◽  
Secondary Outcomes

IntroductionUndisplaced femoral neck fractures (FNFs) are usually treated by internal fixation (IF) but two randomised controlled trials (RCTs) have demonstrated advantages of treatment with arthroplasty. The complication rate was lowered but there were no clinically improved patient-reported outcome measures (PROM), which could be due to underpowering or choice of selected PROM as the studies do appear to report a better functional outcome. We will conduct an RCT comparing IF with arthroplasties in patients aged over 65 years with an undisplaced FNF.Methods and analysisAll hospitals in Denmark treating patients with hip fracture can provide patients for this study; therefore, the study can be considered a national RCT. Patients over 65 years old with an undisplaced FNF will be screened for eligibility and patients will only be excluded if they are unable to understand the study information (due to dementia or language), if they have a posterior tilt >20°, a pathological fracture or they cannot walk. Participants will be electronically randomised (in alternating blocks of 4 or 6) into either IF or arthroplasty. Postoperative care will follow the department standards.Primary and secondary outcomes and measuring points have been established in collaboration with patients with hip fracture by focus group interviews. The primary outcome measure is the New Mobility Score assessed after 1 year. Secondary outcomes are the Oxford Hip Score, EuroQol 5 domain (EQ-5D-5L), degree of posterior tilt, pain Verbal Rating Scale, reoperation and mortality.Ethics and disseminationThe study is approved by the Danish Data Protection Agency (19/7429) and the scientific ethics committee (S-20180036). All participants will sign an informed consent before entering the trial. Because this is a national trial, all relevant healthcare professionals in Denmark will automatically receive the trial results that will be published in international peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (NCT04075461).

scholarly journals Patient-reported outcome measures after hip fracture in patients with chronic cognitive impairment

2021 ◽  
Vol 2 (7) ◽  
pp. 454-465
Author(s):  
Malfrid H. Kristoffersen ◽  
Eva H. Dybvik ◽  
Ole M. Steihaug ◽  
Torbjørn B. Kristensen ◽  
Lars B. Engesæter ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Hip Fracture ◽  
Outcome Measures ◽  
Treatment Method ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
High Morbidity ◽  
Patient Reported ◽  
Five Dimension

Aims Hip fracture patients have high morbidity and mortality. Patient-reported outcome measures (PROMs) assess the quality of care of patients with hip fracture, including those with chronic cognitive impairment (CCI). Our aim was to compare PROMs from hip fracture patients with and without CCI, using the Norwegian Hip Fracture Register (NHFR). Methods PROM questionnaires at four months (n = 34,675) and 12 months (n = 24,510) after a hip fracture reported from 2005 to 2018 were analyzed. Pre-injury score was reported in the four-month questionnaire. The questionnaires included the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, and information about who completed the questionnaire. Results Of the 34,675 included patients, 5,643 (16%) had CCI. Patients with CCI were older (85 years vs 81 years) (p < 0.001), and had a higher American Society of Anesthesiologists (ASA) classification compared to patients without CCI. CCI was unrelated to fracture type and treatment method. EQ-5D index scores were lower in patients with CCI after four months (0.37 vs 0.60; p < 0.001) and 12 months (0.39 vs 0.64; p < 0.001). Patients with CCI had lower scores for all dimensions of the EQ-5D-3L pre-fracture and at four and 12 months. Conclusion Patients with CCI reported lower health-related quality of life pre-fracture, at four and 12 months after the hip fracture. PROM data from hip fracture patients with CCI are valuable in the assessment of treatment. Patients with CCI should be included in future studies. Cite this article: Bone Jt Open 2021;2(7):454–465.

scholarly journals Orthopaedic registries with patient-reported outcome measures

2019 ◽  
Vol 4 (6) ◽  
pp. 357-367 ◽  
Author(s):  
Ian Wilson ◽  
Eric Bohm ◽  
Anne Lübbeke ◽  
Stephen Lyman ◽  
Søren Overgaard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Medical Professional ◽  
Patient Reported ◽  
Measuring Outcomes ◽  
Total Knee ◽  
One Year ◽  
Value Based Care

Total joint arthroplasty is performed to decreased pain, restore function and productivity and improve quality of life. One-year implant survivorship following surgery is nearly 100%; however, self-reported satisfaction is 80% after total knee arthroplasty and 90% after total hip arthroplasty. Patient-reported outcomes (PROs) are produced by patients reporting on their own health status directly without interpretation from a surgeon or other medical professional; a PRO measure (PROM) is a tool, often a questionnaire, that measures different aspects of patient-related outcomes. Generic PROs are related to a patient’s general health and quality of life, whereas a specific PRO is focused on a particular disease, symptom or anatomical region. While revision surgery is the traditional endpoint of registries, it is blunt and likely insufficient as a measure of success; PROMs address this shortcoming by expanding beyond survival and measuring outcomes that are relevant to patients – relief of pain, restoration of function and improvement in quality of life. PROMs are increasing in use in many national and regional orthopaedic arthroplasty registries. PROMs data can provide important information on value-based care, support quality assurance and improvement initiatives, help refine surgical indications and may improve shared decision-making and surgical timing. There are several practical considerations that need to be considered when implementing PROMs collection, as the undertaking itself may be expensive, a burden to the patient, as well as being time and labour intensive. Cite this article: EFORT Open Rev 2019;4 DOI: 10.1302/2058-5241.4.180080

scholarly journals Incorporating Patient‐Reported Outcome Measures into Breast Surgical Oncology: Advancing Toward Value‐Based Care

2019 ◽  
Vol 25 (5) ◽  
pp. 384-390
Author(s):  
Mirelle Lagendijk ◽  
Elizabeth Mittendorf ◽  
Tari A. King ◽  
Christopher Gibbons ◽  
Andrea Pusic ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Surgical Oncology ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Value Based Care

scholarly journals Long-term Patient-reported Quality of Life and Pain After a Multidisciplinary Clinical Pathway for Elderly Patients With Hip Fracture: A Retrospective Comparative Cohort Study

2019 ◽  
Vol 10 ◽  
pp. 215145931984174 ◽  
Author(s):  
Pishtiwan H. S. Kalmet ◽  
Stijn G. C. J. de Joode ◽  
Audrey A. A. Fiddelers ◽  
Rene H. M. ten Broeke ◽  
Martijn Poeze ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cohort Study ◽  
Hip Fracture ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Hip Fractures ◽  
Patient Reported Outcome ◽  
Patient Reported

Introduction: There is an increase in incidence of hip fractures in the ageing population. The implementation of multidisciplinary clinical pathways (MCP) has proven to be effective in improving the care for these frail patients, and MCP tends to be more effective than usual care (UC). The aim of this study was to analyze potential differences in patient-reported outcome among elderly patients with hip fractures who followed MCP versus those who followed UC. Materials and Methods: This retrospective cohort study included patients aged 65 years or older with a low-energy hip fracture, who underwent surgery in the Maastricht University Medical Center, Maastricht, the Netherlands. Two cohorts were analyzed; the first one had patients who underwent UC in 2012 and the second one contained patients who followed MCP in 2015. Collected data regarded demographics, patient-reported outcomes (Short Form 12 [SF-12] and the Numeric Rating Scale [NRS] to measure pain), and patient outcome. Results: This cohort study included 398 patients, 182 of them were included in the MCP group and 216 were in the UC group. No differences in gender, age, or American Society of Anesthesiologists classification were found between the groups. No significant differences were found in SF-12 and the NRS data between the MCP group and UC group. In the MCP group, significantly lower rates of postoperative complications were found than in the UC group, but mortality within 30 days and one year after the hip fracture was similar in both groups. Discussion: Although the effects of hip fractures in the elderly on patient-reported outcome, pain and quality of life have been addressed in several recent studies, the effects of MCP on long-term outcome was unclear. Conclusion: A multidisciplinary clinical pathway approach for elderly patients with a hip fracture is associated with a reduced time to surgery and reduced postoperative complications, while no differences were found in quality of life, pain, or mortality.

scholarly journals Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients

Injury ◽  
2015 ◽  
Vol 46 (11) ◽  
pp. 2206-2211 ◽  
Author(s):  
Susanne Hansson ◽  
Ola Rolfson ◽  
Kristina Åkesson ◽  
Szilard Nemes ◽  
Olof Leonardsson ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Patient Reported Outcome ◽  
Patient Reported ◽  
Annual Cohort

scholarly journals A clinical review of robotic navigation in total knee arthroplasty: historical systems to modern design

2021 ◽  
Vol 6 (4) ◽  
pp. 252-269
Author(s):  
Ahmed Siddiqi ◽  
Timothy Horan ◽  
Robert M. Molloy ◽  
Michael R. Bloomfield ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Functional Outcomes ◽  
Cost Savings ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Significant Heterogeneity ◽  
Patient Reported ◽  
Total Knee ◽  
Value Based Care

Robotic-assisted total knee arthroplasty (RA-TKA) has shown improved reproducibility and precision in mechanical alignment restoration, with improvement in early functional outcomes and 90-day episode of care cost savings compared to conventional TKA in some studies. However, its value is still to be determined. Current studies of RA-TKA systems are limited by short-term follow-up and significant heterogeneity of the available systems. In today’s paradigm shift towards an increased emphasis on quality of care while curtailing costs, providing value-based care is the primary goal for healthcare systems and clinicians. As robotic technology continues to develop, longer-term studies evaluating implant survivorship and complications will determine whether the initial capital is offset by improved outcomes. Future studies will have to determine the value of RA-TKA based on longer-term survivorships, patient-reported outcome measures, functional outcomes, and patient satisfaction measures. Cite this article: EFORT Open Rev 2021;6:252-269. DOI: 10.1302/2058-5241.6.200071

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