scholarly journals Cost–DALY comparison of hip replacement care in 12 Belgian hospitals

2021 ◽  
Vol 10 (3) ◽  
pp. e001263
Author(s):  
Fabian Dehanne ◽  
Maximilien Gourdin ◽  
Brecht Devleesschauwer ◽  
Benoit Bihin ◽  
Philippe Van Wilder ◽  
...  
Keyword(s):  
Patient Safety ◽  
Hip Replacement ◽  
Case Mix ◽  
Patient Safety Indicators ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Case Mix Index ◽  
Replacement Treatment ◽  
Life Years ◽  
Patient’S Perception

BackgroundIn view of the expected increase in expenditure on hip replacement treatment in Belgium, the complication rate and potential waste reduction, as estimated by the Organisation for Economic Cooperation and Development, we are not yet in a position to assess the efficiency of hip replacement treatment in Belgian hospitals. This objective study uses a cost–disability-adjusted life years (DALYs) ratio to propose a comparison of hip replacement surgery among 12 Belgian hospitals.MethodsOur study seeks to innovate by proposing an interhospital comparison that simultaneously integrates the weighting of quality indicators and the costs of managing a patient. To this end, we associated a DALY impact with each patient safety indicator, readmission and mortality outcome. We then compared hospitals using both costs and DALYs adjusted to their case mix index. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model.ResultsWe registered a total of 246.5 DALYs for the 12 hospital institutions, the average cost (SD) of a stay being €8013 (€4304). Our model allowed us to identify hospitals with observed values higher than those predicted. Out of the 12 hospitals evaluated, 4 need to reduce costs and DALYs impacts, 6 have to improve one of the two factors and 2 appear to have good results. The costs for the worst performing hospitals can rise to over €150 000.ConclusionEvaluating the rates of patient safety indicators, associated with cost, is a prerequisite for quality and cost improvement efforts on the part of managers and practitioners. However, it appears essential to evaluate the entire care chain using a comparable unit of measurement. The hospital’s case mix index must also be considered in benchmarking to avoid drawing the wrong conclusions. In addition, other indicators, such as the patient’s perception of the actual results, should be added to our study.

scholarly journals Comparison Cost_Daly Of Hip Replacement Care In 12 Belgian Hospitals

2020 ◽  
Author(s):  
Fabian Dehanne ◽  
Maximilien Gourdin ◽  
Brecht Devleesschauwer ◽  
Benoit Bihin ◽  
Philippe Van Wilder ◽  
...  
Keyword(s):  
Complication Rate ◽  
Hip Replacement ◽  
Good Practice ◽  
Hospital Costs ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Replacement Treatment ◽  
Care Systems ◽  
Hospital Stays ◽  
Patient’S Perception

Abstract Background In view of the expected increase in expenditure on hip replacement treatment in Belgium [10], the complication rate [3] and the possible reduction in waste estimated by the OECD [1], we are not yet in a position to objectify the effectiveness of hip replacement treatment in Belgian hospitals. This objective study aims to propose a hospital comparison through the use of a cost-DALY ratio for hip replacement surgery among 12 Belgian hospitals. Methods In our study, the DALY calculation was applied at the hospital level for complications. Mortality was calculated on the basis of the Belgian mortality and life expectancy tables [15]. A DALY has been assigned to readmissions within 30 days. The costs of this study are the hospital costs of the PACHA hospital analysis. The adjusted values (costs and DALYs) were obtained by relating the observed value to the predicted value obtained from the linear regression model. Results We have 2,411 inpatients with an average age (Standard Deviation) of 69 years (13.5 years). The complication rate during hospital stays is estimated at 6.93% while the mortality rate is 1.20%. The average cost (SD) of a stay is €8,013 (€4,304). We have registered a total of 246.5 DALYs for the 12 hospital institutions in the study. Conclusion Other indicators should complete our study, including the patient's perception of the actual results experienced by the patient. Our analysis invites the authorities to create good practice guides for common diseases such as hip replacement surgery. Based on this first experience for the orthopaedic sector, we are convinced of the usefulness of our approach in evaluating the "cost-effectiveness" of other care systems.

scholarly journals Marital Relationship and Quality of Life in Couples Following Hip Replacement Surgery

Life ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. 401
Author(s):  
Michael Tanzer ◽  
Christopher Pedneault ◽  
Esther Yakobov ◽  
Adam Hart ◽  
Michael Sullivan
Keyword(s):  
Quality Of Life ◽  
Hip Replacement ◽  
Marital Relationship ◽  
Rating Score ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Before And After ◽  
Numerical Rating ◽  
Patient’S Perception

For the majority of patients with osteoarthritis, total hip (THA) arthroplasty results in a significant reduction in pain, emotional distress, and disability and a significant improvement in their quality of life. Little is known about how these recovery-related changes impact the spouse or the marital relationship. Methods: Twenty-nine couples whose spouse underwent a THA (29 THA) participated in a semi-structured retrospective interview designed for this study. They were each asked to recall the level of pain before and after surgery and to provide a numerical rating score for questions pertaining to the level of disability in seven different activities of daily living. Couples were also asked to list in order of importance the five ways in which the surgery affected their overall quality of life. Results: The spouses estimated their partner’s pain, both pre- and postoperatively, to be significantly higher level than the patient’s perception. The spouses perceived a greater improvement in family/home responsibilities, recreation and social activities, and in their occupation than that noted by the partner. After the arthroplasty, the spouses indicated that their lives had improved with respect to doing more activities/leisure (72%), because their partner had less suffering (59%), they had more independence/less caregiving (55%), it improved their marital relationship (52%), they had a better social/family life (28%), and they were able to travel (28%). Conclusions: This study indicates that THA result in a significant improvement in quality of life not only for the patients, but also for their spouses.

scholarly journals The effects of competition and bundled payment on patient reported outcome measures after hip replacement surgery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fanny Goude ◽  
Sverre A. C. Kittelsen ◽  
Henrik Malchau ◽  
Maziar Mohaddes ◽  
Clas Rehnberg
Keyword(s):  
Hip Replacement ◽  
Health Gain ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Economic Incentives ◽  
Bundled Payment ◽  
Treatment Groups ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Patient Reported

Abstract Background Competition-promoting reforms and economic incentives are increasingly being introduced worldwide to improve the performance of healthcare delivery. This study considers such a reform which was initiated in 2009 for elective hip replacement surgery in Stockholm, Sweden. The reform involved patient choice of provider, free establishment of new providers and a bundled payment model. The study aimed to examine its effects on hip replacement surgery quality as captured by patient reported outcome measures (PROMs) of health gain (as indicated by the EQ-5D index and a visual analogue scale (VAS)), pain reduction (VAS) and patient satisfaction (VAS) one and six years after the surgery. Methods Using patient-level data collected from multiple national registers, we applied a quasi-experimental research design. Data were collected for elective primary total hip replacements that were carried out between 2008 and 2012, and contain information on patient demography, the surgery and PROMs at baseline and at one- and six-years follow-up. In total, 36,627 observations were included in the analysis. First, entropy balancing was applied in order to reduce differences in observable characteristics between treatment groups. Second, difference-in-difference analyses were conducted to eliminate unobserved time-invariant differences between treatment groups and to estimate the causal treatment effects. Results The entropy balancing was successful in creating balance in all covariates between treatment groups. No significant effects of the reform were found on any of the included PROMs at one- and six-years follow-up. The sensitivity analyses showed that the results were robust. Conclusions Competition and bundled payment had no effects on the quality of hip replacement surgery as captured by post-surgery PROMs of health gain, pain reduction and patient satisfaction. The study provides important insights to the limited knowledge on the effects of competition and economic incentives on PROMs.

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