scholarly journals Measuring Patient Value after Total Shoulder Arthroplasty

2021 ◽  
Vol 10 (23) ◽  
pp. 5700
Author(s):  
Alexandre Lädermann ◽  
Rodolphe Eurin ◽  
Axelle Alibert ◽  
Mehdi Bensouda ◽  
Hugo Bothorel
Keyword(s):  
Quality Of Care ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Direct Costs ◽  
Factors Associated ◽  
Patient Reported ◽  
Patient Value

Evaluating the value of health care is of paramount importance to keep improving patients’ quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter’s formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6–2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7–1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5–2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, −0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value.

Anatomic total shoulder arthroplasty in rheumatoid arthritis: A systematic review

2020 ◽  
pp. 175857322095415
Author(s):  
Ahmed Haleem ◽  
Ajaykumar Shanmugaraj ◽  
Nolan S. Horner ◽  
Timothy Leroux ◽  
Moin Khan ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Constant Score ◽  
Total Shoulder Arthroplasty ◽  
Significant Heterogeneity ◽  
Tissue Quality ◽  
Patient Reported ◽  
Clinically Significant ◽  
Reverse Total Shoulder

Purpose Given the poor soft-tissue quality in rheumatoid arthritis patients, many believe that rheumatoid arthritis should be treated with reverse total shoulder arthroplasty (rTSA). The purpose of this paper is to systematically assess outcomes of anatomic total shoulder arthroplasty (aTSA) in rheumatoid arthritis to determine if aTSA remains a viable option. Methods A comprehensive literature search was conducted identifying articles relevant to aTSA in the setting of rheumatoid arthritis with intact rotator cuff. Outcomes include clinical outcomes and rates of complication and revision. Results Ten studies were included with a total of 279 shoulders with mean follow-up of 116 ± 69 months. The mean age was 68 ± 10 years. Survivorship was 97%, 97% and 89% at 5, 10 and 20 years, respectively. The overall complication rate was 9%. Radiolucency was present in 69% of patients, of which 34% were at risk of loosening at 79 months. The overall rate of revision was 8.4%. Studies generally reported clinically significant improvements in range of motion, Constant score and ASES score. Conclusion aTSA in the rheumatoid patient results in improvements in range of motion and patient-reported outcomes. Rates of complications and survivorship are generally good in this population. However, it should be noted that there is significant heterogeneity in outcome reporting amongst the literature on this topic and that many studies fail to adequately report complication and revision rates. When compared to rTSA in patients with rheumatoid arthritis, evidence suggests that aTSA is still a viable treatment option despite the shift in utilization to rTSA.

Creation of a standardized set of patient-centered outcomes for advanced prostate cancer: An international effort.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 282-282
Author(s):  
Alicia Katherine Morgans ◽  
Annelotte van Bommel ◽  
Caleb Stowell ◽  
David F. Penson ◽  
Keyword(s):  
Prostate Cancer ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Clinical Data ◽  
Advanced Prostate Cancer ◽  
International Health ◽  
Bowel Dysfunction ◽  
Patient Reported Outcome Measures ◽  
Patient Reported

282 Background: Clinical trials and international registries assess outcomes considered relevant to men with advanced prostate cancer (CaP). However, we lack a single standardized set of outcomes, making direct comparisons between populations and quality of care assessments challenging. We sought to create a minimum standardized set of outcomes relevant to men with advanced CaP. Methods: The International Consortium for Health Outcomes Measurement assembled a multi-disciplinary working group to create a minimum set of measures to collect for men with advanced CaP. We used a modified Delphi method to establish pertinent measures and case-mix characteristics. Results: Approximately 24 experts, including clinicians and patient advocates, from North America, Europe, and Australia participated. We defined the included population as men with metastatic prostate cancer or biochemical recurrence who failed or were ineligible for salvage therapy. Outcomes important to all men with advanced CaP, such as overall survival, and measures specific to subgroups, such as time to metastasis, were identified. Measures gathered from clinical data include risk-stratification characteristics and measures of disease control. Patient-reported outcome measures, like pain control, depression, and erectile, urinary, and bowel dysfunction, were also identified. Conclusions: Standardized outcome measures are necessary to assess quality of care across different populations, and are critical to ensure value in health care. Our international, multi-disciplinary team identified clinical data and patient-reported outcomes to provide a basis for international health outcome comparisons and future assessments of quality of care for men with advanced CaP.

ASCO PRO workgroup update: Patient-reported outcome measures as a quality indicator.

2016 ◽  
Vol 34 (7_suppl) ◽  
pp. 276-276 ◽  
Author(s):  
Angela M. Stover ◽  
Anne C. Chiang ◽  
Ethan M. Basch
Keyword(s):  
Quality Of Care ◽  
Underserved Populations ◽  
Care Delivery ◽  
Symptom Control ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Validity And Reliability ◽  
Quality Metric ◽  
Patient Reported

276 Background: Although patient questionnaires are commonly used to assess healthcare experiences (e.g., satisfaction with care), patient-reported outcome (PRO) measures assessing symptoms and physical functioning have not conventionally been used for quality assessment. More typically, quality of care is measured with administrative data, such as hospital readmission rates. There is an opportunity to advance the science of quality measurement by integrating a patient-centered approach. Methods: ASCO established a multi-stakeholder PRO Workgroup (including extensive patient input) to develop and test PRO-based performance measures (PRO-PMs). The ASCO PRO Workgroup outlined three initial PRO-PMs to test for patients receiving moderately/highly emetogenic chemotherapy: 1) process: proportion self-reporting symptoms at, or within 2 weeks, of last visit; 2) outcome: proportion experiencing moderate/high levels of nausea; and 3) outcome: proportion reporting moderate/high pain. We will give an update on progress of the ASCO PRO Workgroup and outline next steps needed to implement PRO measures as a quality metric. Results: Three key methodological advancements are needed before PRO measures can be used as a quality metric. First, areas of cancer care delivery need to be identified that are important to patients when considering quality of care and are amenable to performance evaluation with PRO measures (e.g., symptom control). Second, existing PRO questionnaires need to be systematically identified and evaluated for potential quality use. The review should evaluate psychometric properties, validity and reliability, and feasibility for clinical use. Third, testing is needed in representative practice settings to iteratively refine: 1) logistical strategy for systematically collecting this information at the practice level; 2) approaches for minimizing missing data, particularly from underserved populations; and 3) adjustments for patient characteristics (case-mix). Conclusions: Methodological advancements are necessary before PRO measures can be implemented as a quality metric. PRO measures have the potential to provide quality assessments that are useful to patients making health care decisions.

scholarly journals Comparative Outcomes of Various Combinations of Bilateral Shoulder Arthroplasty

Hand ◽  
2019 ◽  
Vol 15 (5) ◽  
pp. 707-712 ◽  
Author(s):  
Jennifer Kurowicki ◽  
Jacob J. Triplet ◽  
Samuel Rosas ◽  
Derek D. Berglund ◽  
Brandon Horn ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
External Rotation ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Simple Shoulder Test ◽  
Patient Reported ◽  
And Function

Background: In the setting of bilateral shoulder arthroplasty (BSA), differences in functional outcomes and motion between anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) are unknown. The purpose of this study was to compare the effectiveness of treatment for various combinations of TSA procedures. Methods: A review of prospectively collected data from an institutional shoulder surgery repository was performed for patients who underwent any combination of bilateral TSA or RSA surgery. Based on the combination of shoulder arthroplasty, patients were divided into the following subgroups: bilateral TSA (TSA/TSA), bilateral RSA (RSA/RSA), or unilateral TSA with contralateral RSA (TSA/RSA). A total of 73 patients (146 shoulders), with a minimum of 2-year follow-up, who underwent any combination of bilateral TSA or RSA from 2007 to 2014 were included. Pre- and postoperative patient-reported outcome measures and measured motion were evaluated between the 3 groups. Results: There were 47 TSA/TSA, 17 RSA/RSA, and 9 TSA/RSA patients with a mean age of 72 years and mean follow-up of 51 months. Preoperatively, TSA/TSA had significantly higher Simple Shoulder Test scores, Visual Analog Scale (VAS) function, active elevation, and active external rotation compared with RSA/RSA. Postoperative scores were significantly superior in TSA/TSA compared with other combinations of shoulder arthroplasty except VAS pain and function. Change in pre- to postoperative (effectiveness of treatment) internal rotation was superior in the TSA/TSA group compared with RSA/RSA and TSA/RSA; however, no other differences were observed. Conclusions: Bilateral TSA patients have higher preoperative function and motion. Although some postoperative outcomes differ among combinations of BSA, the overall effectiveness of treatment for patients undergoing BSA is similar between various combinations of arthroplasty.

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