Abstract

BackgroundThe number of total knee replacements (TKRs) and total hip replacements (THRs) has been increasing noticeably in high-income countries, such as Germany. In particular, the number of revisions is expected to rise because of higher life expectancy and procedures performed on younger patients, impacting the budgets of health-care systems. Quality transparency is the basis of holistic patient pathway optimization. Nevertheless, a nation-wide cross-sectoral assessment of quality from a patient perspective does not yet exist. Several studies have shown that the use of patient-reported outcome measures (PROMs) is effective for measuring quality and monitoring post-treatment recovery. For the first time in Germany, we test whether early detection of critical recovery paths using PROMs after TKR/THR improves the quality of care in a cost-effective way and can be recommended for implementation into standard care.Methods/designThe study is a two-arm multi-center patient-level randomized controlled trial. Patients from nine hospitals are included in the study. Patient-centered questionnaires are employed to regularly measure digitized PROMs of TKR/THR patients from the time of hospital admission until 12 months post-discharge. An expert consortium has defined PROM alert thresholds at 1, 3, and 6 months to signal critical recovery paths after TKR/THR. An algorithm alerts study assistants if patients are not recovering in line with expected recovery paths. The study assistants contact patients and their physicians to investigate and, if needed, adjust the post-treatment protocol. When sickness funds’ claims data are added, the cost-effectiveness of the intervention can be analyzed.DiscussionThe study is expected to deliver an important contribution to test PROMs as an intervention tool and examine the determinants of high-quality endoprosthetic care. Depending on a positive and cost-effective impact, the goal is to transfer the study design into standard care. During the trial design phase, several insights have been discovered, and there were opportunities for efficient digital monitoring limited by existing legacy care models. Digitalization in hospital processes and the implementation of digital tools still represent challenges for hospital personnel and patients. Furthermore, data privacy regulations and the separation between the in- and outpatient sector are roadblocks to effectively monitor and assess quality along the full patient pathway.Trial registrationGerman Clinical Trials Register: DRKS00019916. Registered November 26, 2019 – retrospectively registered.

Highlights

  • The number of total knee replacements (TKRs) and total hip replacements (THRs) has been increasing noticeably in high-income countries, such as Germany

  • In 2016, in Germany, there were more than 187,000 procedures (230 per 100,000 population) for TKRs – a 38% increase compared with 2006 – and 233,000 procedures (280 per 100,000 population) for THRs – a 17% increase compared with 2006 [1,2,3]

  • With the help of an algorithm, patients and post-treatment physicians are alerted to intervene in case of critical Patient-reported outcome measure (PROM) values

Read more

Summary

Introduction

The number of total knee replacements (TKRs) and total hip replacements (THRs) has been increasing noticeably in high-income countries, such as Germany. The number of revisions is expected to rise because of higher life expectancy and procedures performed on younger patients, impacting the budgets of health-care systems. Total knee replacements (TKRs) and total hip replacements (THRs) are among the most frequent and increasing surgeries in high-income countries, such as Germany They are considered to be effective and highly invasive procedures to treat osteoarthritis in the knee and hip. The number of primary as well as revision procedures is expected to rise steadily because of increased life expectancies and procedures performed on younger patients [2]. This development has a significant impact on the budgets of health-care systems. Measuring patient-reported quality helps to generate transparency, to evaluate treatments, and as a consequence to optimize patients’ pathways (indication, procedure, and recovery), leading to enlarged revision horizons and a decreased number of revisions [4]

Objectives
Methods
Findings
Conclusion
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call