Decreasing the number of arthroscopies in knee osteoarthritis - a service evaluation of a de-implementation strategy

被引:5
作者
Barlow, Timothy [1 ,2 ]
Rhodes-Jones, Timothy [1 ]
Ballinger, Sue [1 ]
Metcalfe, Andrew [1 ,2 ]
Wright, David [1 ]
Thompson, Peter [1 ]
机构
[1] Univ Hosp Coventry & Warwickshire, Clifford Bridge Rd, Coventry CV2 2DX, W Midlands, England
[2] Warwick Univ UHCW, Clin Sci Res Labs, Clifford Bridge Rd, Coventry CV2 2DX, W Midlands, England
关键词
Knee osteoarthritis; Conservative care; Arthroscopy; CONTROLLED-TRIAL; SURGERY; DESIGNS;
D O I
10.1186/s12891-020-3125-8
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background The Personalised Knee Improvement Programme (P-KIP) was developed based on previously published work, with the hypothesis that surgeons would refer patients to a well-structured conservative management intervention instead of for arthroscopy (de-implementation of arthroscopy by substitution with P-KIP). This meets NICE guidelines and international recommendations but such programmes are not widely used in the UK. Our aim was to determine whether P-KIP would reduce the number of arthroscopies performed for knee osteoarthritis. Methods P-KIP is a conservative care pathway including a group education session followed by individually tailored one-to-one dietician and physiotherapy sessions. Virtual clinic follow-up is conducted three to 6 months after completion of the programme. The service began in July 2015. The number of arthroscopies saved, measured from hospital level coding data, is the primary outcome measure. Interrupted time series analysis of coding data was conducted. As a quality assurance process, patient reported outcome measures (Oxford Knee Score; Euroqol 5D) were collected at baseline and at follow up. Results Time series analysis demonstrates that the programme saved 15.4 arthroscopies a month (95% confidence interval 9-21; p < 0.001), equating to 184 arthroscopies a year in a single hospital. The PROMs data demonstrated improvements in patient reported outcome scores consistent with previous published reports of conservative interventions in similar patient populations. Conclusions Results suggest that P-KIP reduces the number of arthroscopies performed, and patients who took part in P-KIP had an improvement in their knee and general health outcomes. P-KIP has the potential to deliver efficiency savings and relive pressure on operative lists, however replication in other sites is required.
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页数:8
相关论文
共 43 条
[1]   "Nudge" and the epidemic of missed appointments Can behavioural policies provide a solution for missed appointments in the health service? [J].
Aggarwal, Ajay ;
Davies, Joanna ;
Sullivan, Richard .
JOURNAL OF HEALTH ORGANIZATION AND MANAGEMENT, 2016, 30 (04) :558-564
[2]  
American Academy of Orthopaedic Surgeons, 2013, TREATM OST KNEE AAOS
[3]  
[Anonymous], 2014, DISCOVERING STAT USI
[4]  
[Anonymous], 2013, IBM SPSS STAT MAC VE
[5]  
[Anonymous], 2016, EQ 5D, V2016
[6]  
[Anonymous], 2016, NHS OUTC FRAM
[7]   Tailored interventions to address determinants of practice [J].
Baker, Richard ;
Camosso-Stefinovic, Janette ;
Gillies, Clare ;
Shaw, Elizabeth J. ;
Cheater, Francine ;
Flottorp, Signe ;
Robertson, Noelle ;
Wensing, Michel ;
Fiander, Michelle ;
Eccles, Martin P. ;
Godycki-Cwirko, Maciek ;
van Lieshout, Jan ;
Jaeger, Cornelia .
COCHRANE DATABASE OF SYSTEMATIC REVIEWS, 2015, (04)
[8]   Why we still perform arthroscopy in knee osteoarthritis: a multi-methods study [J].
Barlow, Timothy ;
Plant, Caroline Elizabeth .
BMC MUSCULOSKELETAL DISORDERS, 2015, 16
[9]  
Barlow T, 2015, ACTA ORTHOP BELG, V81, P1
[10]  
Briggs T, 2015, BRIT ORTHOPAEDIC ASS