Patient-Centered, Multidisciplinary Collaboration with Orthopedic Surgeons Can Dramatically Improve Joint Replacement Quality Metrics and Value-Based Care

Introduction: Total joint arthroplasty is an effective treatment for advanced arthritis but is associated with pain, prolonged recovery, and both high cost and high utilization. To improve care value (improve outcomes and reduce cost), we established a collaborative partnership in the form of a pati...

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Bibliographic Details
Published in:Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.654
Main Authors: Boezaart, Andre P, Gray, Chancellor F, Deen, Justin T, Smith, Cameron R, Kantamneni, Sowmya, Prieto, Hernan, Parvataneni, Hari K
Format: Article
Language:English
Subjects:
Care and treatment
Complications and side effects
Joint replacement
Medical cooperation
Medical protocols
Methods
Pain, Postoperative
Postoperative care
Quality management
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Summary:Introduction: Total joint arthroplasty is an effective treatment for advanced arthritis but is associated with pain, prolonged recovery, and both high cost and high utilization. To improve care value (improve outcomes and reduce cost), we established a collaborative partnership in the form of a patient- and family-centered care model between the acute pain service and orthopedic surgeon teams, in addition to other total joint arthroplasty episode stakeholders. Among the main goals were to improve early mobilization and pain control to facilitate early home discharge and improved patient experience, ultimately leading to lower episode cost and improved value. Methods: A redesign of the arthroplasty pathway was undertaken in 2016, using the patient- and family-centered care model. Surgeons and the acute pain service met monthly to review data and perform iterative improvements. Data for the year leading up to the redesign were compared with data for the two years after the redesign. Primary outcomes were length of stay, discharge rate to a post-acute care facility, and episode of care cost. Results: Volume increased by 21% annually, from 696 patients (pre-redesign) to 1,689 in the two years after the redesign. Length of stay declined from 3.58 to 2.05 days. Utilization of a post-acute care facility declined from 32% to 13%. Ninety-day episode of care cost for the Medicare patients declined by 22%. All patients received continuous peripheral nerve blocks as part of multimodal analgesia. Conclusion: A close multistakeholder collaboration can lead to dramatic improvements in total joint arthroplasty quality metrics by focusing on patient experience, notably pain control, enhancement of early mobility, and ability for home discharge.
ISSN:1526-2375