Source: Stryker Instance
Total joint arthroplasties (TJA) have been shown to be highly safe and cost-effective procedures for patients with end-stage arthritis, which causes continuous pain, difficulties in functioning, and impaired quality of life.1,2 With nearly one million TJAs performed in the United States annually—and the number projected to triple by 2030—bundled payment models and other value-based measures are increasingly focused on containing costs and optimizing quality throughout the entire episode of care, including post-discharge.1,3 An integral aspect of these value-based measures is patient-centered care; a key component of the Triple Aims of Health Care Reform, which include improving the patient experience of care, improving the health of populations, and reducing the per capita cost of health care.4 While evidence-based guidelines developed by organizations such as the American Academy of Orthopaedic Surgeons (AAOS) focus on specific standards of care for improving TJA safety, including venous thromboembolism (VTE) prophylaxis and surgical site infection prevention, there is wide variation in adherence to patient-centered pathways.3 Yet, such programs have been shown to improve patient satisfaction, shorten lengths of stay (LOS) and/or discharges, and promote more rapid rehabilitation and recovery in total knee arthroplasty (TKAs).5 In addition, comprehensive, patient-centered pathways and programs are well positioned to integrate the latest advances in surgical and communication technologies in order to further enhance the delivery of safe, effective, and efficient care in TJA procedures.3
Based on a 2014 multistakeholder study on developing a generalizable clinical care pathway for TJA, as well as other studies of care pathways in TKA, best practices in pathway design includes processes that are organized by:
1. The preoperative surgical visit; 2. Preparation and planning for surgery; 3. Hospital/surgical center admission through discharge; 4. Post-discharge care.3
These practices and processes can be applied across the continuum of care in TJA, based on principles of patient-centered care that include:
– Reduce opioid usage
– Improve pain scores
– Increase patient satisfaction
– Enhance early recovery
– Facilitate earlier discharge6
As value-based payment models continue to dominate the reimbursement landscape, many orthopedic practices and health systems are becoming more actively involved in testing and adopting patient-centered care initiatives to improve the delivery of high-value care.3 At the same time, as the pace of orthopaedic technology continues to advance, orthopedic surgeons are further tasked with incorporating new technologies into surgical practice while ensuring that are they delivering measurable value for their patients.2 Research has shown that patient-centered care, particularly the relationship between the patient, physician, and care team in ongoing engagement, communication, and shared decision-making, can impact treatment outcomes and lead to greater patient satisfaction.7 In fact, numerous studies have reported growing patient satisfaction following TKR, highlighting patient satisfaction as an important outcome measure in TKA that is most likely closely associated with patient-centered care and value-based initiatives.8
This material and/or presentation is provided for guidance and/or illustrative purposes only and should not be construed as a guarantee of future results or a substitution for legal advice and/or medical advice from a healthcare provider. Stryker Performance Solutions does not practice medicine and assumes no responsibility for the administration of patient care.
©2019 Stryker Performance Solutions, LLC.