Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Value Based Healthcare 13 articles


Shared Decision-making in Orthopaedic Surgery

James Slover MD, MS, Jennifer Shue BS, Karl Koenig MD, MS

The process of clinical decision-making and the patient-physician relationship continue to evolve. Increasing patient involvement in clinical decision-making is embodied in the concept of “shared decision-making” (SDM), in which the patient and physician share responsibility in the clinical decision-making process. Various patients’ decision aid tools have been developed to enhance this process.

Value-based Purchasing of Medical Devices

William T. Obremskey MD, MPH, Teresa Dail RN, BSN, A. Alex Jahangir MD

Health care in the United States is known for its continued innovation and production of new devices and techniques. While the intention of these devices is to improve the delivery and outcome of patient care, they do not always achieve this goal. As new technologies enter the market, hospitals and physicians must determine which of these new devices to incorporate into practice, and it is important these devices bring value to patient care. We provide a model of a physician-engaged process to decrease cost and increase review of physician preference items.

Value-based Care in the Management of Spinal Disorders: A Systematic Review of Cost-utility Analysis

Santoshi S. Indrakanti BS, Michael H. Weber MD, Steven K. Takemoto PhD, Serena S. Hu MD, David Polly MD, Sigurd H. Berven MD

Spinal disorders are a major cause of disability and compromise in health-related quality of life. The direct and indirect costs of treating spinal disorders are estimated at more than $100 billion per year. With limited resources, the cost-utility of interventions is important for allocating resources.

Using Financial Incentives to Improve Value in Orthopaedics

David Lansky PhD, Benedict U. Nwachukwu BA, Kevin J. Bozic MD, MBA

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs.

Does Age or Bilateral Disease Influence the Value of Hip Arthroplasty?

Bryan M. Lawless MD, Meridith Greene BA, James Slover MD, MS, Young-Min Kwon MD, PhD, Henrik Malchau MD, PhD

Measuring value in medicine is an increasingly important issue as healthcare spending continues to rise and cost containment becomes even more important. However, value assessments can be affected by patient factors and comorbidities.

The Use of Three Strategies to Improve Quality of Care at a National Level

Jeannette P. P. So MSc, James G. Wright MD, MPH, FRCSC

Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial.

Public Reporting of Cost and Quality Information in Orthopaedics

Youssra Marjoua MD, MPP, Craig A. Butler MD, MBA, Kevin J. Bozic MD, MBA

Public reporting of patient health outcomes offers the potential to incentivize quality improvement by fostering increased accountability among providers. Voluntary reporting of risk-adjusted outcomes in cardiac surgery, for example, is viewed as a “watershed event” in healthcare accountability. However, public reporting of outcomes, cost, and quality information in orthopaedic surgery remains limited by comparison, attributable in part to the lack of standard assessment methods and metrics, provider fear of inadequate adjustment of health outcomes for patient characteristics (risk adjustment), and historically weak market demand for this type of information.

Quality Indicators in Pediatric Orthopaedic Surgery: A Systematic Review

Angeliki Kennedy MSc, Christina Bakir MD, Carmen A. Brauer MD, MSc (Health Econ), FRCSC

The ability to measure health system quality has become a priority for governments, the private sector, and the public. Quality indicators (QIs) refer to clear, measurable items related to outcomes. The use of QIs can initiate local quality improvement and track changes in quality over time as interventions are implemented.

Care Experience-based Methodologies: Performance Improvement Roadmap to Value-driven Health Care

Anthony M. DiGioia MD, Pamela K. Greenhouse MBA

The literature contains proposals for creating value by creating exceptional patient experiences rather than simply improving services. However, few articles describe replicable applications focused on the patient experience.

Measuring the Value of Total Hip and Knee Arthroplasty: Considering Costs Over the Continuum of Care

Deborah A. Marshall PhD, Tracy Wasylak MSc, CHE, Hoa Khong MD, Robyn D. Parker BSc, Peter D. Faris PhD, Cy Frank MD FRCSC

Controlling escalating costs of hip (THA) and knee arthroplasty (TKA) without compromising quality of care has created the need for innovative system reorganization to inform sustainable solutions.

Is Hip Arthroscopy Cost-effective for Femoroacetabular Impingement?

David W. Shearer MD, MPH, Jonathan Kramer BS, Kevin J. Bozic MD, MBA, Brian T. Feeley MD

The impact of hip arthroscopy on health-related quality of life (HRQoL) among younger patients with symptomatic femoroacetabular impingement (FAI) is unknown, but with increasing recognition of the condition there is likely to be increasing demand for arthroscopy.

Drivers of Surgery for the Degenerative Hip, Knee, and Spine: A Systematic Review

S. Samuel Bederman MD, PhD, FRCSC, Charles D. Rosen MD, Nitin N. Bhatia MD, FACS, P. Douglas Kiester MD, Ranjan Gupta MD

Surgical treatment for degenerative conditions of the hip, knee, and spine has an impact on overall healthcare spending. Surgical rates have increased dramatically and considerable regional variation has been observed. The reasons behind these increasing rates and variation across regions have not been well elucidated.