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Decreasing the number of arthroscopies in knee osteoarthritis – a service evaluation of a de-implementation strategy
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Barlow, Timothy, Rhodes-Jones, Timothy, Ballinger, Sue, Metcalfe, Andrew J., Wright, David and Thompson, Peter (2020) Decreasing the number of arthroscopies in knee osteoarthritis – a service evaluation of a de-implementation strategy. BMC Musculoskeletal Disorders, 21 (1). 140. doi:10.1186/s12891-020-3125-8
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Official URL: http://dx.doi.org/10.1186/s12891-020-3125-8
Abstract
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.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RA Public aspects of medicine R Medicine > RC Internal medicine R Medicine > RD Surgery |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Clinical Trials Unit Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Osteoarthritis -- Treatment, Knee -- Wounds and injuries -- Treatment, Arthroscopy | ||||||
| Journal or Publication Title: | BMC Musculoskeletal Disorders | ||||||
| Publisher: | Biomed central | ||||||
| ISSN: | 1471-2474 | ||||||
| Official Date: | 3 March 2020 | ||||||
| Dates: |
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| Volume: | 21 | ||||||
| Number: | 1 | ||||||
| Article Number: | 140 | ||||||
| DOI: | 10.1186/s12891-020-3125-8 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| RIOXX Funder/Project Grant: |
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