Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT; Tufts University School of Medicine, Boston, MA.
Department of Orthopaedics, Geisel School of Medicine, Hanover, NH.
J Arthroplasty. 2020 Apr;35(4):918-925.e7. doi: 10.1016/j.arth.2019.11.028. Epub 2019 Nov 26.
Patient-reported outcomes are essential to demonstrate the value of hip and knee arthroplasty, a common target for payment reforms. We compare patient-reported global and condition-specific outcomes after hip and knee arthroplasty based on hospital participation in Medicare's bundled payment programs.
We performed a prospective observational study using the Comparative Effectiveness of Pulmonary Embolism Prevention after Hip and Knee Replacement trial. Differences in patient-reported outcomes through 6 months were compared between bundle and nonbundle hospitals using mixed-effects regression, controlling for baseline patient characteristics. Outcomes were the brief Knee Injury and Osteoarthritis Outcomes Score or the brief Hip Disability and Osteoarthritis Outcomes Score, the Patient-Reported Outcomes Measurement Information System Physical Health Score, and the Numeric Pain Rating Scale, measures of joint function, overall health, and pain, respectively.
Relative to nonbundled hospitals, arthroplasty patients at bundled hospitals had slightly lower improvement in Knee Injury and Osteoarthritis Outcomes Score (-1.8 point relative difference at 6 months; 95% confidence interval -3.2 to -0.4; P = .011) and Hip Disability and Osteoarthritis Outcomes Score (-2.3 point relative difference at 6 months; 95% confidence interval -4.0 to -0.5; P = .010). However, these effects were small, and the proportions of patients who achieved a minimum clinically important difference were similar. Preoperative to postoperative change in the Patient-Reported Outcomes Measurement Information System Physical Health Score and Numeric Pain Rating Scale demonstrated a similar pattern of slightly worse outcomes at bundled hospitals with similar rates of achieving a minimum clinically important difference.
Patients receiving care at hospitals participating in Medicare's bundled payment programs do not have meaningfully worse improvements in patient-reported measures of function, health, or pain after hip or knee arthroplasty.
患者报告的结果对于展示髋关节和膝关节置换术的价值至关重要，而髋关节和膝关节置换术是支付改革的常见目标。我们比较了髋关节和膝关节置换术后基于医院参与医疗保险捆绑支付计划的患者报告的总体和特定疾病结果。
我们使用髋关节和膝关节置换术后肺栓塞预防的比较有效性试验进行了一项前瞻性观察研究。使用混合效应回归，在控制基线患者特征的情况下，比较了捆绑和非捆绑医院在 6 个月时患者报告的结果差异。结果是简短的膝关节损伤和骨关节炎结果评分或简短的髋关节残疾和骨关节炎结果评分、患者报告的结果测量信息系统身体健康评分和数字疼痛评分量表，分别衡量关节功能、整体健康和疼痛。
与非捆绑医院相比，捆绑医院的关节置换患者在膝关节损伤和骨关节炎结果评分方面的改善略低（6 个月时的相对差异为 1.8 分；95%置信区间为 -3.2 至 -0.4；P =.011）和髋关节残疾和骨关节炎结果评分（6 个月时的相对差异为 2.3 分；95%置信区间为 -4.0 至 -0.5；P =.010）。然而，这些影响很小，达到最小临床重要差异的患者比例相似。患者报告的结果测量信息系统身体健康评分和数字疼痛评分量表的术前到术后变化呈现出类似的模式，即在捆绑医院的结果略差，但达到最小临床重要差异的比例相似。
在医疗保险捆绑支付计划参与医院接受治疗的患者在髋关节或膝关节置换术后，在患者报告的功能、健康或疼痛改善方面没有明显更差的改善。
