Miller Kathryn A, Baier Manwell Linda M, Bartels Christie M, Yu Tommy Yue, Vundamati Divya, Foertsch Marley, Brown Roger L
Division of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
UW Health, University of Wisconsin-Madison, Madison, WI, USA.
Osteoarthr Cartil Open. 2024 Mar 6;6(2):100452. doi: 10.1016/j.ocarto.2024.100452. eCollection 2024 Jun.
Assess implementation feasibility and outcomes for an Osteoarthritis Management Program (OAMP) at an academic center.
This open study assessed an OAMP designed to deliver care in 1-5 individual or group visits across ≤12 months. Eligibility included adults with knee or hip osteoarthritis with ≥1 visit from 7/1/2017-1/15/2021. A multidisciplinary care team provided: education on osteoarthritis, self-management, exercise, weight loss; pharmacologic management; assessments of mood, sleep, quality of life, and diet. Clinic utilization and growth are reported through 2022. Patient outcomes of body mass index (BMI), pain, and function were analyzed using multivariable general linear models. OAMP outcomes were feasibility and sustainability.
Most patients were locally referred by primary care. 953 patients attended 2531 visits (average visits 2.16, treatment duration 187.9 days). Most were female (72.6%), older (62.1), white (91.1%), and had medical insurance (95.4%). Obesity was prevalent (84.7% BMI ≥30, average BMI 40.9), mean Charlson Comorbidity Index was 1.89, and functional testing was below average. Longitudinal modeling revealed statistically but not clinically significant pain reduction (4.4-3.9 on 0-10 scale, p = 0.002). BMI did not significantly change (p = 0.87). Higher baseline pain and BMI correlated with greater reductions in each posttreatment. Uninsured patients had shorter treatment duration. Increasing clinic hours (4-24 h weekly) and serving 953 patients over four years demonstrated OAMP sustainability.
OAMP implementation was feasible and sustainable. Patients with high baseline pain and BMI were more likely to improve. Noninsurance was a barrier. These results contribute to understanding OAMP outcomes in U.S. healthcare.
评估某学术中心骨关节炎管理项目（OAMP）的实施可行性及效果。
本开放性研究对一个旨在在≤12个月内通过1 - 5次个体或小组就诊提供护理的OAMP进行了评估。入选标准包括2017年7月1日至2021年1月15日期间有≥1次就诊记录的膝或髋骨关节炎成人患者。一个多学科护理团队提供：骨关节炎教育、自我管理、运动、体重减轻方面的指导；药物管理；情绪、睡眠、生活质量和饮食评估。报告了截至2022年的诊所利用率和发展情况。使用多变量一般线性模型分析体重指数（BMI）、疼痛和功能等患者结局。OAMP的结局指标为可行性和可持续性。
大多数患者由初级保健机构转诊至本地。953名患者就诊2531次（平均就诊2.16次，治疗时长187.9天）。大多数为女性（72.6%），年龄较大（62.1岁），白人（91.1%），且有医疗保险（95.4%）。肥胖情况普遍（84.7%的BMI≥30，平均BMI为40.9），平均查尔森合并症指数为1.89，功能测试低于平均水平。纵向模型显示疼痛有统计学意义但无临床显著减轻（0 - 10分制从4.4降至3.9，p = 0.002）。BMI无显著变化（p = 0.87）。更高的基线疼痛和BMI与每次治疗后更大程度的减轻相关。未参保患者的治疗时长较短。每周将诊所用时从4小时增加到24小时，并在四年内为953名患者提供服务，证明了OAMP的可持续性。
OAMP的实施是可行且可持续的。基线疼痛和BMI较高的患者更有可能改善。未参保是一个障碍。这些结果有助于了解美国医疗保健中OAMP的效果。
