期刊
JOURNAL OF SHOULDER AND ELBOW SURGERY
卷 31, 期 1, 页码 72-80出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jse.2021.07.004
关键词
Value; rotator cuff repair; patient-level value analysis; time-driven activity-base cost; patient-reported outcome measures; episode of care
Rotator cuff repair (RCR) is a common orthopedic procedure, with specific types of tears potentially producing the highest value coefficient. While the correlation between cost and patient outcomes is limited, there is significant value variation among providers.
Background: Rotator cuff repair (RCR) is one of the most common elective orthopedic procedures, with predictable indications, techniques, and outcomes. As a result, this surgical procedure is an ideal choice for studying value. The purpose of this study was to perform patient-level value analysis (PLVA) within the setting of RCR over the 1-year episode of care. Methods: Included patients (N = 396) underwent RCR between 2009 and 2016 at a single outpatient orthopedic surgery center. The episode of care was defined as 1-year following surgery. The Western Ontario Rotator Cuff index was collected at both the initial preoperative baseline assessment and the 1-year postoperative mark. The total cost of care was determined using time-driven activity-based costing (TDABC). Both PLVA and provider-level value analysis were performed. Results: The average TDABC cost of care was derived at $5413.78 +/- $727.41 (95% confidence interval, $5341.92-$5485.64). At the patient level, arthroscopic isolated supraspinatus tears yielded the highest value coefficient (0.82; analysis-of-variance F test, P = .01). There was a poor correlation between the change in the 1-year Western Ontario Rotator Cuff score and the TDABC cost of care (r(2) = 0.03). Provider-level value analysis demonstrated significant variation between the 8 providers evaluated (P < .01). Conclusion: RCR is one of the most common orthopedic procedures, yet the correlations between cost of care and patient outcomes are unknown. PLVA quantifies the ratio of functional improvement to the TDABC-estimated cost of care at the patient level. This is the first study to apply PLVA over the first-year episode of care. With health care transitioning toward value-based delivery, PLVA offers a quantitative tool to measure the value of individual patient care delivery over the entire episode of care. (C) 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.
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