TY - JOUR
T1 - A more comprehensive evaluation of quality of care after total hip and knee arthroplasty
T2 - combining 4 indicators in an ordered composite outcome
AU - VAN SCHIE, Peter
AU - VAN BODEGOM-VOS, Leti
AU - VAN STEENBERGEN, Liza N.
AU - Nelissen, Rob G.H.H.
AU - MARANG-VAN DE MHEEN, Perla J.
PY - 2022
Y1 - 2022
N2 - Background and purpose — Most arthroplasty registers give hospital-specific feedback on revision rates after total hip and knee arthroplasties (THA/TKA). However, due to the low number of events per hospital, multiple years of data are required to reliably detect worsening performance, and any single indicator provides only part of the quality of care delivered. Therefore, we developed an ordered composite outcome including revision, readmission, complications, and long length-of-stay (LOS) for a more comprehensive view on quality of care and assessed the ability to reliably differentiate between hospitals in their performance (rankability) with fewer years of data. Methods — All THA and TKA performed between 2017 and 2019 in 20 Dutch hospitals were included. All combi-nations of the 4 indicators were ranked from best to worst to create the ordinal composite outcome for THA and TKA separately. Between-hospital variation for the composite outcome was compared with individual indicators standard-ized for case-mix differences, and we calculated the statisti-cal rankability using fixed and random effects models. Results — 22,908 THA and 20,423 TKA were included. Between-hospital variation for the THA and TKA composite outcomes was larger when compared with revision, readmis-sion, and complications, and similar to long LOS. Rankabili-ties for the composite outcomes were above 80% even with 1 year of data, meaning that largely true hospital differences were detected rather than random variation. Interpretation — The ordinal composite outcome gives a more comprehensive overview of quality of delivered care and can reliably differentiate between hospitals in their performance using 1 year of data, thereby allowing earlier intro-duction of quality improvement initiatives.
AB - Background and purpose — Most arthroplasty registers give hospital-specific feedback on revision rates after total hip and knee arthroplasties (THA/TKA). However, due to the low number of events per hospital, multiple years of data are required to reliably detect worsening performance, and any single indicator provides only part of the quality of care delivered. Therefore, we developed an ordered composite outcome including revision, readmission, complications, and long length-of-stay (LOS) for a more comprehensive view on quality of care and assessed the ability to reliably differentiate between hospitals in their performance (rankability) with fewer years of data. Methods — All THA and TKA performed between 2017 and 2019 in 20 Dutch hospitals were included. All combi-nations of the 4 indicators were ranked from best to worst to create the ordinal composite outcome for THA and TKA separately. Between-hospital variation for the composite outcome was compared with individual indicators standard-ized for case-mix differences, and we calculated the statisti-cal rankability using fixed and random effects models. Results — 22,908 THA and 20,423 TKA were included. Between-hospital variation for the THA and TKA composite outcomes was larger when compared with revision, readmis-sion, and complications, and similar to long LOS. Rankabili-ties for the composite outcomes were above 80% even with 1 year of data, meaning that largely true hospital differences were detected rather than random variation. Interpretation — The ordinal composite outcome gives a more comprehensive overview of quality of delivered care and can reliably differentiate between hospitals in their performance using 1 year of data, thereby allowing earlier intro-duction of quality improvement initiatives.
UR - http://www.scopus.com/inward/record.url?scp=85123230286&partnerID=8YFLogxK
U2 - 10.2340/17453674.2021.861
DO - 10.2340/17453674.2021.861
M3 - Article
C2 - 34984484
AN - SCOPUS:85123230286
SN - 1745-3674
VL - 93
SP - 138
EP - 145
JO - Acta Orthopaedica
JF - Acta Orthopaedica
ER -