Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care.
J Shoulder Elbow Surg
; 31(1): 72-80, 2022 Jan.
Article
en En
| MEDLINE
| ID: mdl-34390841
ABSTRACT
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 (r2 = 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.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Manguito de los Rotadores
/
Lesiones del Manguito de los Rotadores
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
J Shoulder Elbow Surg
Asunto de la revista:
ORTOPEDIA
Año:
2022
Tipo del documento:
Article
País de afiliación:
Estados Unidos