A more comprehensive evaluation of quality of care after total hip and knee arthroplasty

combining 4 indicators in an ordered composite outcome

Journal article (2022)

Authors

Peter van Schie© Leiden University Medical Center
Leti Van Bodegom-Vos Leiden University Medical Center
Leti van Bodegom-Vos Leiden University Medical Center
Liza N. van Steenbergen Dutch Arthroplasty Register (LROI)
R.G.H.H. Nelissen Leiden University Medical Center
P.J. Marang-Van De Mheen Leiden University Medical Center
P.J. Marang-van De Mheen Leiden University Medical Center
P. J. Marang-Van De Mheen Leiden University Medical Center
P.J. Marang-van de Mheen Leiden University Medical Center
P. J. Marang-van De Mheen Leiden University Medical Center
Perla J. Marang-Van De Mheen Leiden University Medical Center
P. J. Marang-van de Mheen Leiden University Medical Center
Perla J. Marang-van de Mheen Leiden University Medical Center
Perla J. Marang-van De Mheen Leiden University Medical Center
Affiliation
External organisation
More Info
expand_more

Published Date

2022

Language

English

Reuse Rights

Other than for strictly personal use, it is not permitted to download, forward or distribute the text or part of it, without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license such as Creative Commons.

Affiliation

External organisation

Abstract

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.