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. 2021 Dec 4;10(23):5700.
doi: 10.3390/jcm10235700.

Measuring Patient Value after Total Shoulder Arthroplasty

Alexandre Lädermann  1   2   3 , Rodolphe Eurin  4 , Axelle Alibert  4 , Mehdi Bensouda  4 , Hugo Bothorel  5
Affiliations

Measuring Patient Value after Total Shoulder Arthroplasty

Alexandre Lädermann et al. J Clin Med. .

Abstract

Evaluating the value of health care is of paramount importance to keep improving patients' quality of life and optimizing associated costs. Our objective was to present a calculation method based on Michael Porter's formula and standard references to estimate patient value delivered by total shoulder arthroplasty (TSA). We retrospectively reviewed the records of 116 consecutive TSAs performed between June 2015 and June 2019. Patient value was defined as quality of care divided by direct costs of surgery. Quality metrics included intra- and postoperative complications as well as weighted improvements in three different patient-reported outcome measures at a minimum of one-year follow-up. Direct costs of surgery were retrieved from the management accounting analyses. Substantial clinical benefit (SCB) thresholds and the standard reimbursement system were used as references for quality and cost dimensions. A multivariable linear regression was performed to identify factors associated with patient delivered value. Compared to a reference of 1.0, the quality of care delivered to patients was 1.3 ± 0.3 (range, 0.6-2.0) and the associated direct cost was 1.0 ± 0.2 (range, 0.7-1.6). Ninety patients (78%) had a quality of care ≥1.0 and 61 patients (53%) had direct costs related to surgery ≤1.0. The average value delivered to patients was 1.3 ± 0.4 (range, 0.5-2.5) with 91 patients (78%) ≥ 1.0, was higher for non-smokers (beta, 0.12; p = 0.044), anatomic TSA (beta, 0.53; p < 0.001), increased with higher pre-operative pain (beta, 0.08; p < 0.001) and lower pre-operative Constant score (beta, -0.06; p = 0.001). Our results revealed that almost 80% of TSAs provided substantial patient value. Patient pre-operative pain/function, tobacco use, and procedure type are important factors associated with delivered patient value.

Keywords: PROMs; VBHC; costs; patient reported outcome measures; patient value; quality; total shoulder arthroplasty; value-based health care.

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Conflict of interest statement

Lädermann reports that he is a paid consultant for Arthrex, Inc., Stryker and Medacta and receives royalties from Stryker. He is the founder of FORE foundation, Med4cast, and of BeeMed. Eurin, Alibert, Bensouda, and Bothorel declare no conflict of interest that could influence the representation or interpretation of reported research results.

Figures

Figure 1
Figure 1
Value dashboard.
Figure 2
Figure 2
Scatter plot illustrating cost versus quality measures with patient delivered value.
See this image and copyright information in PMC

References

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