Blog | Friday, May 11, 2012

QD: News Every Day--Involving internists in knee surgery teams reduced complications


A consortium of leading U.S. health care systems found that managing knee surgery patients with comorbidities with medical teams that included internal medicine specialists among their ranks resulted in improved care.

The High Value Healthcare Collaborative (the Cleveland Clinic, Denver Health, Dartmouth-Hitchcock Medical Center, the Dartmouth Institute for Health Policy and Clinical Practice, Intermountain Healthcare, and Mayo Clinic) used administrative data to examine differences in their delivery of primary total knee replacement. The goal was to identify ways to improve care and cut costs, and tested more coordinated management for medically complex patients.

In the entire sample of total knee replacement patients, 45.6% were ages 45 to 64, and 59.7% were female. Almost 90% of patients were classified as overweight, obese or morbidly obese. The majority of patients had a Charlson score of 0.

Results appeared in Health Affairs. The study authors identified three key findings, including that the one health system with the lowest in-hospital complication rate had brought together patients with a multispecialty team prior to the surgery, including members from anesthesiology and internal medicine to co-manage medically complex patients.

Not surprisingly, other factors included facilities where experienced surgeons and other medical caregivers had the fastest operating times and shortest patient stays. Also, involving patients in their discharge planning process and managing patient expectations resulted in shorter hospitalizations.

"Because our initial analyses confirmed the relationship between greater comorbidity and higher inpatient complication rates, we anticipate that more coordinated management of medically complex patients should reduce complication rates and total knee replacement costs across the participating systems," the authors wrote.