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Quality Measures in Total Hip and Total Knee Arthroplasty

Amanatullah, Derek F., MD, PhD; McQuillan, Thomas, MD; Kamal, Robin N., MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: March 15, 2019 - Volume 27 - Issue 6 - p 219–226
doi: 10.5435/JAAOS-D-17-00283
Research Article

Introduction: Total joint arthroplasty represents the largest expense for a single condition among Medicare beneficiaries. Payment models exist, such as bundled payments, where physicians and hospitals are reimbursed based on providing cost-efficient, high-quality care. There is a need to explicitly define “quality” relevant to hip and knee arthroplasty. Based on prior quality measure research, we hypothesized that less than 20% of developed quality measures are outcome measures.

Methods: This study systematically reviewed current and candidate quality measures relevant to total hip and knee arthroplasty using several quality measure databases and an Internet library search.

Results: We found a total of 35 quality measures and 81 candidate measures, most of which were process measures (N = 21, 60%), and represented the National Quality Strategy priorities of patient- and caregiver-centered experience and outcomes (31%), effective clinical care (28%), or patient safety (19%).

Conclusion: Various stakeholders have developed quality measures in total joint arthroplasty, with increasing focus on developing outcome measures. The results of this review inform orthopaedic surgeons on quality measures that payers could use value-based payment models like the Merit-based Incentive Payment System and Comprehensive Care for Joint Replacement.

Level of Evidence: Level I, systematic review of level I evidence

From the Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA (Dr. Amanatullah and Dr. Kamal), and Harvard Combined Orthopaedic Residency Program, Massachusetts General Hospital, Boston, MA (Dr. McQuillan).

Correspondence to Dr. Kamal: rnkamal@stanford.edu

Dr. Amanatullah or an immediate family member serves as a paid consultant to BlueJay Mobile Health, Exactech, Omni, Sanofi-Aventis, Stryker, and Zimmer Biomet; has received research or institutional support from Acumed, BlueJay Mobile Health, Stryker, and Zimmer Biomet; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. McQuillan and Dr. Kamal.

© 2019 by American Academy of Orthopaedic Surgeons
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