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Appropriateness for Total Joint Replacement: Perspectives of Decision-Makers

BACKGROUND: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. OBJECTIV...

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Detalles Bibliográficos
Autores principales: Clavel, Nathalie, De coster, Carolyn, Pomey, Marie-Pascale, Sanmartin, Claudia, Bohm, Éric, Dunbar, Michael J., Frank, CY, Hawker, Gillian, Noseworthy, Tom
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Longwoods Publishing 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817968/
https://www.ncbi.nlm.nih.gov/pubmed/27027795
Descripción
Sumario:BACKGROUND: Improving access to total joint replacement (TJR) has been a priority. Without robust mechanisms to ensure appropriateness, these procedures may be overused, incurring substantial costs. In that context, decision-makers are particularly concerned with the appropriateness of TJR. OBJECTIVE: While our previous research focused on the appropriateness of TJR from clinical and patient perspectives, this study is aimed at understanding decision-makers' perspectives. METHODS: Using a semi-structured guide, we interviewed a convenience sample of decision-makers in four Canadian provinces (Alberta, Manitoba, Nova Scotia and Quebec) between February and March 2013. For the purposes of this study, a decision-maker was defined as a manager, institutional leader or policy maker. RESULTS: Fifteen interviews were conducted with decision-makers at ministry (n = 3), regional (n = 6) and institutional levels (n = 8). Decision-makers see themselves as having a key role in the appropriateness discourse, that of optimizing resource allocation and efficient delivery of services for TJR, to improve population outcomes. CONCLUSION: The decision-makers' view of appropriateness recognizes the importance of the clinical view, but it offers a very different input into the appropriateness discourse, more closely aligned with appropriateness of setting, which refers to cost-effectiveness considerations.