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A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

PURPOSE: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS: All p...

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Autores principales: Rietbergen, T., Marang-van de Mheen, P. J., de Graaf, J., Diercks, R. L., Janssen, R. P. A., van der Linden-van der Zwaag, H. M. J., van den Akker-van Marle, M. E., Steyerberg, E. W., Nelissen, R. G. H. H., van Bodegom-Vos, L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668785/
https://www.ncbi.nlm.nih.gov/pubmed/35391552
http://dx.doi.org/10.1007/s00167-022-06949-w
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author Rietbergen, T.
Marang-van de Mheen, P. J.
de Graaf, J.
Diercks, R. L.
Janssen, R. P. A.
van der Linden-van der Zwaag, H. M. J.
van den Akker-van Marle, M. E.
Steyerberg, E. W.
Nelissen, R. G. H. H.
van Bodegom-Vos, L.
author_facet Rietbergen, T.
Marang-van de Mheen, P. J.
de Graaf, J.
Diercks, R. L.
Janssen, R. P. A.
van der Linden-van der Zwaag, H. M. J.
van den Akker-van Marle, M. E.
Steyerberg, E. W.
Nelissen, R. G. H. H.
van Bodegom-Vos, L.
author_sort Rietbergen, T.
collection PubMed
description PURPOSE: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β =  − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β =  − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β =  − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE: III.
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spelling pubmed-96687852022-11-18 A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis Rietbergen, T. Marang-van de Mheen, P. J. de Graaf, J. Diercks, R. L. Janssen, R. P. A. van der Linden-van der Zwaag, H. M. J. van den Akker-van Marle, M. E. Steyerberg, E. W. Nelissen, R. G. H. H. van Bodegom-Vos, L. Knee Surg Sports Traumatol Arthrosc Knee PURPOSE: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). METHODS: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. RESULTS: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β =  − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β =  − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β =  − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). CONCLUSIONS: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. LEVEL OF EVIDENCE: III. Springer Berlin Heidelberg 2022-04-07 2022 /pmc/articles/PMC9668785/ /pubmed/35391552 http://dx.doi.org/10.1007/s00167-022-06949-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Knee
Rietbergen, T.
Marang-van de Mheen, P. J.
de Graaf, J.
Diercks, R. L.
Janssen, R. P. A.
van der Linden-van der Zwaag, H. M. J.
van den Akker-van Marle, M. E.
Steyerberg, E. W.
Nelissen, R. G. H. H.
van Bodegom-Vos, L.
A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title_full A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title_fullStr A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title_full_unstemmed A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title_short A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
title_sort tailored intervention does not reduce low value mri’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis
topic Knee
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9668785/
https://www.ncbi.nlm.nih.gov/pubmed/35391552
http://dx.doi.org/10.1007/s00167-022-06949-w
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