Value of Lifestyle Risk Factor Modification prior to joint replacement surgery
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Date
2022-04-20
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Johns Hopkins University
Abstract
Background: Healthcare providers in the United States are under pressure to improve quality and reduce growth in cost of care in order to provide greater value for healthcare spending. CMS has targeted high cost, high volume elective procedures like joint replacement surgery for cost control and quality improvement through initiatives like the Comprehensive Joint Replacement program which provides a bundled payment for hospital and physician services for the initial surgery and 90 days of post-operative care. This dissertation examines the value of Lifestyle Risk Factor Modification (LSRM) on the clinical and financial outcomes of joint replacement surgery at a large academic hospital in Baltimore, Maryland.
Methods: The dissertation begins with the background and significance of this topic. The first manuscript is a review of published literature to identify relevant work on this topic. Results of relevant studies were summarized and findings synthesized into a table of recommendations for lifestyle risk factors. The second manuscript explores the effect of the LSRM intervention on clinical outcomes like pain scores, length of stay, readmissions and joint revisions. The third manuscript looks at the value of the LSRM intervention on financial outcomes like cost of initial surgery/discharge and cost of 90 day episode of care. We end with a robust discussion regarding results of this study and implications for future research.
Results: This study found a statistically significant benefit for patients receiving the LSRM intervention on clinical outcomes like pain score and length of stay as well as financial outcomes like cost of discharge and cost of 90 day episode of care. The study did not find a statistically significant benefit related to 90 day readmission and 180 day joint revision for patients receiving the LSRM intervention, most likely due to study power.
Conclusion: This study suggests that the LSRM intervention has a beneficial effect on clinical and financial outcomes. There are several limitations to the study including a shift in care delivery to outpatient and ASC settings that began during the study period should be examined in future research. We should also explore how the LSRM intervention informs venue of care selection.
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Keywords
joint replacement, modifiable risk factors, pre operative optimization, value, financial outcomes, clinical outcomes, joint arthroplasty