Adding Value in Knee Arthroplasty

The overall outcomes of TKR are favorable and the procedure is in general, cost effective at a macroeconomic level.  However, the value of specific care processes, especially during the transition from hospital to subsequent care, is uncertain. Many organizations (such as Partners HealthCare, which delivers substantial number of TKRs costing about $26 million/year) wish to create global care programs for TKR and other complex procedures. These programs need to identify and remedy aspects of the process of care that lead to fragmentation, suboptimal care and potentially, adverse outcomes. Analysis of the data gathered in this study will provide insight into factors related to improving the value of TKR.

The AViKA program is composed of three studies:

 

  1. AViKA Focus Group – a focus group-based study that ascertained what is important to patients who have recently undergone TKR.  We asked whether care-related processes could be improved and elicited suggestions for how to make these improvements.
  2. AViKA Observational Cohort – the backbone of AViKA is an observational study that rigorously followed a cohort of patients undergoing TKR at BWH.  We evaluated these patients pre- and post-operatively using questionnaires and a knee examination to assess the associations between a range of preoperative factors and functional outcomes of TKR.  Combining patient-reported data with clinical data and TKR costs will allow us to identify associations between costs and outcomes, such as:
    a. Factors that relate to higher than average TKR expenses
    b. Factors that relate to lower than average satisfaction with services
    c. Patterns that lead to complications or longer return to desirable function or satisfaction
  3. AVIKA Care Navigator Intervention – a proof of concept randomized controlled trial to examine the efficacy and cost-effectiveness of adding a “Care Navigator” to TKR rehabilitation protocol for primary TKR patients versus continued “Usual Care” treatment.  The enrollment period for this RCT concluded in November 2013, but follow-up is ongoing.

 

TKR patients of Drs. Wright, Thornhill, Brick, Martin and Ready were recruited into the AViKA studies.