The Dartmouth GreenCare Program: Implementation of Shared Decision Making and Patient-reported Outcomes in a Standardized Care Path for Knee Replacement
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 545
- 主要终点
- Health Gain as measured by the change in Physical Component Summary (PCS) Score
研究概览
简要总结
Evolving reimbursement policies are driving health systems to improve quality and efficiency. Transitioning to an electronic health record (EHR) provided Dartmouth-Hitchcock Medical Center (DHMC) an opportunity to redesign staff roles and care path for Total Knee Replacement (TKR). The organization implemented a coordinated team-based care delivery model that integrated real-time measurement of: (1) compliance with trusted guidelines, (2) process of Shared Decision-Making (SdM), and (3) use of Patient-Reported Outcomes (PROs). The investigators present the implementation protocol and data.
详细描述
Patient-reported outcome measures were completed 1 month preceding TKR and also at 1 and 12 months following surgery. The primary outcome was change in physical function from baseline to 1-year following surgery in the Physical Component Summary (PCS) of the Veterans-Rand (VR-12) Survey. Preoperative measures were: (1) general demographics (patient age, sex, height, weight, body mass index (BMI); (2) treatments tried before surgery; (3) health habits (tobacco use, alcohol use); (4) pre-existing medical conditions (Charlson score); (5) physical exam findings (knee range of motion, knee laxity); (7) lab tests (hemoglobin); and (7) radiographic measures (severity of osteoarthritis on standing x-rays). Secondary outcomes included Physical Score (PS) of the Patient Reported Outcome Measurement Information System Global Survey (PROMIS-10), knee function (Knee Osteoarthritis Outcome Score, KOOS), safety (reoperations, readmissions, emergency visits, and infection) and measures of patient experience (Clinician Group and Hospital Consumer Assessment of Healthcare Providers and Systems).
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Prospective
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Scheduled TKR
- •Osteoarthritis of the knee
排除标准
- •previous TKR on the affected knee
- •diagnosis other than osteoarthritis
- •age less than 18 years
- •declined consent
结局指标
主要结局
Health Gain as measured by the change in Physical Component Summary (PCS) Score
时间窗: 1-year following surgery
Health Gain from baseline to 12 months (from 300 to 400 days following the date) following surgery, as measured by the change in Physical Score based on standardized US adult population benchmarks for the VR12 survey
次要结局
- Health Gain as measured by the change in Global Physical Health (GPH)(1-year)
- Health Gain as measured by the change in Percentile Rank, TKR age and gender matched(1 year)
- Emotional Health(1 year)
- Reoperation(3 months)
- Readmission(3 months)
- Infection(3 months)
- Patient Satisfaction with Hospital(1 month)
- Cost of care(3 months)
- Mortality(1 year)
- Knee Osteoarthritis Outcome Score (KOOS)(1 year)
- ER visits after surgery(3 months)
- Patient Satisfaction with Surgeon(10 months)
- Length of hospital stay(Acute hospitalization)
- Discharge to home(Acute hospitalization)
- Range of motion(90 days)