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· DOS Abstracts
Implementation of value-based healthcare in elective
total hipreplacement at Sahlgrenska University
Hospital
Erik Malchau, Ola Rolfson, Magnus Karlsson, Adina Welander, Peter Grant,
Maziar Mohaddes
Department of Orthopaedics, Sahlgrenska University Hospital; Department of
Orthopaedics, Sahlgrenska University Hospital; Department of Orthopaedics,
Sahlgrenska University Hospital; , Boston Consulting Group; Department of
Orthopaedics, Sahlgrenska University Hospital; Department of Orthopaedics,
Sahlgrenska University Hospital
Background:
During the last decade the annual numbers of primary total hip
replacements (THR) have increased by 30% in Sweden. The statutory health
care guarantee stipulates the patient a right to treatment within 90 days. The
public health system has had difficulties meeting the increasing demand, result-
ing in an emerging market of private providers of THR. In mid 2012, we initi-
ated a systematic review of the care processes in elective THR at Sahlgrenska
University Hospital’s (SU) joint replacement unit. As part of this effort, value-
based healthcare (VBHC) management was introduced in our unit in late 2013.
Purpose / Aim of Study:
To improve quality of care and availability to treat-
ment for patients in need of THR.
Materials and Methods:
Starting in mid 2012, THR care processes were grad-
ually overhauled according to the Fast Track concept. A multiprofessional work-
group involved in the treatment of THR patient was assembled. The first step
was to identify which outcomes to monitor. Outcomes were subcategorized
into three groups: 1) clinical outcomes reported to the Swedish Hip Arthroplasty
Register and local databases 2) cost & resource utilization measures and 3) pro-
cess measures. Available data were analyzed and areas of improvement were
identified.
Findings / Results:
During years 2011-2015 the number of elective THRs in-
creased from 317 to 498. The cost per patient decreased from SEK 75,000 to
65,000. Length of stay decreased from mean 6.4 days to 3.2 days. Satisfaction
with the outcome of surgery one year after THA increased from 76% to 88%.
Adverse events decreased from 28% to 10%. Re-operations within 2 years de-
creased from 2,4% to 1,8%.
Conclusions:
Value-based healthcare management and a systematic approach
to review THR care processes have contributed to improved quality of care and
availability of treatment whilst decreasing cost per patient.
Conflict of Interest
Adina Welander: Project Leader at Boston Consulting Group
67.