Research - 16.10.2024 - 09:00
The replacement of hip and knee joints is one of the most frequently performed operations in most Western countries, including Germany and Switzerland. They are regarded as a key driver of national healthcare expenditure. Costs are incurred not only during the initial stay and operation, but also during the patient's follow-up care. In addition, poor treatment results lead to increased costs incurred by expensive revisions and repeat operations.
The use of patient-reported outcome measures (PROMs) serves, among other things, to monitor patients’ state of health after an operation. PROMs are standardized surveys. For example, they measure the patient’s health-related quality of life, the functionality of the hip or knee, as well as the level of pain or mental health. The information should help to better manage the patient’s follow-up care. Studies with cancer patients have already shown that PROMs improve treatment outcomes (survival, emergency admissions) and reduce healthcare costs (Basch et al. 2016, Lizée et al. 2019).
The use of PROMs is particularly suitable for “remote health monitoring” of patients following hip or knee replacement surgery. This is because there is usually a break in care between the surgeon and the doctor providing follow-up treatment. PROM-based monitoring makes it possible to intervene at an early stage in the event of undesirable treatment results and to make individualized therapy adjustments.
Various questionnaires were used for the Patient-Reported Outcome Measures (PROMs) to assess the following criteria:
The data was collected using the “Heartbeat ONE” software from Heartbeat Medical and processed in the participating clinics. The main results at a glance
Cost-effectiveness of the intervention 12 months after the operation:
Improvement in treatment results 12 months after surgery in almost all health dimensions:
Reduction in costs 12 months after the operation compared to standard care:
The project came to the conclusion that by anchoring the patient perspective more firmly within the process, more individualized treatment paths can be designed and resources can be used more efficiently. Practical implications for Switzerland can also be derived from the results in the German clinics:
The research project “PROMoting Quality” was awarded EUR 3.5. million from the German G-BA Innovation Fund. The authors of the study evaluated whether digital “remote health monitoring” using PROMs is cost-effective – i.e. improves treatment and reduces costs and visits to the doctor. The patients in the intervention group completed the surveys in months 1, 3 and 6 following the operation. They were contacted by their hospital in the event of any abnormalities in the recovery process.
The study, which was conducted in collaboration with the Chair of Health Economics, Policy and Management at the School of Medicine (Med-HSG) and the project consortium led by the Technical University of Berlin (TU Berlin), included information from 2,697 hip and 3,110 knee replacement patients from nine German hospitals between 2019 and 2020. In addition, the billing data from one year before to one year after the operation was added at patient level for around 20% of patients (insured by the BARMER and BKKen health insurance funds).
The project involves the School of Medicine (Med-HSG) at the University of St.Gallen and the consortium leader, the Technical University of Berlin (TU Berlin), the software manufacturer Heartbeat Medical, the health insurance companies BARMER and BKK Dachverband, the aQua Institute and the clinics Charité – Universitätsmedizin Berlin, Diakovere Annastift, Helios ENDO-Klinik Hamburg, Schoen Klinik Neustadt, Schoen Klinik Hamburg Eilbek, Sana Kliniken Berlin-Brandenburg, RoMed Kliniken Prien am Chiemsee, VAMED Ostseeklinik Damp and Waldkliniken Eisenberg.
The results of the project in the journal PLoS Medicine:
https://doi.org/10.1371/journal.pmed.1004459
Further studies as part of the project:
Main image: Adobe Stock / Toowongsa