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Published on: July 5, 2011
Procedure volume as a quality measure for total joint replacement
1Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Clinical and Experimental Rheumatology
|November 29, 2007
Summary
Procedure volume is a strong indicator of quality for total joint replacement, linked to better outcomes and patient satisfaction. However, its use in healthcare policy is limited due to a lack of understanding of underlying processes.
Area of Science:
- Health Services Research
- Orthopedic Surgery Outcomes
Background:
- Procedure volume has been linked to patient outcomes since the 1970s.
- Healthcare payers are increasingly using procedure volume data for policy development.
- Understanding procedure volume's role in quality is critical for healthcare policy.
Purpose of the Study:
- To evaluate procedure volume as a surrogate measure of healthcare quality.
- Specifically focusing on literature related to total joint replacement.
- Assessing procedure volume against validity, reliability, accessibility, and policy enactment capacity.
Main Methods:
- Systematic review of literature on procedure volume and total joint replacement outcomes.
- Analysis of procedure volume as a quality indicator based on four criteria.
- Examination of associations with mortality, complications, and patient satisfaction.
Main Results:
- Procedure volume is easily accessible and consistently associated with positive health outcomes in total joint replacement.
- Positive outcomes include lower mortality, dislocation, infection, and revision rates, with improved patient satisfaction.
- Reliability of volume assessments over time and the processes mediating volume-outcome relationships require further investigation.
Conclusions:
- Procedure volume is a valid, accessible quality indicator for total joint replacement, correlating with superior patient outcomes.
- Its major limitation is the difficulty in translating this data into actionable healthcare policies beyond regionalization.
- Further research is needed to identify causal pathways and optimize regionalization strategies without compromising access for vulnerable populations.
