Measuring Patient Value after Total Shoulder Arthroplasty.

Area of Science:

• Orthopedic Surgery
• Health Economics
• Value-Based Healthcare

Background:

• Healthcare value assessment is critical for improving patient quality of life and managing costs.
• Total shoulder arthroplasty (TSA) is a common procedure where value assessment is important.

Purpose of the Study:

• To develop and apply a method for estimating patient value in TSA using Michael Porter's formula.
• To identify factors influencing patient value delivered by TSA.

Main Methods:

• Retrospective review of 116 TSA cases (June 2015-June 2019).
• Patient value calculated as quality of care divided by direct surgical costs.
• Quality metrics included complications and patient-reported outcomes; costs from management accounting.
• Multivariable linear regression used to identify value-associated factors.

Main Results:

• Average quality of care was 1.3 ± 0.3; average direct cost was 1.0 ± 0.2 (reference=1.0).
• 78% of patients achieved a quality of care ≥1.0; 53% had costs ≤1.0.
• Average patient value was 1.3 ± 0.4, with 78% of patients achieving a value ≥1.0.
• Higher value associated with non-smokers, anatomic TSA, higher pre-operative pain, and lower pre-operative Constant score.

Conclusions:

• Nearly 80% of total shoulder arthroplasties provided substantial patient value.
• Patient pre-operative pain/function, smoking status, and type of TSA procedure significantly impact delivered patient value.