Musculoskeletal Quality Collaborative improves value-based health care delivery across hospital system

Area of Science:

• Orthopedic surgery
• Healthcare management
• Value-based healthcare

Background:

• Rising healthcare costs necessitate value-based healthcare (VBHC) initiatives.
• Large hospital systems can facilitate surgeon collaboration for standardized orthopedic care.
• The Musculoskeletal Quality Collaborative (MSKQC) was formed to address these challenges.

Purpose of the Study:

• To evaluate the formation, implementation, and outcomes of the MSKQC.
• To assess the impact of standardized protocols on consumable use and infection rates.
• To demonstrate a scalable model for orthopedic VBHC.

Main Methods:

• The MSKQC, established in 2019, includes leaders from 14 hospitals.
• The Delphi method was used to identify VBHC interventions, leading to protocols for antibiotic-infused bone cement (AIBC), povidone-iodine irrigation, and negative pressure wound therapy (NPWT) dressings.
• Usage data was tracked quarterly from June 2023 to June 2024, with standardized infection ratios (SIRs) for total hip and total knee arthroplasty calculated against National Healthcare Safety Network (NHSN) baselines.

Main Results:

• Systemwide annual savings exceeded $800,000.
• Antibiotic-infused bone cement (AIBC) use decreased from 19.6% to 5.5%.
• Sterile iodine irrigation decreased by 51.6% to under 10%, while NPWT usage remained below 5%. Total knee arthroplasty (TKA) infection rates remained low (0.27% in 2023 vs. 0.24% in 2022), with an NHSN SIR of 0.906.

Conclusions:

• The MSKQC effectively reduced high-cost consumable use without compromising patient safety or increasing infection rates.
• Regular protocol dissemination and surgeon-specific feedback are key to advancing VBHC.
• This collaborative model provides a scalable framework for orthopedic VBHC implementation, particularly in the absence of national guidelines.