Dartmouth-Hitchcock GreenCare Registry for Total Knee Replacement

Study Overview
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Brief Summary
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Evolving reimbursement policies are driving health systems to improve quality and efficiency. Transitioning to an electronic health record (EHR) provided Dartmouth-Hitchcock Medical Center (DHMC) an opportunity to redesign staff roles and care path for Total Knee Replacement (TKR). The organization implemented a coordinated team-based care delivery model that integrated real-time measurement of: (1) compliance with trusted guidelines, (2) process of Shared Decision-Making (SdM), and (3) use of Patient-Reported Outcomes (PROs). The investigators present the implementation protocol and data.

Detailed Description
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Patient-reported outcome measures were completed 1 month preceding TKR and also at 1 and 12 months following surgery. The primary outcome was change in physical function from baseline to 1-year following surgery in the Physical Component Summary (PCS) of the Veterans-Rand (VR-12) Survey. Preoperative measures were: (1) general demographics (patient age, sex, height, weight, body mass index (BMI); (2) treatments tried before surgery; (3) health habits (tobacco use, alcohol use); (4) pre-existing medical conditions (Charlson score); (5) physical exam findings (knee range of motion, knee laxity); (7) lab tests (hemoglobin); and (7) radiographic measures (severity of osteoarthritis on standing x-rays). Secondary outcomes included Physical Score (PS) of the Patient Reported Outcome Measurement Information System Global Survey (PROMIS-10), knee function (Knee Osteoarthritis Outcome Score, KOOS), safety (reoperations, readmissions, emergency visits, and infection) and measures of patient experience (Clinician Group and Hospital Consumer Assessment of Healthcare Providers and Systems).

Official Title
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The Dartmouth GreenCare Program: Implementation of Shared Decision Making and Patient-reported Outcomes in a Standardized Care Path for Knee Replacement

Conditions
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Arthroplasty, Replacement, Knee

Intervention / Treatment
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* Procedure: Total Knee Replacement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Scheduled TKR Osteoarthritis of the knee Exclusion Criteria: previous TKR on the affected knee diagnosis other than osteoarthritis age less than 18 years declined consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Procedure: Total Knee Replacement|Primary total knee arthroplasty for knee osteoarthritis|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health Gain as measured by the change in Physical Component Summary (PCS) Score | Health Gain from baseline to 12 months (from 300 to 400 days following the date) following surgery, as measured by the change in Physical Score based on standardized US adult population benchmarks for the VR12 survey | 1-year following surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Health Gain as measured by the change in Global Physical Health (GPH) | Health Gain from baseline to 12 months following surgery, as measured by the change in Physical Score based on standardized US adult population benchmarks for the PRIOMIS10 survey | 1-year | 
| Health Gain as measured by the change in Percentile Rank, TKR age and gender matched | Health Gain from baseline to 12 months following surgery, as measured by the change in Physical Score Percentile Rank based on age and gender-matched beta distributions for the Dartmouth TKR population, for the PRIOMIS10 or VR12 survey | 1 year | 
| Emotional Health | Mental Component Summary (MCS) Score change from baseline to 12 months following surgery, as measured by the change in Mental Score based on standardized US adult population benchmarks for the PRIOMIS10 or VR12 survey | 1 year | 
| Knee Osteoarthritis Outcome Score (KOOS) | Change in KOOS score from baseline to 12 months following surgery | 1 year | 
| Reoperation | From 0 to 90 days following the date of surgery | 3 months | 
| Readmission | From 0 to 90 days following the date of surgery | 3 months | 
| ER visits after surgery | From 0 to 90 days following the date of surgery | 3 months | 
| Infection | From 0 to 90 days following the date of surgery | 3 months | 
| Patient Satisfaction with Hospital | HCAHPS survey in 10% random subsample completed between 20 to 40 days following the date of surgery | 1 month | 
| Patient Satisfaction with Surgeon | Clinician Group CAHPS survey in 10% random subsample completed between 300 to 400 days following the date of surgery | 10 months | 
| Cost of care | Episode-based costs for 0 to 90 days following the date of surgery, and also per visit outpatient costs | 3 months | 
| Length of hospital stay | Number of days between date of admission and date of discharge | Acute hospitalization | 
| Discharge to home | Disposition at time of discharge from acute hospitalization | Acute hospitalization | 
| Mortality |  | 1 year | 
| Range of motion | Knee range of motion measured by a clinician between 60 and 120 days following surgery | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Knee Arthroplasty, Total knee replacement, Knee osteoarthritis, Patient-Outcomes Measurement Program, Surgical Registries, Shared Decision Making, Patient Reported Outcomes, Patient Experience, Cohort Studies