Innovation in Health Care

ABJHI and its partners are changing the way bone and joint health care is provided. These exciting developments are occurring at a critical time.  The need for efficient, high quality bone and joint health care is rising rapidly in Alberta, driven by population aging, population growth, increasing longevity, alarming rates of obesity and growing prevalence of chronic disease.

Find out more about the Alberta Bone and Joint Health Institute’s new health care model for Albertans.

An Improved Model of Care for Hip and Knee Replacement Patients in Alberta

Alberta Bone and Joint Health Institute is helping health care administrators and physicians roll out a new model of care for hip and knee replacements across Alberta.

The model, evaluated in a year-long research study in Calgary, Edmonton and Red Deer, takes an entirely new approach to care for hip and knee replacement patients.  It is an approach based totally on the best evidence available worldwide.  Care is delivered by multidisciplinary teams.  Services are fully integrated and standardized so that patients receive the same type and level of treatment regardless of where they are located in Alberta.

The research study, called the Alberta Hip and Knee Replacement Project, was among the most extensive health services delivery evaluations ever undertaken in North America.  It involved 1,125 hip and knee replacement patients who followed the new model for their assessment, diagnosis, surgery and recovery, and 513 patients who followed the conventional service approach.  The results patients in the new model had greater improvement in general health and less pain after surgery.

ABJHI is now working with public health care administrators, surgeons, physicians and other health care providers across the province to implement the new model.  It will be used for all types of hip and knee replacement procedures including total joint replacements, partial knee replacement, hip resurfacing, and revision surgery to repair or replace a damaged artificial joint.

Highlights of the Alberta Hip and Knee Replacement Project:

  • Patients had greater improvement in general health and less pain after surgery.
  • Almost nine in 10 patients were up and mobile the day of their surgery.
  • Hospital stay was cut by almost a day and a half.
  • Wait times were reduced for both consultation and surgery. 
  • Patients and their surgeons were more satisfied with the process and the results.
  • There was more cost-effective use of scarce public health resources

These results were achieved in a controlled research environment designed to prove whether the new model would work as intended.  The model proved a success.  However, it will be more difficult and take longer to achieve similar results in the day-to-day operating environment of public health care where resources are strained and there are wait lists for surgery.

Hip and Knee Replacement Clinics a Service Hub in New Model

Community-based clinics serve as the hub for services under Alberta’s new model for hip and knee replacements.

Devoted strictly to hip and knee care for patients, the clinics are a one-stop shop providing or managing all services other than surgery – including assessment of their condition, diagnosis, education and instruction, and follow-up after surgery. 

Patients have their consultation with a surgeon in the clinic.  They see a physiotherapist, occupational therapist and nurse in the clinic.  They also attend educational sessions and are assigned a case manager in the clinic.  After surgery, all care is coordinated through the clinic and patients return to the clinic for regularly scheduled follow-up.

The case manager’s role is central to the patient’s care.  The case manager assembles the patient’s multidisciplinary care team, arranges instruction and education sessions for patients, and ensures patients follow instructions to prepare for surgery and stay on their recovery and rehabilitation program after surgery.

The case manager also ensures family physicians are kept up to date on their patients’ treatment and condition.

Patients sign a contract stipulating what they must do to prepare for surgery and to improve their outcomes after surgery.  This may involve weight loss, blood sugar control, a stop-smoking program, or other requirements.  The contract also stipulates what the health care team will do for the patient.

Some clinics are planning to expand beyond hip and knee to offer one-stop services for all types of bone and joint health conditions.

National Program to Improve Hip and Knee Replacement Care

Health care administrators and providers in other parts of Canada have been watching the Alberta model closely.  A national organization, Bone and Joint Canada, has been formed to draw on the knowledge and experience in Alberta and on programs and projects in other parts of the country to improve bone and joint care.  Bone and Joint Canada’s major focus initially is on improving hip and knee replacement services.

Principles of the New Hip and Knee Replacement Model

Built on the best evidence from around the world, the new model for hip and knee replacements features:

  • Fully integrated continuous services delivered in a multidisciplinary environment.
  • Assessment, diagnosis and non-surgical treatment centralized in single-purpose clinics.
  • A shared-case approach that puts patients at the centre of their care.
  • The skills and knowledge of Alberta’s health care professionals used to maximal value.
  • Clear patient and care provider responsibilities supported by accountability mechanisms.
  • The right care provided to the right individuals in the right way by the right provider at the right time.