Hip and Knee Osteoarthritis

Hip and knee replacement care is a signature focus of our partner, the Bone and Joint Health Strategic Clinical Network. Their provincial quality program aims to guide, standardize, and improve clinical practices and patient education to deliver the best possible care.

Principles of Hip and Knee Replacement in Alberta

A provincial standardized surgical care path (from referral intake to post-op follow-up)
Case management for patient-centred care
Geographical central intake via clinics (best practices that support safe and equal access to care)
Multi-disciplinary care
Specialist advice care plans
Patient and family/buddy participation
Follow-up appointments at designated time points
A provincial standardized measurement framework

ABJHI’s internationally recognized work in raising the quality of care for hip and knee replacement patients began with designing a care path for Alberta based on the best evidence available worldwide. The new care path was designed in 2004 in collaboration with the Alberta Orthopaedic Society, representing the province’s orthopaedic surgeons, and with provincial health authorities.

All services, other than primary care physician and in-hospital, are provided in or through a hip and knee clinic. Care is fully integrated, provided by a multidisciplinary team, and coordinated by a case manager in the clinic. The care path was tested in a provincial pilot in 2005-06, which was managed by ABJHI. Patients who followed the new care path had significantly greater improvement in general health, less pain after surgery, and greater ability to perform normal daily activities than those who received conventional care. Waiting times for consultation with a specialist and for surgery declined dramatically.

This innovative thinking continues today with the Bone and Joint Health Strategic Clinical Network, and its numerous partners.

Managing and Improving Quality

Hip and knee replacement care in Alberta is optimized through an evidence-based measurement framework designed by ABJHI in collaboration with clinicians. Six essential dimensions of health care quality are its foundation. Evidence and best practice are constantly evolving. Care teams bring forth new knowledge to update provincial standards through a consensus process.

ABJHI supports partner hip and knee clinics and hospitals in applying Plan-Do-Study-Act methodology for process improvement. We analyze and present aggregated and de-identified performance measurements to drive continuous quality improvement. Combined with hospital data, clinic data captures pre- and post-surgical visits for about 90% of hip and knee arthroplasty patients in Alberta. Patient-reported outcome and experience measures are an important component of the program.

Health teams review their team’s performance and compare against provincial benchmarks and other health zones, clinics, and hospitals. Surgeons receive individual performance reports compared against provincial and aggregated scores for the surgeon’s peer group (after adjusting for the complexity of the cases).

Reports flag indicators such as wait times, health complications, patient outcomes, and resource utilization. The network of care teams use the information to improve patient care on the front-lines.

Measurement Tool Example

Publications

The Bigger Picture

Hip and knee arthroplasty is only required by a small fraction of those with osteoarthritis. The demand for arthroplasty is dependent on the prevalence of osteoarthritis in a population. Alberta’s population is increasing and aging, and risk factors such as obesity are trending upwards.

White Paper: The Osteoarthritis Crisis in Alberta: Access, Quality, and Long-term Planning

In short, the prevalence of osteoarthritis keeps growing. And, thus, so do the needs of those with osteoarthritis. This is further motivation for initiatives focused on conservative (non-surgical) management and prevention of osteoarthritis.

Bone and Joint Health Strategic Clinical Network website