AVÐÇÇò

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Overview of measures and data for hip and knee replacements

Overview of measures and data for hip and knee replacements kathschach

June 18, 2024 — This report demonstrates the potential value of bringing together data on hip and knee replacement procedures from various sources, analyzed consistently and reported together to inform health care decisions and planning.

Joint replacements are performed to reduce pain, and to improve mobility and quality of life for patients, particularly after years of managing chronic and debilitating pain. Hip and knee replacements are among the top 3 highest-volume inpatient surgeries performed in Canada.Reference1 In 2021–2022, more than 107,000 hip and knee replacements were performed in Canada, leading to over $1.26 billion in hospital costs.Reference2 There is pressure on health care systems to address long wait times for hip and knee replacement surgeries across the provinces and territories.Reference3 By using patient-reported data with clinical outcomes and costing data, health administrators and planners can facilitate improved health outcomes and health care experiences for patients, and optimize the use of health care resources.

AVÐÇÇò has compiled data from several sources for adult patients diagnosed with osteoarthritis and admitted to hospital for a hip or knee replacement between 2017–2018 and 2021–2022.

Summary of patient population and measures, with available data and correlations

Patient population

The patient population for this report is adult patients age 18+ who were diagnosed with osteoarthritis and admitted to hospital for hip or knee replacement surgery between 2017–2018 and 2021–2022.

This report provides a demonstration of how hospitalization data, PREMs, PROMs and estimated patient-level inpatient costs can be linked together.

Clinical outcomes

Using data from the Discharge Abstract Database (DAD), Hospital Morbidity Database (HMDB) and National Ambulatory Care Reporting System (NACRS), the 3 clinical outcomes reported are Hospital Harm, 30-Day Readmission and 1-Year Revision. 30-Day Readmission and 1-Year Revision include data from all provinces and territories; Hospital Harm includes data from all provinces and territories except Quebec.

Patient-reported experience measures (PREMs)

Using data from the Canadian Patient Experiences Reporting System (CPERS), the 5 PREMs reported are as follows: Information and Understanding When Leaving the Hospital; Communication With Nurses; Communication With Doctors; Involvement in Decision-Making and Treatment Options; and Overall Hospital Experience. These measures include data from Nova Scotia, New Brunswick, Ontario, Manitoba and Alberta.

Patient-reported outcome measures (PROMs)

Using PROMs data, the 3 PROMs reported are 1-Year Change in Functional Status, 1-Year Change in Health-Related Quality of Life (HRQL) and 1-Year Satisfaction After Surgery. These measures  include data from Ontario and Manitoba.

Costs

Using data from the Canadian Patient Cost Database (CPCD), the cost measure reported is Estimated Patient-Level Inpatient Costs. This measure includes data from Nova Scotia, Ontario and Alberta.

This report also looked at the correlations between PREMs and clinical outcomes, PREMs and PROMs, and costs and PROMs.

Notes
PREMs are reported as Top Box results. A Top Box result is the percentage of survey respondents who chose the most positive response to a given survey question.
PROMs are reported as an average change in score (from pre-surgery to 1-year post surgery) for functional status and health-related quality of life, and as the patient’s level of satisfaction with the results of their joint replacement 1-year post surgery. 
Cost estimates are based on patient-level inpatient hospitalization costs; they include both direct and indirect costs, including nursing and staff complement costs, but exclude physician compensation unless paid by the hospital.

Limitations from data availability

The analysis used data available at AVÐÇÇò from relevant data sources, and the number of records differed across data type. Limitations on the availability of data are outlined in the methodology notes.

Related resources

References