549 / 2019-02-28 21:43:18

UTILISATION OF KNEE REPLACEMENT IN NSW, AUSTRALIA: A POPULATION-BASED STUDY

Health service utilization,public health,health,Resource optimization

全体主题 > Safety & Health Care Systems

Background
Clinical guidelines suggest that knee replacement surgery should be used as a last resort for treating knee osteoarthritis (OA) after pharmacological and non-pharmacological alternatives and only when the symptoms do not respond to these non¬surgical treatments [1-2]. However, these guidelines have not been fully complied with in Australia. Australia has been reported to have the highest rate of knee replacement compared with many OECD countries [3] and its annual number of knee replacement procedures has increased by 88% from 2003 to 2014 [4]. It is estimated that 57% of Australians with osteoarthritis has received inappropriate care [1]. There are also wide geographical variations in rates of knee replacement: a four-fold variation has been reported between patients’ residential areas [5], but it remains unknown how much is the variations between health service providers in Australia.

Methods
In the current research, we conducted a population-based study utilising the New South Wales (NSW) hospital admitted patient episode-level data during 2012-2015 to examine how patients’ residential areas, as well as their treating hospitals, affect the utilisation of primary knee joint replacement procedures. We developed cross-classified random-effects logistic regression models, as this approach is capable of considering the effects of both contexts simultaneously. We calculated the variations among all hospitals having performed knee replacements and residential places across the entire NSW, Australia. We also derived the adjusted rates for the procedure by urban and regional areas and by public and private systems.

Results
We found that treating hospitals were the most important factor in explaining whether patients undergo knee replacement surgeries, accounting for nearly 50% of the total variations. The knee replacement utilisation rates vary between public and private systems: a 7-fold and 3-fold variation in the public and private sector, respectively. After accounting for the contextual effects of hospitals, patients’ residential places have minimal effects on the utilisation of knee replacement.

Policy implication
Understanding healthcare utilisation patterns, especially between health service providers, across a large urban space has important policy implications for urban planning and public health strategies. The research findings provided valuable evidence base for public policy development to improve the effectiveness in health service delivery and efficiency in health resource allocation across large urban areas.

Reference
1. Australian Commission on Safety and Quality in Health Care. Clinical Care Standard for The Management of Knee Pain. Sydney: ACSQHC; 2017
2. Arthritis Australia. Time to Move: Osteoarthritis. Sydney: Arthritis Australia; 2014
3. OECD. Geographic Variations in Health Care: What Do We Know and What Can Be Done to Improve Health System Performance? OECD Health Policy Studies: OECD; 2014
4. Australian Orthopaedic Association. National Joint Replacement Registry Annual Report 2015. Adelaide: AOA; 2015
5. Australian Commission on Safety and Quality in Health Care. The Second Australian Atlas of Healthcare Variation. Sydney: ACSQHC; 2017