International Journal for Quality in Health Care Advance Access originally published online on May 5, 2005
International Journal for Quality in Health Care 2005 17(4):315-321; doi:10.1093/intqhc/mzi047
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Appropriateness of total hip joint replacement
1 Hospital de Galdakao, Unidad de Investigacion, Galdakao, Vizcaya, Spain, 2 Hospital de Basurto, Unidad de Investigación, Bilbao, Vizcaya, Spain, 3 Hospital de Mendaro, Servicio de Traumatología, Mendaro, Guipuzcoa, Spain, 4 Hospital de Santiago, Servicio de Traumatología, Vitoria, Alava, Spain
Objective. To evaluate the appropriateness of the use of total hip joint replacements.
Design. Observational study of consecutive patients with a diagnosis of hip osteoarthritis and who had undergone total hip arthroplasty over a 1-year period from seven hospitals.
Main measures. The appropriateness of the use of hip replacement was judged by explicit criteria developed by a panel of experts using RAND methodology. The length of hospital stay during the admission and complications were recorded 6 months post-operatively. Patients were also surveyed 6 months after discharge to determine whether they believed they had recovered or their satisfaction with the intervention. Appropriateness results of this study were compared with a previous study performed with the same criteria 4 years previously.
Results. In total, 784 patients participated in the study. Indications for surgery were considered necessary in 52.2% of cases, appropriate in 21.3%, uncertain in 21.4%, and inappropriate in 5.1%. Differences were found in the rates of appropriateness exclusively from one hospital. At 6 months after discharge, differences between centres were found for the proportion of patients that reported they had recovered from surgery (range 57.7–24.8%) and in the length of hospital stay during admission (range 10–16 days). Improvement in the appropriateness rates were found for all participant hospitals during both periods.
Conclusions. We identified a low percentage of inappropriate indications and differences in some outcomes between centres. Compared with previously, there has been improvement in the use of this technique, although both periods are not methodologically comparable.
Keywords: appropriateness, outcome measurement, total hip replacement, utilization review, variation
Address reprint requests to J. M. Quintana, Hospital de Galdakao. Unidad de Investigación. Bº Labeaga s/n. 48960 Galdakao, Vizcaya, Spain. E-mail: jmquinta{at}hgda.osakidetza.net
Accepted for publication March 22, 2005.
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