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Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial.

Authors
  • Østerås, Nina1
  • Aas, Eline2
  • Moseng, Tuva3
  • van Bodegom-Vos, Leti4
  • Dziedzic, Krysia5
  • Natvig, Bård6
  • Røtterud, Jan Harald7
  • Vlieland, Thea Vliet8
  • Furnes, Ove9
  • Fenstad, Anne Marie10
  • Hagen, Kåre Birger11
  • 1 Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. Electronic address: [email protected]. , (Norway)
  • 2 Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway; Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway. Electronic address: [email protected]. , (Norway)
  • 3 Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway. Electronic address: [email protected]. , (Norway)
  • 4 Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: [email protected]. , (Netherlands)
  • 5 Impact Accelerator Unit, Primary Care Centre Versus Arthritis, Keele University, United Kingdom. Electronic address: [email protected]. , (United Kingdom)
  • 6 Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: [email protected]. , (Norway)
  • 7 Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway. Electronic address: [email protected]. , (Norway)
  • 8 Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: [email protected]. , (Netherlands)
  • 9 The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: [email protected]. , (Norway)
  • 10 The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway. Electronic address: [email protected]. , (Norway)
  • 11 Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway. Electronic address: [email protected]. , (Norway)
Type
Published Article
Journal
Osteoarthritis and Cartilage
Publisher
Elsevier
Publication Date
Jan 01, 2024
Volume
32
Issue
1
Pages
108–119
Identifiers
DOI: 10.1016/j.joca.2023.10.003
PMID: 37839506
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. ClinicalTrials.gov NCT02333656. Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.

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