In 2014, the Physician Executive Council analyzed care variation reduction opportunities to help physician leaders prioritize quality improvement opportunities to reduce care variation. In that analysis, we found that hip and knee joint replacement, two rapidly growing procedures, both represent a significant opportunity to reduce care variation at most organizations.
This probably isn’t news to many physician leaders already working to reduce care variation in joint replacement. Many have already reduced length of stay for joint replacements, while others are working to standardize physician preference for implant devices.
But our analysis revealed that looking beyond supply costs and length of stay, pharmacy variation and ICU utilization are also major drivers of care variation in joint replacement. So it only makes sense to ask: What can physician leaders do to standardize pharmacy utilization in joint replacement? Is there a way to reduce potentially avoidable complications that send patients to the ICU?
Ready-to-present slides: Orthopedic and spine market trends for 2014
Introducing the UC Irvine Health Joint Replacement Surgical Home
We asked Dr. Zeev Kain, Professor and Chair of Anesthesiology and Associate Dean of Clinical Operations at University of California at Irvine Health, about the organization's Joint Replacement Surgical Home. He explained that part of the variation in joint replacement is due to wide variation in patient experience before surgery.
It’s difficult to standardize intra- and post-operative processes when patients’ experience before surgery are all very different. When patients start from a similar baseline, it’s easier to follow a standardized protocol and reduce avoidable complications.
For example, correcting preoperative anemia in patients before surgery has been associated with a lower length of stay. But it also reduces care variation, as physicians no longer have to deviate from guidelines if the patient isn’t anemic. However, managing anemia prior to surgery isn’t always done because surgical care before, during, and after surgery is often disconnected.
This fragmentation of care is exactly what the perioperative surgical home aspires to solve. At UC Irvine Health, the Joint Replacement Surgical Home has made more coordinated, standardized care possible, reducing complications and avoidable readmissions as a result.