Physicians showed ‘modest’ adherence to AAOS clinical practice guidelines for knee OA
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One orthopedic clinic found “modest” adherence to American Academy of Orthopaedic Surgeons Clinical Practice Guideline recommendations for nonarthroplasty treatment of knee osteoarthritis regardless of Kellgren-Lawrence grade or history of treatment, according to published results.
Kevin J. Bozic, MD, MBA, and colleagues retrospectively analyzed demographic, radiographic and treatment information for 1,096 consecutive ambulatory visits with a primary diagnosis of knee OA at a single center. Researchers considered the frequency of agreement between treatment recommendations and the AAOS Clinical Practice Guidelines as the primary outcome, and associated costs of care as the secondary outcome.
Of the 1,955 total number of interventions generated during the visits, results showed surgeons adhered to AAOS guidelines in 65% of new/never treated, 60% of new/previously treated and 40% of return patients. Researchers found the most common intervention was intra-articular injection with either corticosteroids or hyaluronic acid, followed by physical therapy. Adherence to the AAOS guidelines decreased as the severity of OA increased, according to results.
Of the estimated annual cost of $2,403,543.18 associated with treatment recommendations, researchers noted $1,206,757.80 was supported by evidence. Results showed intra-articular hyaluronic acid injection, which carried a strong evidence against use, was the most expensive treatment intervention.
“Even within a single practice, there is wide variation in practice patterns in the management of a common condition, knee arthritis, and a large percentage of treatment recommendations are not supported by evidence,” Bozic told Healio Orthopedics. “This suggests there is opportunity to increase efforts to incorporate evidence-based practice recommendations into shared medical decision-making between patients and their care teams when considering options for the management of their knee OA.” – by Casey Tingle
Disclosures: Bozic reports he is a paid consultant for CMS and Cardinal Analytx; is an unpaid consultant for Harvard Business School Institute for Strategy and Competitiveness; has stock or stock options with Carrum Health; is on the board of directors for the American Joint Replacement Registry; and is on the American Association of Hip and Knee Surgeons Quality Measures Committee. Please see the study for all other authors’ relevant financial disclosures.
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P. Maxwell Courtney, MD
Mohamad J. Halawi, MD, and colleagues present an interesting article looking at adherence to AAOS clinical practice guidelines (CPG) for nonoperative management of knee osteoarthritis at their clinic in University of Texas at Austin. Of 1,096 ambulatory office visits for knee OA, they found adherence to AAOS guidelines dropped as severity of the arthritis increased (from 61% to 49%), with the most expensive non-recommended intervention being hyaluronic acid injections.
Despite a strong AAOS recommendation against their use, physicians still continue to utilize hyaluronic acid injections for knee OA, resulting in a considerable economic burden to our health system. Insurers continue to pay for these injections because they are less expensive than a knee replacement, despite limited data on efficacy. In the era of value-based care, we need to move toward a system that rewards providers for providing evidenced-based nonoperative treatment and appropriate surgical referral, not a compensation model based upon how many injections they provide. Patients often think that an injection can cure all, but it is our responsibility to educate our patients on the data regarding nonoperative knee OA management. Sometimes exercise and anti-inflammatories are the best medicine.
Rothman Orthopaedic Institute
Thomas Jefferson University
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