Integrated Care for Comprehensive Management of Patients with Osteoarthritis: Program Development and Implementation

Abstract

Treatment of symptomatic osteoarthritis (OA) is often complicated by comorbidities, which put patients at potentially higher risks following operative interventions. Management of these comorbidities is usually separate from orthopaedic care, with patients invited to return to their orthopaedic surgeon once surgical risk factors are better controlled. However, this practice can lead to disjointed care, resulting in uncertainty, mistrust, unmanaged pain, and dissatisfaction for patients. Integrated care teams provide an effective option for coordinated comprehensive nonoperative and preoperative management of patients with knee OA and medical comorbidities. The objective of this article is to summarize the process for implementation of an integrated program to manage patients with symptomatic knee OA and the initial outcomes at our institution as an example of the effects of integrated patient management in orthopaedics. At the author's institution, an integrated program was implemented, successfully addressing the unmet need for coordinated care for patients with bone and joint health problems and medical comorbidities. Patients who completed the full program experienced significant improvements in both pain and function. Potential applications for knee surgeons considering implementing integrated care models could include pre- and postoperative management programs, nonoperative management program, and programs seeking to meet key metrics such as improved readmission rates, patient satisfaction, or value-based care. For effective program implementation, careful planning with convenient referral mechanisms, leadership buy-in, and patient-centered communication protocols are required.

Keywords

osteoarthritis - integrated care - knee - pain - exercise - therapy

Publikationsverlauf

Eingereicht: 22. Dezember 2022

Angenommen: 15. April 2023

Artikel online veröffentlicht:
23. Mai 2023

• References

• 1 Lawrence RC, Helmick CG, Arnett FC. et al. Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States. Arthritis Rheum 1998; 41 (05) 778-799
• 2 Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010; 26 (03) 355-369
• 3 United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS), Fourth Edition, 2014. Rosemont, IL. Accessed November 12, 2022 at: http://www.boneandjointburden.org/
• 4 Mitchell NS, Catenacci VA, Wyatt HR, Hill JO. Obesity: overview of an epidemic. Psychiatr Clin North Am 2011; 34 (04) 717-732
• 5 Warren M, Beck S, Delgado D. The State of Obesity: Better Policies for a Healthier America. Trust for America's Health: Washington, DC; 2020
• 6 Vina ER, Kwoh CK. Epidemiology of osteoarthritis: literature update. Curr Opin Rheumatol 2018; 30 (02) 160-167
• 7 Cowie CC, Casagrande SS, Geiss LS. Prevalence and incidence of type 2 diabetes and prediabetes. In: Cowie CC, Casagrande SS, Menke A. et al., eds. Diabetes in America. 3rd ed.. National Institute of Diabetes and Digestive and Kidney Diseases (US): Arlington, VA; 2018
• 8 Murray CJL, Atkinson C, Bhalla K. et al; U.S. Burden of Disease Collaborators. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. JAMA 2013; 310 (06) 591-608
• 9 King LK, March L, Anandacoomarasamy A. Obesity & osteoarthritis. Indian J Med Res 2013; 138 (02) 185-193
• 10 Changulani M, Kalairajah Y, Peel T, Field RE. The relationship between obesity and the age at which hip and knee replacement is undertaken. J Bone Joint Surg Br 2008; 90 (03) 360-363
• 11 Busato A, Röder C, Herren S, Eggli S. Influence of high BMI on functional outcome after total hip arthroplasty. Obes Surg 2008; 18 (05) 595-600
• 12 Bjorgul K, Novicoff WM, Saleh KJ. Evaluating comorbidities in total hip and knee arthroplasty: available instruments. J Orthop Traumatol 2010; 11 (04) 203-209
• 13 Muckelt PE, Roos EM, Stokes M. et al. Comorbidities and their link with individual health status: a cross-sectional analysis of 23,892 people with knee and hip osteoarthritis from primary care. J Comorb 2020; 10: 2235042-X20920456
• 14 Department of Economics and Management of Health, Faculty of Public Health, Medical University - Varna, Bulgaria. Petrova GR, Nenova G, Mihov K, Dobrilov S, Kostadinova TI. Role of multidisciplinary teams for integrated care in the surgical treatment of osteoarthritis. JofIMAB 2015; 21 (03) 843-845
• 15 Iolascon G, Ruggiero C, Fiore P, Mauro GL, Moretti B, Tarantino U. Multidisciplinary integrated approach for older adults with symptomatic osteoarthritis: SIMFER and SI-GUIDA Joint Position Statement. Eur J Phys Rehabil Med 2020; 56 (01) 112-119
• 16 Reiss-Brennan B, Brunisholz KD, Dredge C. et al. Association of integrated team-based care with health care quality, utilization, and cost. JAMA 2016; 316 (08) 826-834
• 17 Thompson JW, Haddad FS. Integrated care systems in trauma to elective care: can we emulate the integration of services in orthopaedic trauma care within elective practice?. Bone Jt Open 2021; 2 (06) 411-413
• 18 Nawaz H, Edmondson AC, Tzeng TH, Saleh JK, Bozic KJ, Saleh KJ. Teaming: an approach to the growing complexities in health care: AOA critical issues. J Bone Joint Surg Am 2014; 96 (21) e184
• 19 Olsson LE, Karlsson J, Ekman I. The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture. J Orthop Surg Res 2006; 1: 3
• 20 Pearsall EA, Meghji Z, Pitzul KB. et al. A qualitative study to understand the barriers and enablers in implementing an enhanced recovery after surgery program. Ann Surg 2015; 261 (01) 92-96
• 21 Ross KM, Gilchrist EC, Melek SP, Gordon PD, Ruland SL, Miller BF. Cost savings associated with an alternative payment model for integrating behavioral health in primary care. Transl Behav Med 2019; 9 (02) 274-281
• 22 Looman W, Struckmann V, Köppen J. et al; SELFIE consortium. Drivers of successful implementation of integrated care for multi-morbidity: mechanisms identified in 17 case studies from 8 European countries. Soc Sci Med 2021; 277: 113728
• 23 Raney LE, Lasky G, Scott C. Integrated Care: A Guide for Effective Implementation. American Psychiatric Association Publishing; 2017
• 24 Scott CEH, Bugler KE, Clement ND, MacDonald D, Howie CR, Biant LC. Patient expectations of arthroplasty of the hip and knee. J Bone Joint Surg Br 2012; 94 (07) 974-981
• 25 Ditton E, Johnson S, Hodyl N. et al. Improving patient outcomes following total knee arthroplasty: identifying rehabilitation pathways based on modifiable psychological risk and resilience factors. Front Psychol 2020; 11: 1061
• 26 Iijima H, Aoyama T, Fukutani N. et al. Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study. BMC Psychol 2018; 6 (01) 19
• 27 Hall AJ, Stubbs B, Mamas MA, Myint PK, Smith TO. Association between osteoarthritis and cardiovascular disease: systematic review and meta-analysis. Eur J Prev Cardiol 2016; 23 (09) 938-946
• 28 Piva SR, Susko AM, Khoja SS, Josbeno DA, Fitzgerald GK, Toledo FGS. Links between osteoarthritis and diabetes: implications for management from a physical activity perspective. Clin Geriatr Med 2015; 31 (01) 67-87 , viii
• 29 Middleton KR, Anton SD, Perri MG. Long-term adherence to health behavior change. Am J Lifestyle Med 2013; 7 (06) 395-404
• 30 Messier SP, Mihalko SL, Legault C. et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: the IDEA randomized clinical trial. JAMA 2013; 310 (12) 1263-1273
• 31 Wright BJ, Galtieri NJ, Fell M. Non-adherence to prescribed home rehabilitation exercises for musculoskeletal injuries: the role of the patient-practitioner relationship. J Rehabil Med 2014; 46 (02) 153-158
• 32 Hall SF, Edmonds SW, Lou Y. et al. Patient-reported reasons for nonadherence to recommended osteoporosis pharmacotherapy. J Am Pharm Assoc (2003) 2017; 57 (04) 503-509
• 33 Guralnik JM, Simonsick EM, Ferrucci L. et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994; 49 (02) M85-M94