Impact of a national guideline on use of knee arthroscopy : An interrupted time-series analysis

OBJECTIVE: To assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DESIGN: Interrupted time series analysis.SETTING: Public health care in Skåne region.PARTICIPANTS: Patients aged ≥40 years who u...

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Bibliographic Details
Published in:International Journal for Quality in Health Care
Main Authors: Kiadaliri, Ali, Bergkvist, Dan, Dahlberg, Leif E, Englund, Martin
Format: Article in Journal/Newspaper
Language:English
Published: Oxford University Press 2019
Subjects:
Orthopedics
Public Health
Global Health
Social Medicine and Epidemiology
DML
Online Access:https://lup.lub.lu.se/record/78cf1586-d539-49e8-8cdd-21c96ff05c1f
https://doi.org/10.1093/intqhc/mzz089
Description
Summary:OBJECTIVE: To assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DESIGN: Interrupted time series analysis.SETTING: Public health care in Skåne region.PARTICIPANTS: Patients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015.INTERVENTION(S): National guideline's recommendation against the use of knee arthroscopy in patients with knee OA.MAIN OUTCOME MEASURE(S): 1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years.RESULTS: A total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period.CONCLUSION: The national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.

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