Evaluation of Centers of Excellence Program for Knee and Hip Replacement

Published In: Medical Care, v. 51, no. 1, Jan. 2013, p. 28-36

Posted on RAND.org on January 01, 2013

by Ateev Mehrotra, Elizabeth M. Sloss, Peter S. Hussey, John L. Adams, Susan L. Lovejoy, Nelson F. SooHoo

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Research Question

  1. Do hospitals designated as centers of excellence have better outcomes and lower costs than other hospitals?

BACKGROUND: Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement. OBJECTIVE: Comparison of outcomes and costs associated with knee and hip replacement at designated hospitals and other hospitals. RESEARCH DESIGN: Retrospective claims analysis of approximately 54 million enrollees. STUDY POPULATION: Individuals with insurance from one of the sponsors of this centers of excellence program who underwent a primary knee or hip replacement in 2007–2009. OUTCOMES: Primary outcomes were any complication within 30 days of discharge and costs within 90 days after the procedure. RESULTS: A total of 80,931 patients had a knee replacement and 39,532 patients had a hip replacement of which 52.2% and 56.5%, respectively, were performed at a designated hospital. Designated hospitals had a larger number of beds and were more likely to be an academic center. Patients with a knee replacement at designated hospitals did not have a statistically significantly lower overall complication rate with an odds ratio of 0.90 (P=0.08). Patients with hip replacement treated at designated hospitals had a statistically significant lower risk of complications with an odds ratio of 0.80 (P=0.002). There was no significant difference in 90-day costs for either procedure. CONCLUSIONS: Hospitals designated as joint replacement centers of excellence had lower rates of complications for hip replacement, but there was no statistically significant difference for knee replacement. It is important to validate the criteria used to designate centers of excellence.

Key Findings

The costs of knee and hip replacement in designated centers of excellence do not differ from costs in other hospitals.

  • But patients who had hip replacements in such centers had lower complication rates.

Complication rates for knee replacement did not differ from those in other hospitals.

Recommendation

  • The criteria for defining a center of excellence should be validated.

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