Standardizing the processes of care can improve quality and utilization outcomes, including length of stay, costs, complications and 30-day readmissions (Loftus, et. al., 2014; Barbieri, et. al., 2009). In addition, Medicare is expected to mandate a bundled payment program, further incentivizing organizations to improve financial and clinical performance. Although implementation of one of two interventions alone can improve quality and utilization outcomes (Loftus, et. al, 2014), a comprehensive approach is recommended (Bree, 2013).
The Bree Collaborative is a widely recognized comprehensive approach and “defines the expected components of pre-operative, intra-operative, and post-operative care needed for successful TKR/THR surgery” (Bree, 2013). The Bree Collaborative is a partnership among many different stakeholders within the State of Washington that is working to identify and promote strategies to reduce variation in care while improving care, safety, and health with evidence-based recommendations.
In December of 2022 the AAOS published its evidence based clinical practice guideline to help guide provider decision making towards evidence-based treatments of OA of the hip. The AAOS guideline is supported by the American society of Anesthesiologists, The Hip Society, The American College of Radiology, and American Association of Hip and Knee Surgeons. The AAOS guideline contains 20 recommendations for the pre-operative, perioperative, and postoperative care of patients with OA of the hip who are considering surgical treatment. The AAOS conducted an extensive literature review and analyzed evidence. Recommendations were graded by the strength of methodology of the available evidence. A strong recommendation means the quality of supporting evidence is high (two or more high strength studies with consistent findings for recommending for or against the intervention), a moderate recommendation means that the benefits exceed the potential harm (or that the potential harm clearly exceeds the benefits in the case of a negative recommendation), and a limited recommendation means there is a lack of compelling evidence and an unclear balance between benefits and potential harm (AAOS, 2022).
Patients will receive: