All adult patients with knee osteoarthritis (OA) will be assessed and provided care throughout the continuum based on the Bree Collaborative and American Academy of Orthopedic Surgeons Guidelines(AAOS,2022).
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/ 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 knee. The AAOS guideline is supported by the American society of Anesthesiologists, The Knee Society, The American College of Radiology, American Association of Hip and Knee Surgeons, and the Geriatrics Healthcare Professionals. The AAOS guideline contains 20 recommendations for the pre-operative, perioperative, and postoperative care of patients with OA of the knee 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 McGrory, et. al., 2016).
The clinical approach is based on consensus guidelines and includes expected practices which will be designed and implemented for the patients with knee osteoarthritis. Recommended clinical care is also included.
All educational and community promotional materials will align with these guidelines.