BACKGROUND Value is defined as the ratio of patient outcomes to the cost of care. One method to assess value is through patient-level value analysis (PLVA). To our knowledge, this tool has not previously been implemented in the setting of total hip arthroplasty (THA). The purposes of this study were to perform PLVA for a 1-year episode of care among patients undergoing primary THA and to identify characteristics that affect value in a metropolitan health-care system. METHODS The patient-reported outcome (PRO) measure database of the institution was queried for all primary THAs from 2018 to 2019. The PRO measure that was utilized was the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Cost was evaluated with use of time-driven activity-based costing (TDABC) for a 1-year episode of care (consisting of the day of surgery, inpatient stay, discharge facility, postoperative appointments, and physical therapy). The primary outcome was the 1-year value quotient, or the ratio of the 1-year change in HOOS-JR to the cost of the episode of care (VHOOS). The value quotient was compared among all included patients and evaluated for variables that may affect the overall value of the episode of care. RESULTS In total, 480 patients were included in the analysis. The mean improvement in the HOOS-JR was +34.9 ± 16.1 (95% confidence interval [CI]: 33.5, 36.3). The mean cost was $13,835 ± $3,471 (95% CI: $13,524, $14,146). The largest contributor to cost was implants (39.0%), followed by post-recovery care (i.e., inpatient stay and specialized nursing facilities; 24.1%). Change in the HOOS-JR was poorly correlated with the cost of care (r = -0.06; p = 0.19). THAs performed at an ambulatory surgery center (ASC) with discharge to home demonstrated higher value (VHOOS = 0.42) than THAs performed at a hospital with discharge to a rehabilitation facility (VHOOS = 0.15; analysis of variance F-test, p < 0.01). CONCLUSIONS Our study found that PROs did not correlate with costs in the setting of primary THA. Implants were the largest cost driver. Surgical setting (an ASC versus a hospital) and discharge destination influenced value as well. PLVA is a value measurement tool that can be utilized to optimize components of the care delivery pathway. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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全髋关节置换术中的患者水平价值分析：优化护理服务的价值。


背景 价值定义为患者结果与护理成本的比率。评估价值的一种方法是通过患者层面的价值分析 （PLVA）。据我们所知，该工具以前从未在全髋关节置换术 （THA） 中实施过。本研究的目的是对接受原发性 THA 的患者进行为期 1 年的护理，并确定影响大都市医疗保健系统价值的特征。方法 查询了 2018 年至 2019 年该机构的所有主要 THA 的患者报告结果 （PRO） 测量数据库。使用的 PRO 指标是髋关节残疾和骨关节炎结果评分，关节置换 （HOOS-JR）。使用时间驱动的基于活动的成本核算 （TDABC） 评估 1 年护理事件（包括手术当天、住院时间、出院设施、术后预约和物理治疗）的成本。主要结局是 1 年价值商，或 HOOS-JR 的 1 年变化与护理费用 （VHOOS） 的比率。比较所有纳入患者的值商，并评估可能影响护理事件总体价值的变量。结果 总共纳入了 480 例患者。HOOS-JR 的平均改善为 +34.9 ± 16.1 （95% 置信区间 [CI]： 33.5， 36.3）。平均成本为 13,835 美元± 3,471 美元（95% CI：13,524 美元，14,146 美元）。成本的最大贡献者是植入物 （39.0%），其次是康复后护理 （即住院和专业护理机构;24.1%）。HOOS-JR 的变化与护理成本的相关性较差 （r = -0.06;p = 0.19）。 在门诊手术中心 （ASC） 进行并出院回家的 THA 显示出比在出院到康复机构进行的 THA 更高的价值 （VHOOS = 0.15;方差分析 F 检验，p < 0.01）。结论 我们的研究发现，在初级 THA 的情况下，PRO 与成本无关。植入物是最大的成本驱动因素。手术环境 （ASC 与医院） 和出院目的地也影响价值。PLVA 是一种价值测量工具，可用于优化护理提供途径的组成部分。证据级别 治疗 III 级。有关证据级别的完整描述，请参阅作者说明。