Background: The number of total knee and hip replacements (TKR/THR) has been increasing noticeably in high-income countries, such as Germany. Especially the number of revisions is expected to rise due to higher life expectancy and procedures performed on younger patients, impacting budgets of the health care systems. Quality transparency is the basis of holistic patient pathway optimization. Nevertheless, a nation-wide cross-sectoral assessment of quality from patient perspective does not yet exist. Several studies have shown that the use of patient-reported outcome measures (PROMs) is effective in measuring quality and for monitoring post-treatment recovery. For the first time in Germany, we test whether early detection of critical recovery paths using PROMs after TKR/THR improves the quality of care in a cost-effective way and can be recommended for implementation into standard care.
Methods/design: The study is a two-arm multi-center patient-level randomized controlled trial. Patients from nine hospitals are included in the study. Patient-centered questionnaires are employed to regularly measure digitized PROMs of TKR/THR patients from the time of hospital admission until 12 months post-discharge. An expert consortium has defined PROM alert thresholds at 1, 3, and 6 months to signal critical recovery paths after TKR/THR. An algorithm alerts study assistants if patients are not recovering in line with expected recovery paths. The study assistants then contact patients and their physicians to investigate and, if needed, adjust the post-treatment protocol. By adding sickness funds’ claims data, the cost-effectiveness of the intervention can be analyzed.
Discussion: The study is expected to deliver an important contribution to test PROMs as an intervention tool and examine the determinants of high-quality endoprosthetic care. Depending on a positive and cost-effective impact, the goal is to transfer the study design into standard care. During the trial design phase, several insights have been discovered, with opportunities for efficient digital monitoring limited by existing legacy care models. Digitalization in hospital processes and the implementation of digital tools still represents challenges for hospital personnel and patients. Furthermore, data privacy regulations and the separation between the in- and outpatient sector are additional roadblocks to effectively monitor and assess quality along the full patient pathway.
Trial registration: German Clinical Trials Register: DRKS00019916. Registered 26 November 2019 – retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML& TRIAL_ID=DRKS00019916.