EFFECT OF FEEDBACK ON RESOURCE USE AND MORBIDITY IN HIP AND KNEE ARTHROPLASTY IN AN INTEGRATED GROUP-PRACTICE SETTING

Objective: To assess the effect of a structured program of feedback ab out resource utilization and morbidity on resource consumption and com plications in an orthopedic surgical practice. Design: We prospectivel y analyzed use and outcomes before and after an intervention (departme ntal data presentation). Material and Methods: Feedback on resource ut ilization and morbidity for 2,820 patients who underwent a primary tot al hip or knee arthroplasty for a diagnosis of osteoarthritis between Jan. 1, 1990, and Dec. 31, 1992, was provided to members of the orthop edic department of an academic medical center, Data were adjusted for severity of disease. Results: On reassessment 18 months after the begi nning of the feedback program, total charges and length of hospital st ay for hip or knee arthroplasty were significantly reduced. Interpract itioner variability was also reduced but not significantly. The feedba ck process was instrumental in identifying a specific complication-pul monary embolism after bilateral total knee replacement-which was signi ficantly reduced by addition of warfarin prophylaxis. Conclusion: The intervention was successful in reducing resource use (length of hospit al stay) and complications (pulmonary embolism). In addition, total ch arges for hip and knee arthroplasty declined significantly at a time w hen medical center charges overall were increasing. Efforts to maintai n continuous improvement will primarily focus on the development of cr itical pathways.