Nina Østerås
Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: a cluster-randomized controlled trial
Østerås, Nina; Aas, Eline; Moseng, Tuva; van Bodegom-Vos, Leti; Dziedzic, Krysia; Natvig, Bård; Røtterud, Jan Harald; Vlieland, Thea Vliet; Furnes, Ove; Fenstad, Anne Marie; Hagen, Kåre Birger
Authors
Eline Aas
Tuva Moseng
Leti van Bodegom-Vos
Professor Krysia Dziedzic k.s.dziedzic@keele.ac.uk
Bård Natvig
Jan Harald Røtterud
Thea Vliet Vlieland
Ove Furnes
Anne Marie Fenstad
Kåre Birger Hagen
Abstract
Objective
To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis in primary healthcare as compared to usual care.
Design
In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design we recruited 40 general practitioners, 37 physiotherapists, and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for general practitioners and physiotherapists. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB).
Results
Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% CI 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in QALYs gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months.
Conclusions
This study showed that implementing the model of care for osteoarthritis in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care.
Trial registration number
ClinicalTrials.gov NCT02333656
Citation
Østerås, N., Aas, E., Moseng, T., van Bodegom-Vos, L., Dziedzic, K., Natvig, B., …Hagen, K. B. (2024). Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: a cluster-randomized controlled trial. Osteoarthritis and Cartilage, 32(1), 108-119. https://doi.org/10.1016/j.joca.2023.10.003
Journal Article Type | Article |
---|---|
Acceptance Date | Oct 10, 2023 |
Online Publication Date | Oct 13, 2023 |
Publication Date | 2024-01 |
Deposit Date | Jan 9, 2024 |
Journal | Osteoarthritis and Cartilage |
Print ISSN | 1063-4584 |
Publisher | Elsevier |
Peer Reviewed | Peer Reviewed |
Volume | 32 |
Issue | 1 |
Pages | 108-119 |
DOI | https://doi.org/10.1016/j.joca.2023.10.003 |
Keywords | Osteoarthritis; Randomized controlled trial; Quality of health care; Cost analysis |
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