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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

Nina Østerås

Eline Aas

Tuva Moseng

Leti van Bodegom-Vos

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