A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

T. Rietbergen; P.J. Marang-van de Mheen; J. de Graaf; R.L. Diercks; R.P.A. Janssen; H.M.J. van der Linden-van der Zwaag; M.E. van den Akker-van Marle; E.W. Steyerberg; R.G.H.H. Nelissen; L. van Bodegom-Vos; P. Pander; D.J. Hofstee; R.C.I. van Geenen; K.L.M. Koenraadt; J. P.A.H. Onderwater; Y. V. Kleinlugtenbelt; T. Gosens; T.V.S. Klos; P. C. Rijk; B. Dijkstra; A.V.C.M. Zeegers; R.A.G. Hoogeslag; M.H.A. Huis in't Veld; A.A. Polak; N.R. Paulino Pereira; T.M.J.S. Vervest; H.C.  van der Veen; N. Lopuhaä

doi:10.1007/s00167-022-06949-w

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

T. Rietbergen, P.J. Marang-van de Mheen, J. de Graaf, R.L. Diercks, R.P.A. Janssen, H.M.J. van der Linden-van der Zwaag, M.E. van den Akker-van Marle, E.W. Steyerberg, R.G.H.H. Nelissen, L. van Bodegom-Vos (Corresponding author), P. Pander, D.J. Hofstee, R.C.I. van Geenen, K.L.M. Koenraadt, J. P.A.H. Onderwater, Y. V. Kleinlugtenbelt, T. Gosens, T.V.S. Klos, P. C. Rijk, B. DijkstraA.V.C.M. Zeegers, R.A.G. Hoogeslag, M.H.A. Huis in't Veld, A.A. Polak, N.R. Paulino Pereira, T.M.J.S. Vervest, H.C. van der Veen, N. Lopuhaä

Orthopaedic Biomechanics

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Purpose: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence: III.

Original language	English
Pages (from-to)	4134-4143
Number of pages	10
Journal	Knee Surgery, Sports Traumatology, Arthroscopy
Volume	30
Issue number	12
DOIs	https://doi.org/10.1007/s00167-022-06949-w
Publication status	Published - Dec 2022

Bibliographical note

Funding Information:
This study is funded by the Netherlands Organization for Health Research and Development (ZonMw) grant 8392010022. They have no role in the study design or analysis.

Funding

This study is funded by the Netherlands Organization for Health Research and Development (ZonMw) grant 8392010022. They have no role in the study design or analysis. We would like to acknowledge all hospitals that participated in the SMART study (alphabetically): Amphia, Breda; Antonius Ziekenhuis, location Sneek; Deventer Ziekenhuis, Deventer; Elisabeth-TweeSteden Ziekenhuis (ETZ), location Tilburg; Franciscus Gasthuis, Rotterdam; ICONE, Schijndel; Leids Universitair Medisch Centrum (LUMC), Leiden; Medisch Centrum Leeuwarden (MCL), Leeuwarden; Medisch Spectrum Twente, location Enschede; Noordwest Ziekenhuisgroep, location Alkmaar; OCON Orthopedische Kliniek, location Hengelo; TerGooi, Hilversum and Blaricum; Universitair Medisch Centrum Groningen (UMCG), Groningen. SMART study group: P. Pander, MD, Department of Orthopaedic Surgery, Northwest clinics orthopaedic department, Alkmaar, the Netherlands. D. J. Hofstee, MD, Department of Orthopaedic Surgery, Northwest clinics orthopaedic department, Alkmaar, the Netherlands. R. C. I. van Geenen, MD, PhD, Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands. K. L. M. Koenraadt, Foundation for orthopedic research, care & education (FORCE), Amphia Hospital, Breda, the Netherlands. J. P. A. H. Onderwater, MD, Department of Orthopaedic Surgery, Antonius Zorggroep, Sneek/Emmeloord, the Netherlands. Y. V. Kleinlugtenbelt, MD, PhD, Department of Orthopaedic Surgery, Deventer Hospital, Deventer, the Netherlands. T. Gosens, MD, PhD, Department of Orthopaedic Surgery, Elisabeth-Tweesteden Hospital, Tilburg, the Netherlands. T. V. S. Klos, MD, PhD, Department of Orthopaedic Surgery, ICONE, Schijndel, the Netherlands. P. C. Rijk, MD, PhD, Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands. B. Dijkstra, MSc, Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands. A. V. C. M. Zeegers, MD, PhD, Department of Orthopaedic Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. R. A. G. Hoogeslag, MD, Department of Orthopaedic Surgery, OCON, Hengelo, the Netherlands. M. H. A. Huis in’t Veld, PhD, Department of Orthopaedic Surgery, OCON, Hengelo, the Netherlands. A. A. Polak, MD, Department of Orthopaedic Surgery, Franciscus Gasthuis, Rotterdam, the Netherlands. N. R. Paulino Pereira, MD, PhD, Department of Orthopaedic Surgery, TerGooi Hospital, Hilversum, the Netherlands. T. M. J. S. Vervest, Department of Orthopaedic surgery, Tergooi Hospital, Hilversum, the Netherlands. H. C. van der Veen, MD, PhD, Department of Orthopaedics, University Medical Center Groningen, Groningen, the Netherlands. N. Lopuhaä, ReumaNederland, Amsterdam, The Netherlands.

Funders	Funder number
Amphia Hospital
Medisch Centrum Leeuwarden
ZonMw : Dutch Organisation for Health Research and Development
Medisch Spectrum Twente Spaarne Gasthuis
ZonMw : Dutch Organisation for Health Research and Development	8392010022
Leiden University Medical Centre
University Medical Centre Groningen

Keywords

Choosing wisely
De-implementation
Degenerative knee disease
Knee arthroscopy
Low-value care
Magnetic resonance imaging
Knee
Magnetic Resonance Imaging
Arthroscopy
Knee Joint/diagnostic imaging
Humans
Knee Injuries/surgery

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Rietbergen, T., Marang-van de Mheen, P. J., de Graaf, J., Diercks, R. L., Janssen, R. P. A., van der Linden-van der Zwaag, H. M. J., van den Akker-van Marle, M. E., Steyerberg, E. W., Nelissen, R. G. H. H., van Bodegom-Vos, L., Pander, P., Hofstee, D. J., van Geenen, R. C. I., Koenraadt, K. L. M., Onderwater, J. P. A. H., Kleinlugtenbelt, Y. V., Gosens, T., Klos, T. V. S., Rijk, P. C., ... Lopuhaä, N. (2022). A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis. Knee Surgery, Sports Traumatology, Arthroscopy, 30(12), 4134-4143. https://doi.org/10.1007/s00167-022-06949-w

@article{baa056c3a1a14619afc598e9e36025f3,

title = "A tailored intervention does not reduce low value MRI{\textquoteright}s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis",

abstract = "Purpose: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI{\textquoteright}s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence: III.",

keywords = "Choosing wisely, De-implementation, Degenerative knee disease, Knee arthroscopy, Low-value care, Magnetic resonance imaging, Knee, Magnetic Resonance Imaging, Arthroscopy, Knee Joint/diagnostic imaging, Humans, Knee Injuries/surgery",

author = "T. Rietbergen and {Marang-van de Mheen}, P.J. and {de Graaf}, J. and R.L. Diercks and R.P.A. Janssen and {van der Linden-van der Zwaag}, H.M.J. and {van den Akker-van Marle}, M.E. and E.W. Steyerberg and R.G.H.H. Nelissen and {van Bodegom-Vos}, L. and P. Pander and D.J. Hofstee and {van Geenen}, R.C.I. and K.L.M. Koenraadt and Onderwater, {J. P.A.H.} and Kleinlugtenbelt, {Y. V.} and T. Gosens and T.V.S. Klos and Rijk, {P. C.} and B. Dijkstra and A.V.C.M. Zeegers and R.A.G. Hoogeslag and {Huis in't Veld}, M.H.A. and A.A. Polak and {Paulino Pereira}, N.R. and T.M.J.S. Vervest and {van der Veen}, H.C. and N. Lopuha{\"a}",

note = "Funding Information: This study is funded by the Netherlands Organization for Health Research and Development (ZonMw) grant 8392010022. They have no role in the study design or analysis. ",

year = "2022",

month = dec,

doi = "10.1007/s00167-022-06949-w",

language = "English",

volume = "30",

pages = "4134--4143",

journal = "Knee Surgery, Sports Traumatology, Arthroscopy",

issn = "0942-2056",

publisher = "John Wiley and Sons Inc",

number = "12",

}

Rietbergen, T, Marang-van de Mheen, PJ, de Graaf, J, Diercks, RL, Janssen, RPA, van der Linden-van der Zwaag, HMJ, van den Akker-van Marle, ME, Steyerberg, EW, Nelissen, RGHH, van Bodegom-Vos, L, Pander, P, Hofstee, DJ, van Geenen, RCI, Koenraadt, KLM, Onderwater, JPAH, Kleinlugtenbelt, YV, Gosens, T, Klos, TVS, Rijk, PC, Dijkstra, B, Zeegers, AVCM, Hoogeslag, RAG, Huis in't Veld, MHA, Polak, AA, Paulino Pereira, NR, Vervest, TMJS, van der Veen, HC & Lopuhaä, N 2022, 'A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 30, no. 12, pp. 4134-4143. https://doi.org/10.1007/s00167-022-06949-w

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis. / Rietbergen, T.; Marang-van de Mheen, P.J.; de Graaf, J. et al.
In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 30, No. 12, 12.2022, p. 4134-4143.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account

T2 - a difference-in-difference analysis

AU - Rietbergen, T.

AU - Marang-van de Mheen, P.J.

AU - de Graaf, J.

AU - Diercks, R.L.

AU - Janssen, R.P.A.

AU - van der Linden-van der Zwaag, H.M.J.

AU - van den Akker-van Marle, M.E.

AU - Steyerberg, E.W.

AU - Nelissen, R.G.H.H.

AU - van Bodegom-Vos, L.

AU - Pander, P.

AU - Hofstee, D.J.

AU - van Geenen, R.C.I.

AU - Koenraadt, K.L.M.

AU - Onderwater, J. P.A.H.

AU - Kleinlugtenbelt, Y. V.

AU - Gosens, T.

AU - Klos, T.V.S.

AU - Rijk, P. C.

AU - Dijkstra, B.

AU - Zeegers, A.V.C.M.

AU - Hoogeslag, R.A.G.

AU - Huis in't Veld, M.H.A.

AU - Polak, A.A.

AU - Paulino Pereira, N.R.

AU - Vervest, T.M.J.S.

AU - van der Veen, H.C.

AU - Lopuhaä, N.

N1 - Funding Information: This study is funded by the Netherlands Organization for Health Research and Development (ZonMw) grant 8392010022. They have no role in the study design or analysis.

PY - 2022/12

Y1 - 2022/12

N2 - Purpose: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence: III.

AB - Purpose: To evaluate the effectiveness of a tailored intervention to reduce low value MRIs and arthroscopies among patients ≥ 50 years with degenerative knee disease in 13 Dutch orthopaedic centers (intervention group) compared with all other Dutch orthopaedic centers (control group). Methods: All patients with degenerative knee disease ≥ 50 years admitted to Dutch orthopaedic centers from January 2016 to December 2018 were included. The tailored intervention included participation of clinical champions, education on the Dutch Choosing Wisely recommendation for MRI’s and arthroscopies in degenerative knee disease, training of orthopaedic surgeons to manage patient expectations, performance feedback, and provision of a patient brochure. A difference-in-difference analysis was used to compare the time trend before (admitted January 2016–June 2017) and after introduction of the intervention (July 2017–December 2018) between intervention and control hospitals. Primary outcome was the monthly percentage of patients receiving a MRI or knee arthroscopy, weighted by type of hospital. Results: 136,446 patients were included, of whom 32,163 were treated in the intervention hospitals. The weighted percentage of patients receiving a MRI on average declined by 0.15% per month (β = − 0.15, P < 0.001) and by 0.19% per month for arthroscopy (β = − 0.19, P < 0.001). However, these changes over time did not differ between intervention and control hospitals, neither for MRI (β = − 0.74, P = 0.228) nor arthroscopy (β = 0.13, P = 0.688). Conclusions: The extent to which patients ≥ 50 years with degenerative knee disease received a MRI or arthroscopy declined significantly over time, but could not be attributed to the tailored intervention. This secular downward time trend may reflect anoverall focus of reducing low value care in The Netherlands. Level of evidence: III.

KW - Choosing wisely

KW - De-implementation

KW - Degenerative knee disease

KW - Knee arthroscopy

KW - Low-value care

KW - Magnetic resonance imaging

KW - Knee

KW - Magnetic Resonance Imaging

KW - Arthroscopy

KW - Knee Joint/diagnostic imaging

KW - Humans

KW - Knee Injuries/surgery

UR - http://www.scopus.com/inward/record.url?scp=85127623315&partnerID=8YFLogxK

U2 - 10.1007/s00167-022-06949-w

DO - 10.1007/s00167-022-06949-w

M3 - Article

C2 - 35391552

AN - SCOPUS:85127623315

SN - 0942-2056

VL - 30

SP - 4134

EP - 4143

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

IS - 12

ER -

Rietbergen T, Marang-van de Mheen PJ, de Graaf J, Diercks RL, Janssen RPA, van der Linden-van der Zwaag HMJ et al. A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2022 Dec;30(12):4134-4143. doi: 10.1007/s00167-022-06949-w

A tailored intervention does not reduce low value MRI’s and arthroscopies in degenerative knee disease when the secular time trend is taken into account: a difference-in-difference analysis

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Bibliographical note

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