Evaluation of centers of excellence program for knee and hip replacement

Abstract

Background: Medicare and private plans are encouraging individuals to seek care at hospitals that are designated as centers of excellence. Few evaluations of such programs have been conducted. This study examines a large national initiative that designated hospitals as centers of excellence for knee and hip replacement.

Objective: Comparison of outcomes and costs associated with knee and hip replacement at designated hospitals and other hospitals.

Research design: Retrospective claims analysis of approximately 54 million enrollees.

Study population: Individuals with insurance from one of the sponsors of this centers of excellence program who underwent a primary knee or hip replacement in 2007-2009.

Outcomes: Primary outcomes were any complication within 30 days of discharge and costs within 90 days after the procedure.

Results: A total of 80,931 patients had a knee replacement and 39,532 patients had a hip replacement of which 52.2% and 56.5%, respectively, were performed at a designated hospital. Designated hospitals had a larger number of beds and were more likely to be an academic center. Patients with a knee replacement at designated hospitals did not have a statistically significantly lower overall complication rate with an odds ratio of 0.90 (P=0.08). Patients with hip replacement treated at designated hospitals had a statistically significant lower risk of complications with an odds ratio of 0.80 (P=0.002). There was no significant difference in 90-day costs for either procedure.

Conclusions: Hospitals designated as joint replacement centers of excellence had lower rates of complications for hip replacement, but there was no statistically significant difference for knee replacement. It is important to validate the criteria used to designate centers of excellence.

Figure 1

Adjusted odds ratio of selected complications and readmissions at designated hospitals compared to other hospitals Footnote: Panel a shows odds ratios for the selected complications and readmission for knee replacement, and Panel b shows the odds ratios for hip replacement. All analyses adjusted for age, gender, and comorbidities. The point estimates for the odds ratios are represented by the box and the horizontal lines represent the 95% confidence intervals.