Natalia A. Wilson

Hip And Knee Implants: Current Trends And Policy Considerations

This paper constitutes an analysis of the issues, relationships, emerging hospital strategies, and policy needs surrounding hip and knee implants. Demand for hip and knee replacements is rising annually, and growth is expected to be substantial. Costs are high, reaching

Professionalism in 21st Century Professional Practice: Autonomy and Accountability in Orthopaedic Surgery

11 billion for hospitals in 2004 and

Executive Summary: Aligning Stakeholder Incentives in Orthopaedics

5 billion for Medicare in 2006. Relationships among stakeholders add complexity. Case studies reveal emerging strategies by hospitals for management of implants. Policy considerations include development of a national council for data and technology assessment, a national joint registry, price transparency, and incentives.

Value of Unique Device Identification in the Digital Health Infrastructure

Orthopaedic surgical practice is becoming increasingly complex. The rapid change in pace associated with new information and technologies, the physician-supplier relationship, the growing costs and growing gap between costs and reimbursements for orthopaedic surgical procedures, and the influences of advertising on the patient, challenge all involved in the delivery of orthopaedic care. This paper assesses the concepts of professionalism, autonomy, and accountability in the 21st century practice of orthopaedic surgery. These concepts are considered within the context of the complex value chain surrounding orthopaedic surgery and the changing forces influencing clinical decision making by the surgeon. A leading impetus for challenge to the autonomy of the orthopaedic surgeon has been cost. Mistrust and lack of understanding have characterized the physician-hospital relationship. Resource dependency has characterized the physician-supplier relationship. Accountability for the surgeon has increased. We suggest implant surgery involves shared decision making and “coproduction” between the orthopaedic surgeon and other stakeholders. The challenge for the profession is to redefine professionalism, accountability, and autonomy in the face of these changes and challenges.

Revision total hip and knee arthroplasty implant identification: implications for use of Unique Device Identification 2012 AAHKS member survey results.

Productive discussion and analysis of how to align stakeholder incentives in orthopaedics requires identifying the key stakeholders, understanding their perspectives, delineating the issues necessitating alignment, and being willing to delve into contentious areas. The participants of the 2008 ABJS Carl T. Brighton Workshop in Tampa, Florida did just this and pushed themselves to never lose sight of Dr. Carl T. Brighton’s questions: “Where are we now?”; “Where do we need to go?”; and “How do we get there?” We summarize the discussion, thoughts, and work presented by the workshop participants surrounding the very important topic of aligning stakeholder incentives in orthopaedics and key areas in need of focus. These key areas include insurance reform, specialty hospitals, physician-hospital alignment, physician-industry relationships, regulatory changes, movement beyond physician-centric issues, and the overall need to create value for the healthcare system. We have addressed the pertinent questions surrounding stakeholder alignment in orthopaedics and laid out the groundwork needed to answer Dr. Brighton’s last question, “How do we get there?” Concluding remarks address the necessity of leadership by orthopaedic surgeons to drive change in these key areas.

National projections of time, cost and failure in implantable device identification: Consideration of unique device identification use

In recent years, high-profile cases of medical device failure resulting in patient harm�such as implantable cardioverter-defibrillator leads and metal-on-metal hip implants�have received substantial attention both in the medical literature and popular press.1- 2 These examples illustrate the need for a more effective system of monitoring device performance and protecting patient safety.

Science of Health Care Delivery: An Innovation in Undergraduate Medical Education to Meet Society's Needs

FDAs Unique Device Identification (UDI) Rule will mandate manufacturers to assign unique identifiers to their marketed devices. UDI use is expected to improve implant documentation and identification. A 2012 American Association of Hip and Knee Surgeons membership survey explored revision total hip and knee arthroplasty implant identification processes. 87% of surgeons reported regularly using at least 3 methods to identify failed implants pre-operatively. Median surgeon identification time was 20 min; median staff time was 30 min. 10% of implants could not be identified pre-operatively. 2% could not be identified intra-operatively. UDI in TJA registry and UDI in EMR were indicated practices to best support implant identification and save time. FDAs UDI rule sets the foundation for UDI use in patient care settings as standard practice for implant documentation.

Advancing medical device innovation through collaboration and coordination of structured data capture pilots: Report from the Medical Device Epidemiology Network (MDEpiNet) Specific, Measurable, Achievable, Results-Oriented, Time Bound (SMART) Think Tank.

BACKGROUND U.S. health care is responding to significant regulation and meaningful incentives for higher quality care, patient safety, electronic documentation and data exchange. FDAs Unique Device Identification (UDI) Rule, a relatively new regulation aligned with these goals, requires standard labeling of medical devices by manufacturers. This lays the foundation for UDI scanning and documentation in the electronic health record, expected to change the landscape of medical device identification and postmarket surveillance. METHODS We developed national projections for time, cost and failure in implant identification prior to revision total hip and knee arthroplasty (THA/TKA) using American Association of Hip and Knee Surgeons 2012 membership survey data, Nationwide Inpatient Sample 2011 data and THA/TKA demand projection data. RESULTS Our projections suggest that cumulative surgeon time spent identifying failed implants could reach 133,000 h in 2030, representing opportunity to perform over 500,000 15 min established patient office visits. Staff time could reach 220,000 h with a cost of

The Value of Unique Device Identifiers in Plastic Surgery

3.3m. Failed implants that cannot be identified may be greater than 50,000 preoperatively and 25,000 intraoperatively in 2030. CONCLUSION Study projections indicate significant time, cost and inability to identify failed implants, supporting need for improvement of implant documentation. FDAs UDI Rule sets the foundation for UDI scanning and documentation in the electronic health record, a process poised to serve as the standard system for device documentation.

Integrity and efficiency in collaborative purchasing

The purpose of this special article is to describe a new, 4-year Science of Health Care Delivery curriculum at Mayo Clinic School of Medicine, including curricular content and structure, methods for instruction, partnership with Arizona State University, and implementation challenges. This curriculum is intended to ensure that graduating medical students enter residency prepared to train and eventually practice within person-centered, community- and population-oriented, science-driven, collaborative care teams delivering high-value care. A Science of Health Care Delivery curriculum in undergraduate medical education is necessary to successfully prepare physicians so as to ensure the best clinical outcomes and patient experience of care, at the lowest cost.