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 (2023)

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., & More Authors (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

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. ; More Authors. / 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. In: Knee Surgery, Sports Traumatology, Arthroscopy. 2022 ; Vol. 30, No. 12. pp. 4134-4143.

@article{53a1233778f048f9916f56de0c5d9134,

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",

author = "T. Rietbergen and {Marang-van de Mheen}, {P. J.} and {de Graaf}, J. and Diercks, {R. L.} and Janssen, {R. P.A.} and {van der Linden-van der Zwaag}, {H. M.J.} and {van den Akker-van Marle}, {M. E.} and Steyerberg, {E. W.} and Nelissen, {R. G.H.H.} and {van Bodegom-Vos}, L. and {More Authors}",

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 Information: 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{\textquoteright}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. Lopuha{\"a}, ReumaNederland, Amsterdam, The Netherlands. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

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 = "1433-7347",

publisher = "Springer",

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 & More Authors 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.; 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.; More Authors.

In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 30, No. 12, 12.2022, p. 4134-4143.

Research output: Contribution to journal › Article › Scientific › 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 - More Authors, null

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. Funding Information: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.Publisher Copyright:© 2022, The Author(s).

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

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

VL - 30

SP - 4134

EP - 4143

JO - Knee Surgery, Sports Traumatology, Arthroscopy

JF - Knee Surgery, Sports Traumatology, Arthroscopy

SN - 1433-7347

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. https://doi.org/10.1007/s00167-022-06949-w