Purpose: To meet the increasing demand for arthroplasty in Canada healthcare providers are investigating efficiency improvements to maximize utilization of limited surgical resources. One target is routine annual arthroplasty follow-up for which there are no established guidelines. A previous study by the authors revealed that 52% of arthroplasty patients could be followed with standardized questionnaires and x-rays resulting in a 30% savings to the healthcare system. In this study we report the patient time, travel and financial burdens for annual follow-up at a tertiary care centre versus a hypothetical model using standardized assessment at community hospitals and a web-enabled PACS.
Method: A consecutive sample survey of elective THA and TKA patients (n=158; 99 females; 94 THA; 64 TKA; mean age=69 years) who were at least twelve months postoperative. Patient’s address, work status, mode of travel and times required for travel, physician consult, x-ray, and clinic wait were recorded. A web-based mapping application was used to determine distances from patients’ homes to the tertiary care centre and nearest community hospital. Financial burden was calculated using Statistics Canada figures for average Canadian wage and private vehicle travel costs.
Results: Sixteen patients were working at the time of the study and 149 travelled in a private vehicle. For the tertiary care centre: round-trip distance was 168 km, total time burden was 194 minutes (travel=129 minutes, clinic wait=54 minutes, time with physician=6 minutes, x-ray=5 minutes), and total financial burden per patient was $58. For the community hospital: round-trip distance was 19 km, total time burden was 39 minutes (travel=14 minutes, clinic wait=20 minutes, x-ray=5 minutes), and total financial burden was $7.
Conclusion: Utilizing community hospital resources for arthroplasty follow-up could reduce patients’ travel by 89%, financial burden by 88%, and time burden by 81%. This approach has the potential to enable the focusing of arthroplasty clinic follow-up resources only on patients reporting problems or with symptomatic x-rays thus freeing up surgeon time for surgeries. There are also the broader societal implications of reducing ‘health miles’ and the resulting carbon dioxide emissions related to health care delivery by leveraging new technologies to move information rather than people.
