Study: New model could contain arthritis imaging, costs
Osteoarthritis (OA) management fails to reflect evidence-based recommendations and often subjects patients to inappropriate excess imaging, according to a study published in the January issue of Arthritis Care & Research. The authors argued for reform that adheres to evidence-based guidelines and delivers patient-centered and provider-integrated management.
Recent estimates suggest that symptomatic knee OA occurs in 13 percent of persons aged 60 years and older, shared lead author David J. Hunter, PhD, of the University of Sydney in New South Wales, Australia and New Baptist Hospital in Boston, and colleagues.
OA incidence is expected to rise and is linked with increasing costs. “According to the Centers for Disease Control and Prevention (CDC), arthritis and other rheumatic conditions cost the $128 billion in 2003, a 24 percent surge since 1997 and an amount equal to 1.2 percent of GDP,” wrote Hunter.
Hunter and colleagues set out to characterize the quality of clinical management of OA. Although OA imaging should be limited to cases of unclear diagnosis, they described “an overuse of inappropriate imaging” and cited an absence of rational for serial radiography in stable clinical cases.
In addition, the authors noted that clinicians frequently failed to adequately recommend conservative nonpharmalogic management including weight management and exercise, which initiated a chain of unnecessary imaging and inappropriate referral to orthopedic surgeons.
The researchers noted multiple existing guidelines and suggested that future efforts be targeted to encouraging effective practices and facilitating research to answer questions with little evidence. They suggested that the current environment features “a set of situational conditions for the funding, development, use and publication of this new vision for the linkage of the patient-centered and provider-integrated model for OA management,” and offered that pay for performance could provide a mechanism to encourage adoption of recommendations, indictors and performance monitoring.
Recent estimates suggest that symptomatic knee OA occurs in 13 percent of persons aged 60 years and older, shared lead author David J. Hunter, PhD, of the University of Sydney in New South Wales, Australia and New Baptist Hospital in Boston, and colleagues.
OA incidence is expected to rise and is linked with increasing costs. “According to the Centers for Disease Control and Prevention (CDC), arthritis and other rheumatic conditions cost the $128 billion in 2003, a 24 percent surge since 1997 and an amount equal to 1.2 percent of GDP,” wrote Hunter.
Hunter and colleagues set out to characterize the quality of clinical management of OA. Although OA imaging should be limited to cases of unclear diagnosis, they described “an overuse of inappropriate imaging” and cited an absence of rational for serial radiography in stable clinical cases.
In addition, the authors noted that clinicians frequently failed to adequately recommend conservative nonpharmalogic management including weight management and exercise, which initiated a chain of unnecessary imaging and inappropriate referral to orthopedic surgeons.
The researchers noted multiple existing guidelines and suggested that future efforts be targeted to encouraging effective practices and facilitating research to answer questions with little evidence. They suggested that the current environment features “a set of situational conditions for the funding, development, use and publication of this new vision for the linkage of the patient-centered and provider-integrated model for OA management,” and offered that pay for performance could provide a mechanism to encourage adoption of recommendations, indictors and performance monitoring.