Taking Total Joint Replacement Surgery and Care to the Next Level


Violeta Rabrenovich, MHA; Kate Koplan, MD


Introduction: With the evolution of new medical technologies, treatments, and care delivery models, both clinicians and patients frequently face the challenge of understanding and adopting the complex scientific evidence in the self-care or care delivery process. At Kaiser Permanente (KP), Total Joint Care Teams have been innovating and improving quality outcomes and affordability of care for years. Recent innovations have led to shifting total joint recovery from the hospital to home. Patients who are engaged in selecting their recovery pathway and are reliably given the care in these programs report greater satisfaction with experience and sustained or improved quality outcomes. KP’s aim is to accelerate adoption of these patient-centered models of care that demonstrate significant value to an individual patient, to practitioners, and to the organization.
Methods: KP’s Total Joint Care Teams and leaders collaborate across the program in an innovative and methodical approach to spread the National Total Joint Replacement Initiative (NTJRI). At the national level, an interregional multidisciplinary team of clinical and administrative experts (eg, orthopedics, anesthesiology, perioperative nursing and management, performance improvement, analytics, and communications) collaborates to design, spread, and implement clinical improvement efforts. The following are some highlights of our approach: 1) ongoing evaluation of opportunities for improvement and a methodical process to address these opportunities; 2) sharing of reliable performance data in a transparent and collaborative way; 3) systematic communication to support spread and to engage clinical teams; 4) carefully designed learning sessions to support each Region’s learning objectives; 5) applying performance improvement methodology.
Results: On the basis of regional feedback and performance data, the NTJRI team initiated several interventions: 1) developed a spread guidebook with successful practices; 2) completed a baseline analysis of patient and clinician satisfaction and shared results with KP Regions for appropriate actions; 3) created a methodology and tool to assist Regions in calculating the value of this program; and 4) incorporated shared decision making into care delivery practices.
Conclusion: The KP NTJRI leads a process that emphasizes a person-centered approach to care delivery to accelerate spread and adoption of successful practices at KP.


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