There is adequate scientific evidence that arthroscopic surgery has no added value for patient in terms of physical functioning, pain and patient satisfaction compared to conservative policy, and MRIs have no added value for clinical policy compared to a standing X-ray of the knee (anteroposterior and lateral recording, preferably fixed flexion view). In addition, arthroscopies and MRIs are associated with risks, burden for the patient and unnecessary costs.
In current Dutch guidelines and the Choosing Wisely recommendations of the Dutch Orthopaedic Association, MRIs and arthroscopies in patients with knee pain (without locking symptoms) of 50 years and older are considered unnecessary.
This project aimed to reduce the percentage of orthopedic patients with knee complaints ≥ 50 years that receive an MRI or an arthroscopy by 50%
A tailor-made strategy for 13 centers consisted of the appointment of a clinical champion, interactive training (including an overview of the guidelines and literature, feedback, a benchmark with participating hospitals, a skills training on communication with the patient) and making available a patient folder.
A controlled before-after study including process and cost evaluation was used to determine the effect of the strategy. The final effect evaluation is performed using national data from Dutch Hospital Data (DHD) on the use of MRIs and arthroscopies in the participating and control centers that will be available early 2020. The data for the process and cost evaluation was collected on the basis of so-called “field notes” and a questionnaire survey among the clinical champions, orthopedics, young doctors and research coordinators from the participating centers.
Currently only preliminary data from participating centers is available, and data from the control group will be available early 2020. The data from the participating centers show a reduction in from 14% before to 6% after de-implementation MRIs in patients ≥ 50 years with knee complaints and arthroscopies in patients ≥ 50 years with knee complaints reduced from 9% to 4%.
Orthopedics and young doctors in the participating centers indicate that the training and patient information contributed most to an increase in their knowledge and the change in their use of MRI and arthroscopy in orthopedic patients ≥ 50 years with knee complaints.
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