Evidence map›Paper›PMID 35391552›Full record

ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022

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.

T Rietbergen, P J Marang-van de Mheen, J de Graaf, R L Diercks, R P A Janssen, H M J van der Linden-van der Zwaag, M E van den Akker-van Marle, E W Steyerberg, R G H H Nelissen, L van Bodegom-Vos and 1 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.7field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Reduction in use of MRI and arthroscopy among patients with degenerative knee disease in independent treatment centers versus general hospitals: a time series analysis.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

T RietbergenDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
P J Marang-van de MheenDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
J de GraafDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
R L DiercksDepartment of Orthopaedics, University Medical Center Groningen, Groningen, The Netherlands.
R P A JanssenDepartment of Orthopaedic Surgery and Trauma, Maxima Medical Center, Eindhoven, The Netherlands.
H M J van der Linden-van der ZwaagDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
M E van den Akker-van MarleDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
E W SteyerbergDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
R G H H NelissenDepartment of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
L van Bodegom-VosDepartment of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Postzone J10-s, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. l.vanbodegom-vos@lumc.nl.ORCID http://orcid.org/0000-0002-8486-6404
SMART study group
Leiden University Medical Center · NLRadboud University Nijmegen · NLUniversity Medical Center Groningen · NL

Funding

ZonMw 8392010022
6 · The paper itself

Abstract

purposeTo 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).

methodsAll 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.

results136,446 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).

conclusionsThe 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.

Indexed as

ArthroscopyKnee InjuriesHumansKneeKnee JointMagnetic Resonance ImagingChoosing wiselyDegenerative knee diseaseDe-implementationKnee arthroscopyLow-value careMagnetic resonance imaging

Identifiers

PMID35391552
PMCPMC9668785
OpenAlexW4225777922

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.