The Productivity Development of Total Hip Arthroplasty in Sweden: A Multiple Registry-Based Longitudinal Study Using the Malmquist Productivity Index

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Goude, Fanny; Göran Garellick; Sverre A C Kittelsen; Szilard Nemes and Clas Rehnberg




BMJ Open



Objective The increasing demand for total hip arthroplasty (THA) combined with limited resources in healthcare puts pressure on decision-makers in orthopaedics to provide the procedure at minimum costs and with good outcomes while maintaining or increasing access. The objective of this study was to analyse the development in productivity between 2005 and 2012 in the provision of THA. Design The study was a multiple registry-based longitudinal study. Setting and participants The study was conducted among 65 orthopaedic departments providing THA in Sweden from 2005 to 2012. Outcome measures The development in productivity was measured by Malmquist Productivity Index by relating department level total costs of THA to the number of noncemented, hybrid and cemented THAs. We also break down the productivity change into changes in efficiency and technology. Results Productivity increased significantly in three periods (between 1.6% and 27.0%) and declined significantly in four periods (between 0.8% and 12.1%). Technology improved significantly in three periods (between 3.2% and 16.9%) and deteriorated significantly in two periods (between 10.2% and 12.6%). Significant progress in efficiency was achieved in two periods (ranging from 2.6% to 8.7%), whereas a significant regress was attained in one period (3.9%). For the time span as a whole, an average increase in productivity of 1.4% per year was found, where changes in efficiency contributed more to the improvement (1.1%) than did technical change (0.2%). Conclusions We found a slight improvement of productivity over time in the provision of THA, which was mainly driven by changes in efficiency. Further research is, however, needed where differences in quality of care and patient case mix between departments are taken into account.