Predictive Factors of Neutropenia in HIV-Infected Patients with Malignancy Receiving Chemotherapy or Radiotherapy.

OBJECTIVES

Rising health care costs necessitate value-based health care (VBHC) initiatives. Large hospital systems offer a platform for surgeon collaboration in developing standardized, interdisciplinary orthopedic care. This study evaluates the formation, implementation, and outcomes of the Musculoskeletal Quality Collaborative (MSKQC) across a hospital system.

METHODS

Established in 2019, the MSKQC comprises physician, quality, and nursing leaders from 14 hospitals. Using the Delphi method, surgeons identified VBHC interventions, leading to protocols for antibiotic-infused bone cement (AIBC), povidone-iodine irrigation, and negative pressure wound therapy (NPWT) dressings, implemented in May 2023. Usage was tracked across hospitals and reviewed quarterly from June 2023 to June 2024. Total hip arthroplasty and total knee arthroplasty (TKA) standardized infection ratios (SIRs) were calculated using National Healthcare Safety Network (NHSN) baselines. Surgeons performing more than 30 cases annually with more than 30% utilization of a target consumable were deemed high utilizers.

RESULTS

The systemwide savings opportunity exceeded $800,000 annually. AIBC use dropped from 19.6% to 5.5%. Two high-use hospitals showed gradual improvement, and 7 high-use surgeons were identified. NPWT usage remained stable at less than 5%. Sterile iodine irrigation decreased by 51.6% to less than 10%. TKA infections occurred in 18 of 6592 (0.27%) surgeries in 2023, compared with 14 of 5955 (0.24%) in 2022. The NHSN SIR was 0.906.

CONCLUSIONS

The MSKQC successfully reduced high-cost consumable use while maintaining low infection rates. Regular protocol distribution and surgeon-specific feedback proved effective in advancing VBHC initiatives. This model offers a scalable approach for orthopedic VBHC implementation in the absence of national guidelines.