System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

<h4>Background</h4>The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We appl...

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Autores principales:	Mathias Worni, Ricardo Pietrobon, Guilherme Roberto Zammar, Jatin Shah, Bryan Yoo, Mauro Maldonato, Steven Takemoto, Thomas P Vail
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/4236bedff1c3434da9b5f41b4116718f
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spelling	oai:doaj.org-article:4236bedff1c3434da9b5f41b4116718f2021-11-18T07:21:30ZSystem dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.1932-620310.1371/journal.pone.0030578https://doaj.org/article/4236bedff1c3434da9b5f41b4116718f2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22536313/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA.<h4>Methods and findings</h4>The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020.<h4>Conclusion</h4>System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.Mathias WorniRicardo PietrobonGuilherme Roberto ZammarJatin ShahBryan YooMauro MaldonatoSteven TakemotoThomas P VailPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 4, p e30578 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mathias Worni Ricardo Pietrobon Guilherme Roberto Zammar Jatin Shah Bryan Yoo Mauro Maldonato Steven Takemoto Thomas P Vail System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
description	<h4>Background</h4>The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA.<h4>Methods and findings</h4>The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020.<h4>Conclusion</h4>System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.
format	article
author	Mathias Worni Ricardo Pietrobon Guilherme Roberto Zammar Jatin Shah Bryan Yoo Mauro Maldonato Steven Takemoto Thomas P Vail
author_facet	Mathias Worni Ricardo Pietrobon Guilherme Roberto Zammar Jatin Shah Bryan Yoo Mauro Maldonato Steven Takemoto Thomas P Vail
author_sort	Mathias Worni
title	System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
title_short	System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
title_full	System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
title_fullStr	System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
title_full_unstemmed	System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
title_sort	system dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/4236bedff1c3434da9b5f41b4116718f
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System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

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