Hip & Knee Surgery Study

Demonstration Data Project

Hip and Knee Surgery Study

There are many different models of care in the provision of surgical care throughout the Maritimes. Prince Edward Island (PEI) is a rural province with a total of eight hospitals spread throughout three counties. The policy of Regionalization (i.e. centralization) of health services, the provision of care at a limited number of sites, and the advantages and disadvantages to the policy are frequently discussed within PEI. Cost, quality, and access are considered to be key aspects of any health care system and Regionalization allows decision makers to focus their resources, as well as highly-trained personnel, into prioritized locations. This can be particularly advantageous in the area of surgical care, as it allows a concentration of skills and resources within specific areas, creating surgical strength and expertise in that location. A potentially negative consequence of Regionalization, however, is variation of services across regions which may be a reflection of insufficient care in some areas and over-utilization in others. Variations are not necessarily undesirable so long as varying health requirements are being met, but it is important to understand the extent of that variation in order to recognize any adverse implications for health care that can come as a result of Regionalization.

This project examines hip and knee replacement surgeries within Prince Edward Island, as well as considering those who need to go out of province for the surgeries. The project also examines patients being transferred between different hospitals throughout PEI, and the record keeping regarding readmission into the same or hospital, and also patients who have the surgery in one hospital, only to be readmitted due to complications at another hospital. In this report, we describe rates of hip replacement and knee replacement across geographic regions of Prince Edward Island. Aggregate measures of variation are examined to compare surgery types and investigate changes over time. The preliminary conclusions for the first phase of the study areas are as follows:

  • Comparisons among surgery types show hip replacement surgery had a smaller disparity across PEI regions compared with knee replacement surgeries;
  • Small area analysis statistics suggest the 2005-2007 years showed the highest regional variation for each procedure;
  • Hip and knee replacements surgery rates increased from 2001-2010;
  • The Charlottetown region, the largest urban region on PEI, as well as the region in which the only hospital which performs hip and knee replacement surgeries resides, had the lowest rates of hip and knee replacement surgeries over all periods.

This project was developed in response to similar work done in Nova Scotia and intends to explore the extent of shared services across the Maritimes. The NS findings were similar to those in PEI. The next steps for this work on PEI include investigating the association between location of care/service volumes and treatment outcomes for these surgeries. The perspective of patients will also be incorporated in the future as we will conduct focus groups consisting of individuals who have undergone each of the study surgery types.