Aug 272007

Their hips and joints will rock the health-care system

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From The Globe and Mail:

The baby boomers are about to become senior citizens and if the first 61 years are any indication, their idea of “rock on” doesn’t include a quilted blanket and rocking chair from which to quietly watch the world pass by.

The ramifications for Canada’s public health-care system are disquieting: There will be more people using more of its services for a longer time, and proportionately fewer people working to pay for these services. And seniors require a greater degree of physical maintenance and repair. This, in turn, means Canada is in for a surge in demand for health-care services – and from a generation that has been the most potent political, economic and social force in society.

A major area of concern is bone and joint health care. Demographics suggests this as the biggest single area of demand growth. Seniors are most susceptible to incapacitating pain and loss of mobility from arthritic joints; porous and weakened bones from osteoporosis; and disfigurement from inflammatory joint disease. Up to 20 per cent of patients with a hip fracture die in the first year after the fracture.

Added to this is the rising rate of obesity in the population – an omen of increasing bone and joint problems. Baby boomers, the first generation to grow up on fast food, may want to rock on but they are doing so with a bulge around the middle that puts stress on their skeletal structure, especially the knees, hips and spine. Obesity increases nine-fold the risk of developing osteoarthritis, a degenerative joint disease that is the leading cause of hip and knee replacements.

Meanwhile, the demand for hip and knee replacements can’t help but grow. Many people reject joint replacement out of fear of the knife, keeping surgery volumes substantially lower than they would be if the fear factor did not exist. It can be expected, however, that as technology continues to advance, services improve and artificial joint manufacturers recognize the potential of direct-to-consumer advertising, demand will be driven closer to actual need. It could conceivably become hip to have a new knee. If so, costs will escalate.

Musculoskeletal conditions, including all bone and joint problems, are already the most costly health-care burden in Canada after cardiovascular illness. They cost the economy an estimated $17-billion a year in health resources and lost productivity. They are also the leading cause of disability, accounting for approximately $12.5-billion – almost 40 per cent of long-term disability costs.

So what are we to do about a generation that intends to rock on with aging bones and joints, defying time and gravity? Clearly, we need to become much more innovative in our approach to health-care delivery.

Let us begin by adopting the common-sense concept of evidence-based care in everything we do for patients. This means continuously searching the world for what works best and combining the evidence with sound medical judgment to shape and guide the menu of health services and products.

We can benchmark services against international leaders. Benchmarking is an indispensable part of any quest to continuously improve.

We can standardize to ensure there is consistent and equitable service for all patients.

We can ensure services are integrated and delivered in a team environment that uses the skills and knowledge of our health professionals to maximum value.

We can build in accountability mechanisms that require patients to take an active role in their treatment and recovery.

And we can do much more to prevent disease by improving public education.

These are some of the principles that underpin a new model for hip and knee replacement developed and piloted in Alberta. The pilot project, conducted over a 12-month period and involving almost 1,650 surgeries, showed that the new model dramatically reduced wait times, got patients out of hospital sooner and improved their outcomes. The wait for a consultation dropped from 145 working days to 21 days. The wait from consultation to surgery fell from 290 working days to 37 days. Stay in hospital declined almost a day and a half – to 4.7 days from six days. Almost nine of every 10 patients were up and mobile the day of their surgery, and patients were better able to function physically and had less pain following surgery.

These results were accomplished by engaging in one of the most comprehensive and collaborative efforts in health care service delivery ever seen in Canada – a partnership of researchers, medical practitioners, service leaders, policy-makers and administrators. And the pilot showed that significantly improved health care is possible when innovation and collaboration converge.

Baby boomers may not be able to defy time and gravity. But they may just rock Canada’s public health-care system into urgently needed reform.

Cy Frank is Executive director of the Alberta Bone and Joint Health Institute and a Calgary orthopedic surgeon.

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