Objective: To understand how the different data collections methods of the Alberta Health Services Infection Prevention and Control Program (IPC) and the National Surgical Quality Improvement Program (NSQIP) are affecting reported rates of surgical site infections (SSIs) following total hip replacements (THRs) and total knee replacements (TKRs). Design: Retrospective cohort study. Setting: Four hospitals in Alberta, Canada. Patients: Those with THR or TKR surgeries between September 1, 2015, and March 31, 2018. Methods: Demographic information, complex SSIs reported by IPC and NSQIP were compared and then IPC and NSQIP data were matched with percent agreement and Cohen’s κ calculated. Statistical analysis was performed for age, gender and complex SSIs. A P value <.05 was considered significant. Results: In total, 7,549 IPC and 2,037 NSQIP patients were compared. The complex SSI rate for NSQIP was higher compared to IPC (THR: 1.19 vs 0.68 [P = .147]; TKR: 0.92 vs 0.80 [P = .682]). After matching, 7 SSIs were identified by both IPC and NSQIP; 3 were identified only by IPC, and 12 were identified only by NSQIP (positive agreement, 0.48; negative agreement, 1.0; κ = 0.48). Conclusions: Different approaches to monitor SSIs may lead to different results and trending patterns. NSQIP reports total SSI rates that are consistently higher than IPC. If systems are compared at any point in time, confidence on the data may be eroded. Stakeholders need to be aware of these variations and education provided to facilitate an understanding of differences and a consistent approach to SSI surveillance monitoring over time.

There is limited evidence on the geographic distribution of osteoarthritis (OA) in Alberta to inform planning of equitable access to health care services. This research aimed to explore the geographic variation in age-sex standardized OA prevalence rates by geographic areas across the rural-urban continuum, and by six-digit postal codes using global Moran’s I and hot spot analysis. The results demonstrated a substantially higher OA prevalence rate in Rural Remote (134.7 cases per 1000 population) and Rural (128.5), compared to Metro (107.4) and Urban areas (107.3). Metro-Edmonton had a substantially higher OA prevalence rate (124.4) compared to Metro-Calgary (94.4). OA hot spots were identified in north rural communities and Metro-Edmonton. These variations should be considered when planning programs for health promotion and prevention of osteoarthritis and access to associated health care services. Further research is needed to identify the underlying factors contributing to this geographic variation.

Objective The objective of this study was to evaluate the effectiveness of an online patient decision aid with individualised potential outcomes of surgery, on the quality of decisions for knee replacement surgery in routine clinical care. Design A pragmatic Randomized Controlled Trial (RCT) in patients considering total knee replacement at a high-volume orthopedic clinic. Patients were randomized at their routine online pre-surgical assessment to either complete a decision aid or not. At their consultation, those in the intervention arm had a surgeon report summarizing the decision aid results. The primary outcome was decision quality, defined as being knowledgeable and choosing the option that matched informed treatment preferences. Multivariate logistic and linear regression analysis was conducted to consider surgeon level clustering and baseline differences between study arms. Results Of 163 patients randomized, 155 completed post-surgical surveys and were included in the analysis. The average patient was aged 65 years, obese and had moderate to severe osteoarthritis symptoms at baseline. Patients in the intervention arm had a higher odds of making a quality decision (Odds Ratio ​= ​2.08, 95% CI: 1.08 to 4.02), predominantly through increased knowledge. Conclusions This study supports the benefit of a decision aid in combination with a surgeon report to significantly improve decision quality in routine care. While the independent contribution of tailoring the decision aid to patient baseline characteristics and including a surgeon report remains unclear, we demonstrated the feasibility of integrating the decision aid into an online pre-surgical assessment in routine clinical care.