Value-based Purchasing for Osteoarthritis and Total Knee Arthroplasty: What Role for Patient-reported Outcomes?

Prompted by the aims to improve the patient experience of care (including quality and satisfaction), improve the health of populations, and reduce the per capita cost of health care, the US healthcare system is embarking upon a new era in care delivery that seeks to optimize healthcare value. Value, the consideration of quality relative to cost, can be increased by improving quality, reducing cost, or doing both. Given that patient-reported outcomes related to pain, function, and quality of life underlay both the reason patients seek care for and the benchmarks by which treatment success is measured for osteoarthritis, measures of these patient-reported outcomes figure prominently in understanding the quality and hence value. Directed attention to patient-reported outcomes has the potential to drive quality and efficiency improvements, but only if the quality measures that are developed from them are clinically important, scientifically acceptable, usable, and feasible.