Browsing by Author "Hildebrand, Kevin A."
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- ItemOpen AccessA Comprehensive Case Study of an Orthopaedic Surgery Central Intake Service in the Winnipeg Regional Health Authority: A Single-Entry Model to Manage Waiting Times for Total Joint Replacement Surgery of the Hip and Knee(2018-04-09) Damani, Zaheed; Marshall, Deborah A.; Noseworthy, Thomas Wm.; Quan, Hude; Bohm, Éric Richard; MacKean, Gail; Yelin, Edward H.; Hildebrand, Kevin A.Background: Single-entry is an increasingly prominent waiting time management strategy in healthcare but its impact on quality of care is poorly understood. We evaluated the Winnipeg Central Intake Service (WCIS) for total joint replacement (TJR) surgery of the hip or knee, a single-entry model (SEM) to manage patients referred for TJR surgery of the hip or knee. Methods: A pre/post mixed-methods case study approach was used to measure the WCIS' influence on six dimensions of quality of care: acceptability, accessibility, appropriateness, effectiveness, efficiency, safety. Qualitative interviews were used to assess experiences of patients, family physicians, orthopaedic surgeons, surgical office assistants and WCIS project team members. A pre/post intervention cross-sectional design was used to quantitatively assess changes in the six dimensions by comparing historical and prospective cohorts. Results: Our qualitative inquiry revealed that benefits of the WCIS included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations, and under-reporting of data by surgeons' offices. Stakeholder acceptability was conditional, not universal. Assessment of capacity and readiness to change, and efforts to increase awareness, preparedness and uptake are critical. Factors for successful implementation include clear communication, robust data collection, physician leadership, and patience by all (especially implementation teams) allowing for an effective top-down, and bottom up approach. Our quantitative analysis revealed that the WCIS reduced variability across surgeon waiting times, with modest reductions in overall waits for surgery. There was improvement in some, but not all, dimensions of quality. Waiting time was significantly improved (WT) for consult for TJR of the hip (WT1) and all WTs for TJR of the knee. Total knee replacement surgeries performed within the nationally-recommended 26-week benchmark increased by 5.9% post-WCIS. Post-surgical complication rates (safety) were lower post-WCIS. Accessibility and safety were the only quality dimensions that changed (post-WCIS for TJR of the hip and knee). Conclusion: Overall, WCIS implementation contributed to improvement in some, but not all dimensions of quality of care. This is the first study to comprehensively assess the influence of SEMs on the delivery of TJRs across all dimensions of quality. Findings of this research are generally consistent with existing literature related to SEMs and change management in healthcare. SEMs show an ability to improve accessibility without adversely affecting other dimensions of quality, albeit with conditional, not universal stakeholder acceptability. Limitations of this study include non-longitudinal cohorts, and availability and quality of data. Findings from this research can help strengthen existing SEMs and inform development of new ones for improved patient experience and outcomes and system performance.
- ItemOpen AccessIntramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report(BioMed Central, 2011-07-20) Lewkonia, Peter; Medlicott, Shaun A. C.; Hildebrand, Kevin A.
- ItemOpen AccessPatient gender and rotator cuff surgery: are there differences in outcome?(2021-09-30) Sabo, Marlis T.; LeBlanc, Justin; Hildebrand, Kevin A.Abstract Background Although rotator cuff syndrome is common and extensively studied from the perspective of producing healed tendons, influence of gender on patient-reported outcomes is less well examined. As activity and role demands may vary widely between men and women, clarity on whether gender is an important factor in outcome would enhance patient education and expectation management. Our purpose was to determine if differences exist in patient-reported outcomes between men and women undergoing rotator cuff surgery. Methods One hundred forty-eight participants (76 W:72 M) aged 35–75 undergoing surgery for unilateral symptomatic rotator cuff syndrome were followed for 12 months after surgery. Demographics, surgical data, and the Western Ontario Rotator Cuff (WORC) scores were collected. Surgery was performed by two fellowship-trained shoulder surgeons at a single site. Results There were no gender-based differences in overall WORC score or subcategory scores by 12 months post-op. Pain scores were similar at all time points in men and women. Women were more likely to have dominant-arm surgery and had smaller rotator cuff tears than men. Complication rates were low, and satisfaction was high in both groups. Conclusion Patient gender doesn’t appear to exert an important effect on patient-reported rotator cuff outcomes in this prospective cohort. Further work examining other covariates as well as the qualitative experience of going through rotator cuff repair should provide greater insight into factors that influence patient-reported outcomes.
- ItemOpen AccessPosttraumatic contractures of the rabbit knee: the role of the mast cell myofibroblast axis(2009) Monument, Michael J.; Hildebrand, Kevin A.
- ItemOpen AccessThe biomechanics of medial collateral ligament healing: porcine model development and breed comparison(2008) Germscheid, Niccole M.; Hildebrand, Kevin A.