BACKGROUND The Personalised Knee Improvement Programme (P-KIP) was developed based on previously published work, with the hypothesis that surgeons would refer patients to a well-structured conservative management intervention instead of for arthroscopy (de-implementation of arthroscopy by substitution with P-KIP). This meets NICE guidelines and international recommendations but such programmes are not widely used in the UK. Our aim was to determine whether P-KIP would reduce the number of arthroscopies performed for knee osteoarthritis. METHODS P-KIP is a conservative care pathway including a group education session followed by individually tailored one-to-one dietician and physiotherapy sessions. Virtual clinic follow-up is conducted three to 6 months after completion of the programme. The service began in July 2015. The number of arthroscopies saved, measured from hospital level coding data, is the primary outcome measure. Interrupted time series analysis of coding data was conducted. As a quality assurance process, patient reported outcome measures (Oxford Knee Score; Euroqol 5D) were collected at baseline and at follow up. RESULTS Time series analysis demonstrates that the programme saved 15.4 arthroscopies a month (95% confidence interval 9-21; p < 0.001), equating to 184 arthroscopies a year in a single hospital. The PROMs data demonstrated improvements in patient reported outcome scores consistent with previous published reports of conservative interventions in similar patient populations. CONCLUSIONS Results suggest that P-KIP reduces the number of arthroscopies performed, and patients who took part in P-KIP had an improvement in their knee and general health outcomes. P-KIP has the potential to deliver efficiency savings and relive pressure on operative lists, however replication in other sites is required.

中文翻译：

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减少膝骨关节炎的关节镜检查数量——取消实施策略的服务评估。


背景 个性化膝关节改善计划 (P-KIP) 是根据之前发表的工作制定的，假设外科医生会将患者转介至结构良好的保守治疗干预措施，而不是进行关节镜检查（通过用 P-KIP 替代关节镜检查来取消关节镜检查的实施）。基普）。这符合 NICE 指南和国际建议，但此类计划在英国并未广泛使用。我们的目的是确定 P-KIP 是否会减少膝骨关节炎的关节镜检查次数。方法 P-KIP 是一种保守护理途径，包括小组教育课程，以及随后量身定制的一对一营养师和物理治疗课程。虚拟诊所随访在项目完成后三至六个月进行。该服务于 2015 年 7 月开始。根据医院级别编码数据测量的保存的关节镜检查数量是主要结果指标。对编码数据进行中断时间序列分析。作为质量保证过程，在基线和随访时收集患者报告的结果测量（牛津膝关节评分；Euroqol 5D）。结果 时间序列分析表明，该计划每月节省 15.4 次关节镜检查（95% 置信区间 9-21；p < 0.001），相当于一家医院每年节省 184 次关节镜检查。 PROMs 数据表明，患者报告的结果评分有所改善，与之前发表的类似患者群体保守干预的报告一致。结论 结果表明，P-KIP 减少了进行关节镜检查的次数，并且参加 P-KIP 的患者的膝关节和总体健康状况有所改善。 P-KIP 有潜力提高效率并缓解操作人员名单上的压力，但需要在其他站点进行复制。