Abstract
PURPOSE: Germany has high rates of total joint arthroplasty for osteoarthritis of the knee and hip. Ambulatory health interventions can affect the progression of these conditions and the need for total joint arthroplasty. Quality indicators and guideline recommendations facilitate the transparent measurement and demonstration of care quality. Therefore, a systematic literature review of quality indicators and guideline recommendations for ambulatory care of osteoarthritis of the knee and hip before total joint arthroplasty was conducted, focusing on those that could be quantified using routine data from German statutory health insurers. METHODS: Five electronic databases for quality indicators and guidelines published between 2000 and 2021 related to the ambulatory management of osteoarthritis of the knee and hip before total joint arthroplasty were searched. Two reviewers independently selected and appraised the quality of the studies. To synthesise a routine-data-compatible set of quality indicators, similarities and differences among existing quality indicator sets and guideline recommendations were identified and resolved. RESULTS: This systematic search yielded 10,841 potentially relevant records, leading to the identification of 20 sets of quality indicators and 35 guidelines with measures quantifiable using routine data. The present evidence synthesis produced 24 routine-data-compatible process quality indicators related to the type, order or frequency of musculoskeletal appointments, diagnostic imaging procedures, referrals to physical therapists and pharmaceutical prescriptions. CONCLUSION: The synthesised set of routine-data-compatible quality indicators can provide a resource-saving tool for offering individual feedback to physicians on the processes involved in the ambulatory management of osteoarthritis of the knee and hip. Engaging in interdisciplinary discussions on variations in quality indicator outcomes could contribute to improving interdisciplinary physician collaboration in ambulatory care for these conditions. LEVEL OF EVIDENCE: Level III.