Referral, enrollment, and health care use in a comprehensive patient-centered management program for osteoarthritis of the hip and knee

Objective: Osteoarthritis management programs (OAMPs) have become a more common way to deliver patientcentered care. However, there is limited information on real-world use of these programs to guide implementation, payment policy, accessibility, and scaling in the United States. This paper describes 5-year use metrics for the Duke Joint Health Program, an OAMP embedded within a US academic health system. Method: This analysis includes patients referred into the Program between October 2017 and April 2022. We generated descriptive statistics of referral and enrollment totals, demographics and patient-reported measures of enrollees, retention and healthcare use metrics (e.g., office visit frequency), and data capture rates for patientreported outcomes. Results: During the study period, 6863 patients were referred to the program and 4162 (61 %) enrolled. We observed statistically significant differences between those who did and did not enroll by age (mean difference f SE: 2.49 f 2.8 years), sex (70.0 % vs 67.7 % female), race (65.1 % vs 55.3 % Caucasian/White), employment status (50.0 % vs 40.2 % retired), and insurance type (53.5 % vs 47.0 % Medicare). The median (Q1, Q3) number of visits was 2 (1, 4) and ranged from 1 to 67. The median (Q1, Q3) number of days from first to last program visit was 23 (0, 84) days. Questionnaire completion rates were 72 % at baseline, 46 % at 6 weeks, 39 % at 3 months, and 40 % at 6 and 12 months. Conclusion: Findings can guide the planning, development, and implementation of future OAMPs and inform policies to ensure programs are accessible and equitable.