Improving patient care pathways: Evaluation of "enhanced recovery after orthopedic surgery"


The team is composed of:


From January to November 2018


The APECO project Improving patient care pathways: Evaluation of "enhanced recovery after orthopedic surgery" aims to analyse different forms of organisation of orthopaedic surgery care pathways and their impact in terms of quality and cost of overall patient care. More specifically, the project is intended to establish the impact of different healthcare organisations on hospital efficiency, but also on the efficiency of care pathways through better coordination of actors.

This project benefits from a specific funding from the ELSAN group .


Patients who underwent surgery for hip or knee replacement, and healthcare professionals involved.


The APECO survey collects data on patient reported health outcomes and patients' opinion on the quality of care they have received.

Our goal is to obtain a quantifiable measure of health care outcomes, in addition to health care consumption data accessible through the National Health Data System (SNDS, Système national des données de santé) .

Patients were asked to answer various questionnaires aiming to measure their health outcomes (PROM, Patient Reported Outcome Measures) and collect information on their experience (PREM, Patient Reported Experience Measures).

These questionnaires, which are validated and recommended at the international level to measure the quality of care, are not routinely collected and require a specific organization in voluntary clinics. A self-administered questionnaire was proposed in 6 clinics between January and November 2018 in order to generate a representative sample of patients.


The PROM questionnaire (different depending on whether it is a hip or knee surgery) was distributed to all patients operated on for scheduled surgery during this period, once before the operation and once again a month later.

For these questionnaires, IRDES followed the recommendations of the International Consortium for Health Outcomes Measurement (ICHOM) and compiled existing questionnaires, already translated into French (KOOS, HOOS, EQ-5D-5L questionnaires and a pain assessment scale).

The PREM questionnaire then is distributed to these same patients a month after the surgery.

This questionnaire was developed in collaboration with the Picker Institute , which proposed a range of questions in English specifically targeting health care coordination.